Published - November/December 2020

The Robots are Coming, The Robots are Coming
By Dave Jakielo

Our industry has never been on the cutting edge when it comes to adopting and implementing new technologies. Medical billing companies' mantra for decades was, "Because we have always done it that way."

It took years before companies would shred documents after scanning them into a software program. They would scan documents, then file the hard copies, and hold onto them for months—just to make sure they didn't need them. I'll bet some companies are still following this procedure.

However, with what is becoming available in our industry today, companies will have a chance to reduce cost and improve performance. Here are two new technologies you will eventually need to embrace:

  • Robotic Process Automation (BOTS)
  • Artificial Intelligence

Robotic Process Automation (RPA) refers to software tools that automate human tasks that are rule-based and repetitive. RPA can record tasks performed by an employee on their computer, then perform those same tasks on its own.

Artificial Intelligence (AI) is unlike traditional programs that can only do tasks that you explicitly program it to do. AI is designed to mimic the functions of the human brain. Rather than simply obeying commands, software powered by AI has the ability to learn as it goes, identifying patterns and solving problems like a human would.

While industries like banking, scientific research, and medicine have utilized AI for quite some time, the revenue cycle (RCM) still relies largely on manual processes. Adopting AI in the RCM will eliminate the need for your staff to perform routine and mundane tasks that can, and should be, automatic.

Utilizing BOTS and AI improves accuracy, increases speed, and lowers costs. It will increase the productivity of both your billing system and your staff.

Some fear AI and BOTS because they think it will replace humans. While it may not replace a human, it will eliminate the need for them to do repetitive tasks. An additional plus is that your accuracy rate will improve.

In reality, AI and BOTS are powerful tools that assist humans with better decision making and present enormous potential to cut costs and increase effectiveness across the revenue cycle.

Here are some potential applications for both RPA and AI:

Robotic Process Automation

  • Checking and updating demographics
  • Coverage verification
  • Claim scrubbing
  • Claim status (276)
  • Denial posting and work assignment
  • Credit balance worksheets
  • Bad debt write-offs and placements
  • Small balance write-offs

Artificial Intelligence

  • Coding
  • Analysis of AR for collectability
  • Denial prediction
  • Payment timing prediction and flagging
  • Payment contract compliance
  • Provider behaviors

As an example, to expand on a few of the above functions, AI can predict denials with a high degree of accuracy and precision and build that into the workflow prior to submission. By learning overarching patterns and probabilities of claim denials, AI can guide humans on where to focus their efforts in order to maximize the amount of payment received.

Another function AI can handle is when a claim has gone unpaid for an irregularly long time and requires human intervention. This increases efficiency and helps people manage their time so they can direct their efforts to the most problematic claims.

AI is also a valuable tool for ensuring a better patient financial experience. As patient financial responsibility continues to grow, it is critical to provide a consumer-friendly billing experience while safeguarding a healthy revenue flow. AI can interpret data to model a patient's propensity to pay and what follow-up messages you should use. It can also predict which patients are unlikely to pay and you can avoid spending time and resources on "lost causes."

AI and BOTS are real game changers in the medical billing industry. The number of clerical tasks that are performed manually today will drastically decline for companies that implement the newer technologies. This will lead to lower costs, higher accuracy, and improved efficiencies.

Companies that adopt the "Ostrich Strategy," keeping their heads in the sand hoping that this too shall pass, are in for a rude awakening. If you aren't ahead of the curve, you aren't behind it yet, but you will be if you try to stay the course.

Remember: what you don't know will hurt you, so you better start doing your research on the developments in AI and RPA that are being embraced by companies in the Medical Billing Industry.

Dave Jakielo, is an International Speaker, Consultant dedicated to the Medical Billing Industry, Executive Coach, and Author, and is President of Seminars & Consulting. Dave is a Founder and past President of Healthcare Business and Management Association and the National Speakers Association, Pittsburgh. Sign up for his FREE weekly Success Tips at Dave can be reached via email; phone 412-921-0976.

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