RPA in Healthcare

RPA in Healthcare

• 1.
  Introduction | Tools| Use Cases Robotic Process Automation in Healthcare RPA (Robotic Process Automation) promises to automate various complex tasks for healthcare organizations – payers and providers – to improve member experience, lower costs and relieve employees from rising pressure of work. But when it comes to actual applications of RPA, most companies are having a difficult time. This brief eBook outlines the benefits, challenges, tools and key healthcare use cases of RPA that can help healthcare organizations boost their productivity.
• 2.
  What is RoboticProcess Automation? “It can do repetitive stuff more quickly, tirelessly than humans, freeing them to do other tasks requiring human strengths such as emotional intelligence, reasoning, judgment, and interaction with the customer.” - Leslie Willcocks, London School of Economics Robotic An entity capable of being programmed by a computer for doing complex tasks is known as Robot Process A sequence of actions or steps taken in order to achieve a task Automation Performing a task or activity without human intervention 1
• 3.
  RPA eases theadministrative burden by automating patient data migration and processing, reporting for doctors, medical bill processing, insurance data automation and claim processing, triggering emails from medical billing systems, claim status and eligibility automation, and patient record storage. 1. Low Risk, Non-Invasive Fills the gaps between existing systems 2. Cost Savings Anywhere from 20-60% of baseline FTE cost 3. ROI RPA projects include multiple functional ‘pilots’ but programs complete ~9 to 12 months with a ROI >1 year 4. Super Scalable Instant ramp-up and down to meet demand peaks/troughs 5. Accuracy Double digit reductions in error rates 6. Consistency Identical processes & tasks eliminating output variations 7. Reliability/Compliance Services available 365 days; regularly maintained logs to ensure compliance 8. Increased Speed & Productivity Remove non-value-add activities to focus on areas that require judgement RPA: Value Proposition 12
• 4.
  Manual Activity Post RPAImplementation Claims form received from customer in email Attach claim form to claim processing system Verify customer details in the system Copy paste data from claim form to the system Notify customer that claim is processed Bot opens email application Bot downloads claim form Bot attaches claim form to claim processing system Bot verifies customer details Bot copy pastes data from claim form to system Bot notifies customer about processed claim RPA: How it Works 3 Large volume of claims data Reduction of errorsAutomate high-volume, repetitive tasks Slow, error prone manual verification, reconciliation and notification process Quick response time
• 5.
  Although flexible andeasy to implement, RPA occasionally lacks the ability to automate certain aspects of process management. Process Parameters Favorable for RPA Unfavorable for RPA Decision Making Rule-based Judgement-based Input Data Structured Unstructured Data Format Digitized Non-digitized Output Consistency Standardized Multiple expectations Stability Stable over time Frequent changes Management Centralized Decentralized Errors Frequent Rare Frequency Continuous Periodic RPA: How it Works 4
• 6.
  Non-standardized Processes Unstructured Data Legacy Technology Security 7 Key Challenges Communication & Interfacing EmployeeBuy-in Healthcare use cases may have multiple input methods i.e. images, IVR, voice, OCR, API, HL7, etc. Leveraging RPA for such scenarios is currently challenging. Use cases will vary significantly, i.e. RPA claims management will have a greater ROI for a large hospital than a small clinic. Use of RPA bots to automate certain processes will affect human interaction and affordability of resources. This can create conflict. Current RPA bots can’t keep up with rapidly changing scenarios and may be best suited for repeatable, predictable use cases such as patient registration, claims, billing errors etc. RPA works best with structured data due to the nature of interfacing and bot workflow design. Healthcare has lots of challenging unstructured data. Healthcare systems have a lot of legacy systems often operating in siloes. These systems pose a challenge to RPA in terms of data extraction, flow control and command execution. Some scenarios will require bots to access and transmit ePHI information. This would need HIPAA compliance for the bot and RPA framework. Defining Use Cases RPA: Implementation Barriers 5
• 7.
  Usability Scalability Security Deployment VendorRecord Data Capture Reliability Governance Cost of Ownership Tech Compatibility RPA: Tool Selection Factors for Healthcare 6
• 8.
  Usability ▪ Ease ofuse & documentation ▪ Bot design (GUI, script, code) ▪ Human interaction recorder (Macro) Security ▪ Support encryption, Veracode, etc. ▪ Bot & process files restricted access ▪ Audit trails, logging & alerts Scalability ▪ Handling volume & variability ▪ Automated versioning/deployment ▪ Code provisioning templates Reliability ▪ Exception handling features ▪ Error management & logging ▪ Notifications & alerts Governance ▪ Analytics tools to assess performance ▪ Bot management controls ▪ Scheduled activities RPA: Key Tool Selection Factors For Healthcare 7
• 9.
