Automating the Revenue Cycle: 10 things to consider before you invest in process automation

Over the last few years, the buzz around the potential for automating healthcare process has increased significantly, especially in the revenue cycle processes. With maturing automation hype cycle, some real solutions have emerged as well. However, automation has its own pitfalls and challenges.  In this paper, we discuss several elements to be considered while embarking on an endeavor to automate business processes:

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1. Break down the processes to the most granular level to discover automation opportunities

Process automation can take two primary formats - 1) a completely automated process, and 2) a process where only certain steps are performed through intelligent software applications known popularly as bots, while other steps are performed by a human agent. A deep understanding of the complete business process, at a granular level, is required to create a sustainable automation model.

2. Revenue cycle process nuances determine the choice of the automation platform

Each process in the complex chain of revenue cycle processes has different requirements – EDI, voice/web, medical language processing, optical character recognition, rules-based processing – to name a few.  Let’s look at how each set of work processes has different requirements for your automation team.

  • Front End Processes - As patient interacts through different channels, the focus should not only be on automating a particular channel but also creating a comprehensive end-to-end human and bot enabled strategy.

  • Medical Coding Services – Medical coding processes require various aspects such as knowledge of medical terminology, ability to apply ICD and CPT beside HCPCS and modifiers. Therefore, automation with the help of machine learning can make it easy for the coders to determine the appropriate codes for the diagnosis.

  • Accounts Receivable and Denial Management - With over 3,000 healthcare payers in the United States, information exchange can be a daunting task. While you evaluate the automation opportunities, it is important to evaluate the workflow effectiveness and quality of the automation processes, and more importantly, the ability to make a real impact on business outcomes.

3. Be judicious in choosing the automation platform

While evaluating revenue cycle automation tools, you should keep the following aspects in mind.

Choice of Platform - The architecture of the platform and the underlying technology framework determines how deep automation can be taken within your process ecosystem.

  • Tools that have industry-specific frameworks are essential for your business processes to function effectively

  • Intelligent bots that can mimic human actions and behaviors – it is the combination of emerging technologies, including artificial intelligence, deep learning, machine learning, and cognitive intelligence, optical character recognition, business rules - deliver extraordinary results.

  • Choose an automation technology that has the backing of a large corporation with a significant investment in R&D, ability scale-up, and agile

4. Insights from workflow and knowledge management systems are key to discovering automation opportunities

The operational reports from the workflow application can provide insights such as types of errors committed, identify repetitive tasks, and eliminate non-value activities. Also, the business rules and a library of microbots help to identify and deploy automation and can yield a new level of business value

5. Involving practitioners accelerates opportunity discovery and improves adoption

Involving practitioners in the process of identifying automation opportunities will not only drive better results and better adoption but will also create a healthy partnership with the automation team.

6. Creating a repetitive and scalable deployment model has a dependency on the architecture of the automation tools

Scalable deployment architectures require bots that can work with each other. Furthermore, if your service provider has a pre-built stack of industry-specific automation tools, you will find this extremely helpful and a key to your ultimate success.

  • Microbots and Micro-services can infuse scalability by building a library of single-purpose bots (with the ability to transfer data with one another) to create process specific automation tools on demand.

  • Process Design and Redesign is Key - Make sure that your automation team can deconstruct and reconstruct the work processes, with extensive utilization of the Microbots and micro-services architecture.

7. Managing the automated environment – a robust governance framework is needed

As more and more bots get deployed, the quality and throughput of the automated processes require a similar management model as you would with human agents.

  • Quality Assurance will not only provide governance and control but also provides insights to further your automation agenda.

  • Managing Bots by the Bots – Create a control tower that monitors the performances of the bots in operation - to identify areas where the bots are successful, understand the areas where it fails, and enable a deeper penetration of the bots. Further, the solution must synchronize with the workflow applications to provide a powerful view of the automation solution’s quality and throughput vis-à-vis human agents

8. Automation is a marathon, not a sprint.

Sustainable benefits of automation will accrue to those who have an ongoing approach to identify opportunities, implement automation solutions and methodology, develop monitoring processes, and adopt a change management model.

9. Nothing succeeds like success. Write the story. Tell the story. Repeat.

  • Create a measurement model - Create dashboards that tell your story effectively with quantifiable results.

  • Collaborate and share with other teams - Other teams, through collaboration and sharing of process implementation success stories, business outcomes delivered, challenges encounters, and the learning opportunities, can identify the replication opportunities for automation within their business processes.

10. Trust a process automation service provider that knows your industry.

While they may be an expert in the automation projects, the potential automation service providers should also know your industry – understanding of revenue cycle system nuances, specialty specifics, business rules of healthcare providers, information interchange standards, and the operating policies and procedures – to meet your needs now and in future.

About the Authors:

Prabhakar Munusamy is a seasoned professional with over two decades of experience in the IT and business process services industry. His expertise lies in leading application development teams through the life cycle, defining the strategic roadmap for process innovation by using machine learning (ML), artificial intelligence (AI) and  robotic process automation (RPA). Prabhakar can be reached at prabhakar.m@accesshealthcare.com.

Satheesh Seetharaman is an entrepreneurial, agile technology leader with over 18 years of experience in healthcare and telecom industries. He has extensive knowledge across a wide range of technologies, business platforms and CRM solutions. He leads business process innovation and transformation projects at Access Healthcare. Satheesh can be reached at satheesh.seetha@accesshealthcare.com.

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