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Robotic Process Automation and RCM

Posted by Meduit RCM on Apr 28, 2019, 9:32:40 AM

 

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Robotic process automation has the power to accelerate cash flow through efficiency and reduced human touches. An industry leader in technology innovation, Meduit utilizes this technology, specifically web bots, to scrape information from payor websites and determine why a particular claim has not been paid. The web bots are able to identify:

  • Amount of payment
  • Status of payment
  • Cause of denial if claim is denied

Once this information is gathered, the web bots bring the data back into the Meduit system and identify next steps to getting the claim paid, triggering automated workflow and eliminating human touches.

 

By using web bots, an estimated 70% to 80% of work once done by people can now be automated.

 

Information is gathered faster, cheaper, and more efficiently, eliminating manual steps in the process. For example, if the payor denies a claim because of a medical records issue, the web bot identifies that reason, routing the claim directly to someone in medical records, who pulls the records and sends them to the payor, saving time and improving efficiency.

Meduit is able to:

DO THE WORK CHEAPER than clients can do it themselves

ACCELERATE CASH FLOW by ensuring payor deadlines are met

COLLECT CASH FASTER thanks to a more efficient process

The traditional method of obtaining data from a payor electronically is to use standardized HIPAA transaction code sets to view status of a claim where the payor sends back an automated status of the claim. However, approximately 30% to 40% of the HIPAA transaction inquiries result in a generic “claim denied” status from the payor. By using web bots, Meduit’s system is able to view how the payor specifically defines the denial, resulting in increased actionable information.

In another example, the HIPAA transaction set inquiry results in “claim not coded correctly”. Web bots scraping the payor website find this status: “final day of charges denied due to lack of authorization”. This information unleashes a whole set of actions to get the claim paid.

Data recovered from the web bots also feed Meduit’s business intelligence repository, allowing Meduit to provide clients with more detailed end-of-month denial reporting. This data arms clients with useful information to support renegotiating contracts with payors.

To ensure that you are getting best results from payors regarding claim status inquiries, make sure your RCM support team is actively employing web bots and not simply relying on HIPAA transaction sets.

Topics: May2019