  Technology Compatibility ▪ Integrationmethods (API, Citrix) ▪ Compatibility with current apps ▪ Support of OS (W7/10, Linux etc.) Vendor Record ▪ Product roadmap & growth ▪ Financial/operational stability ▪ Customer testimonials Data Capture ▪ Support data formats (CSV, HL7) ▪ Other methods (OCR, NLP, IVR, etc.) ▪ Accuracy of captured data Costs ▪ Setups costs & license fees ▪ Easy bug fixes / maintenance Deployment ▪ Ease of bot configuration / replication ▪ Ease of using bot orchestrator ▪ Client-server or web- based RPA: Key Tool Selection Factors For Healthcare 8
• 10.
  ▪ New PatientRegistration ▪ Appointment Scheduling ▪ Care Coordination ▪ Payment Posting ▪ AR (Accounts Receivable) / PAR (Patient AR) ▪ Claim Validation ▪ Claim Adjudication ▪ Claim Logging ▪ Claim Denials & Appeals ▪ Reports & Dashboards ▪ Supply Chain R&DData Management RPA: Healthcare Use Cases 9
• 11.
  Use Cases Activities NewPatient Registration ▪ Checking and updating patient details ▪ Capturing Demographic details, location details, insurance details to create new account ▪ Capturing / Retrieving account related medical history & charts Appointment Scheduling ▪ Scheduling & rescheduling appointment ▪ Managing appointment based on workload, specialty etc. Care Coordination ▪ Following up with patient for prescriptions, scheduled visits etc. ▪ Helping implement patient’s discharge instructions i.e. medication, recommendations, etc. Payment Posting ▪ Accessing ERA / EOB received from payer ▪ Accessing and checking payment received ▪ Posting application data entry and reconciliation ▪ Creating AR updates and follow up AR (Accounts Receivable) / PAR (Patient AR) ▪ Retrieving follow-ups from Billing / PP / other teams ▪ Follow-up for claims with nearing TFL via IVRS / mail ▪ Allocation of follow ups / outreach RPA: Key Healthcare Use Cases (1/3) 10
• 12.
  Use Cases Activities Claim Validation ▪Membership checks ▪ Eligibility checks ▪ Entitlement checks ▪ COB checks ▪ DRG / pricing assignment Claim Adjudication ▪ Adjudication rules o Eligibility o DRG o Payment Limit ▪ Claim authorization - policy segment ▪ Audit: Logging, Denial Claim Logging ▪ Manual claims entry ▪ Electronic claims ▪ Direct data entry ▪ Verify in/out network, diagnosis Claim Denials & Appeals ▪ Denial management ▪ Appeals based on denial type RPA: Key Healthcare Use Cases (2/3) o Workflow o Payment o Denial 11
• 13.
  Use Cases Activities Reports& Dashboards ▪ Automating report generation such as Daily Outstanding Report, Daily Productivity Report, etc. ▪ Automating audit reports generation Supply Chain ▪ Order processing ▪ Returns management ▪ Sourcing and procurement ▪ Inventory management Data Management ▪ Retrieving details, forms from website, IVR or API ▪ Running validation and quality checks on data ▪ Uploading files (Public Health, MACRA etc.) to Govt. portals ▪ Extracting & collating data from multiple applications R&D ▪ Site initiation documentation ▪ Investigator payments ▪ Enrollment tracking ▪ Monitoring visit reporting ▪ Clinical and medical writing RPA: Key Healthcare Use Cases (3/3) 12
• 14.
  With over 4,000professionals worldwide, CitiusTech enables healthcare organizations to drive clinical value chain excellence, across integration & interoperability, data management (EDW, Big Data), performance management (BI / analytics), AI/ML (predictive analytics, Machine Learning, AI) and digital engagement (mobile, IoT). CitiusTech helps customers accelerate innovation in healthcare through specialized solutions, healthcare technology platforms, proficiencies and accelerators. With cutting-edge technology expertise, world-class service quality and a global resource base, CitiusTech consistently delivers best-in-class solutions and an unmatched cost advantage to healthcare organizations worldwide. To know more about CitiusTech, visit www.citiustech.com CitiusTech: Accelerating Innovation in Healthcare 4,000+ healthcare technology professionals worldwide 800+ data management professionals 500+ HL7 & FHIR certified professionals 300+ data science & consulting professionals
• 15.
  Page intentionally leftblank
• 16.
  Princeton | NewYork | Rochester | Dallas | Boston | Philadelphia | Mumbai | Bengaluru | Chennai | Dubai | Singapore | London www.citiustech.comCopyright 2020 CitiusTech. All Rights Reserved.