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Robotic Process Automation in the Healthcare Industry

COVID-19 has had a massive impact on healthcare providers. Dire need has pushed many healthcare professionals to the limit to the point of affecting their own health.

Many have turned to intelligent automation technologies in an effort to do more with the limited resources that they have.

The pandemic highlighted and accelerated the already present need to optimize costs, decrease dependency on humans for routine and administrative tasks, and prepare for any similar future impacts.

According to Gartner, 50% of US healthcare providers will invest in RPA over the next three years. Artificial Intelligence (AI) enablement within clinical or nonclinical processes for patient interactions, which is a mere 4% today, will increase at least five fold.

Using RPA in healthcare is excellent for improving administrative tasks; it mimics human manual processes by mapping interactions between computer keystrokes and data repositories (Read more about RPA here). AI in combination with RPA allows decisions to be made based on the sophisticated rules created from existing case data.

In many cases, this can be done without human intervention and can also automate subsequent decisions and actions to form a completely automated business process.

It can also draw on patient data that is hidden or not easily accessible to predict patient needs, helping healthcare providers identify medical issues and help patients more. Here are some use cases/examples of RPA in healthcare:

Appointment Scheduling and Management

According to one report, 88% of all patient appointments and bookings are made manually, sometimes leading to over two months between a referral and an appointment. The sheer magnitude of manually managed tasks is prone to errors, dropouts due to no follow-through leads, to patient dissatisfaction and colossal revenue losses of up to $150 billion.

RPA can be easily applied to remove administrative errors and reduce healthcare staff spending hours doing mundane, repetitive tasks. Also, adding a layer of artificial intelligence and intelligent automation can improve patient interaction and improve appointment follow-throughs without increasing manual hours.

Read how the team at Nividous increased appointment bookings by 50% for an eyecare group and increased efficiency by 60% with their voice and chat-enabled AI-powered RPA Bots.

The Bots empowered the patients with a consumer-focused appointment system. Built to interact with a legacy system, the Bots check patient eligibility and help locate the nearest stores, check on customer orders, availability, change or even cancel appointments.

Automating Medical Coding and Billing

Medical coding and billing are the backbones of healthcare revenue cycle management. They help establish and categorize patient information that dictates the billing of Medicare and insurance companies.

The sheer number of medical codes maintained by agencies such as American Medical Association (AMA) and Centers for Medicare & Medicaid Services (CMS) is incredible.

It would be impossible for anyone to memorize these even if they were static but there are also regular updates (AMA recently announced new CPT codes for SARS-CoV-2 vaccine). Staying up to date on changing codes, documentation requirements, and payment methods are imperative for billing to ensure accurate and timely payment.

Typically, a manually managed process can take up to 5-7 weeks and will likely be subject to manual errors. Automation can drastically reduce the time taken to complete coding and billing while also increasing the accuracy. Faster and more accurate coding leads to faster payment and ensures that money is not left on the table.

The Nividous team designed and implemented AI-powered RPA Bots for automating medical coding and billing process for its customer – Kane Wound Care. The Bots understand and analyze each of the patient’s wound documentation to create billing codes that are then used to create invoices. The team achieved a 90% reduction in manual work, 80% improvement in coding accuracy and 85% improved process turnaround time.

Revenue Cycle Management

Revenue Cycle Management or RCM is an essential part of a healthcare practice to maintain financial viability and provide quality care for patients. It is the process of identifying, collecting, and managing the practice’s revenue from payers based on the services provided. Fragmented administrative processes and poor inventory management are some of the challenges that trouble healthcare providers.

Nividous deployed RPA Bots to automate end-to-end revenue cycle management for a leading eyecare group. The Bots were deployed as part of a complete RCM platform to standardize the interface used by all employees. The Bots automated a series of cross-functional operations involving doctors and administrative staff, leading to $16M claims processed and reconciled, 40% improvement in time to integrate new acquisitions, and a 9-day reduction in processing cash claims.

Patient Data Extraction, Review, and Claim Submissions

Reviewing and extracting patient data is laborious and time-consuming work. Furthermore, unstructured, and fragmented administrative systems can cause delays in processing claims and an overall negative customer experience. Streamlining the data extraction and healthcare claims can help reduce time as well as increase the bottom line for the healthcare providers.

Automation of this process can reduce errors and help with claims by ensuring the right data is extracted, reviewed, and used. Healthcare claims automation can help hospitals and clinics to reduce the backlog, increase claims submissions and reconciliation.

The Nividous team built Bots to reduce process handling time by 70% and operational cost by 45% for a leading specialty care management company with an exclusive focus on cancer and cardiac care. The team automated the end-to-end data extraction, review, and claim submission process with its intelligent automation platform.

Auditing and Submitting Insurance Claim Processes

As noted above, claims management is crucial for hospitals and clinics. The manual tasks involving navigating through systems and data often lead to errors and cause delays and oversight that lead to resubmissions.

RPA is perfect for automating tasks such as data management, and verification, report generation reducing the load on the team to close mundane tasks and instead focus on more important aspects.

Read how Nividous team automated the process of checking claims eligibility across 40+ insurance for an eyecare group and saved 1500 hours per month.

Healthcare providers are under pressure to improve the overall patient experience while dealing with compliance issues, fighting shrinking payments, and now even to fight a pandemic. This creates an environment that is ready to embrace technology driven change.

However, uncertainty about cost and return on investment continue to temper the mood and often lead to inaction. RPA backed by AI hits the sweet spot for healthcare providers by providing quick return on investment at a relatively low risk and the team at Nividous can help you to figure out where to get started so that you can maximize your investment and free up much needed human resources.

To learn more about Nividous Healthcare Automation offerings, visit us here, or to speak to an expert, reach out to us at

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