The buzz around process automation in the revenue cycle industry is gaining rapid attention. Third-party automation solutions and revenue cycle services providers aggressively make claims about how their products provide pervasive automation solutions. Before you make a significant investment in automation, recognize that revenue cycle process automation needs to be about achieving strategic business outcomes and less about applying technology for technology's sake.
In this paper, we discuss several elements to be considered while embarking on an endeavor to automate business processes.
When automating your processes Keep the following in mind:
Automation is a marathon, not a sprint.
Obtaining executive buy-in is key to driving adoption and ensuring a smooth transition from manual to digital.
As bots become smarter, you will be surprised how closely they begin to mimic human behavior. This happens for two primary reasons – 1) the processes being automated are designed by humans and 2) as with all processes, they continually evolve. This, in turn, leads to changes in the success rate of the automated solution. Therefore, the smarter your bots become, the smarter you need to be to properly manage them.
Process discovery
Understanding every step in every process is crucial for successful automation.
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.
Regardless of the format it takes, it is imperative that a deep understanding of the complete business process is obtained to perform a creative deconstruction of the processes, understanding the different work types, and equally important knowing the desired production performance metrics.
Process variability
Differing process requirements will determine whether you can apply full automation or require partial automation with human assistance.
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. The complex world of revenue cycle potentially has many areas that can be automated. Let’s take a look at how each set of work processes has different requirements for your automation team.
Front-end processes
From prior authorizations to patient scheduling to registration, each process step has different requirements – inbound/ outbound calling, EDI transactions or just paper or image-based processing. The complex set of interactions across multiple channels creates unique process automation channels. As your patients interact with you through different channels, you should evaluate automation technologies that do not merely address sub-processes within one of these channels but have a comprehensive end-to-end human and bot enabled strategy that enables you to respond at the speed of the customer.
Medical coding processes
By definition, medical coding processes require the knowledge of medical terminology and the ability to apply ICD (International Classification of Diseases) and CPT (Current Procedure Terminology) beside HCPCS (Healthcare Common Procedure Coding System) and modifiers. Also, each coding system and provider organization provide medical charts in a different manner. From super-bills to handwritten paper notes to HL7 based medical records, there are inherent differences in the nature and form of the information is available to your coders.
Accounts receivable and denial management processes
With over 3,000 healthcare payers in the United States, EDI and portal-based information exchange is not applied consistently across organizations - partly as a result of the underlying platforms being on antiquated technologies. While this unlocks a significant opportunity to automate processes, it also means that AI/machine learning methods have to be applied to achieve a healthy percentage of automated transactions. Multiple automation providers have popped-up within the last few years, each of them claiming to create a fully automated accounts receivable and denial management process. However, such claims should be evaluated in terms of the workflow effectiveness and quality of the automation processes, and more importantly, the ability to make a real impact on business outcomes.
Value of practitioner involvement
Ensure the accuracy and robustness of automated processes by involving the practitioners who complete these steps every day.
Quite clearly, no one understands revenue cycle business processes better than your operations team performing them every day. A key point to acknowledge is that identifying automation opportunities is not a one-time effort but an iterative, ongoing exercise. Anyone believing this is a one-time endeavor will be highly disappointed in the long term. 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.
Workflow and knowledge management systems can help
Accelerate automation deployment by leveraging workflow applications and knowledge management systems.
Operations reports from a mature workflow application can provide significant insights into each granular process step, identify repetitive tasks, and eliminate non-value activities performed. Furthermore, the workflow application can provide insights into the types of errors commitment by human agents and allow for stratification of these errors. Armed with this intelligence along with the knowledge of the business rules of the process, the insights from the workflow reports, and a library of Microbots, automation deployment can be accelerated and yield a new level of business value.
Importance of automation tool architecture
Ensure scalability with a solution that provides an industry-specific stack of 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 - Infusing scalability
Welcome to the world of Microbots and micro-services. When bots get designed for a single purpose, have the ability to hand-off from one bot to another bot for the next sub-process with a seamless transfer of data. Once you have a library of bots, it will become easier to create process specific automation tools more rapidly.
Process design and redesign is key
Break down the process to be automated to a granular level to identify process steps or whole work queues that can be automated. It is imperative that your automation team has the capability to breakdown and reconstruct the work processes, with extensive utilization of the Microbots and micro-services architecture.
Managing the automated environment
Bots are smart, and they require robust governance.
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
The quality assurance process needs to mimic, if not be better than what is being done for human agents. Not only would it provide governance and control, but also give you insights to further your automation agenda.
Managing bots by the bots
With higher speeds of processing of the bots, you need solid checks and balances in place not just for quality but also real-time monitoring of the performance of the bots deployed. Consider using a solution with a control towers that includes real-time monitoring, bot initiation (start/stop), and scheduling functionality, along with dashboard-based reporting. This will enable you to identify areas where the bots are successful, understand the reasons why they fail with some transaction types, and enable a deeper penetration of the bots. Further, we recommend using a solution that synchronizes with the workflow applications to give you powerful views on the automation solution’s quality and throughput vis-à-vis human agents.
Choosing an automation platform
The platform you choose is an important factor of success. Ensuring the industry-specific functionality is present will be key.
In the world of automation, the half-life of technologies is very short. While evaluating revenue cycle automation tools, you should keep the following aspects in mind.
The architecture of the platform and the underlying technology framework determines how deep automation can be taken within your process ecosystem.
• Industry Specific Frameworks. Processes such as medical coding require specific underlying data sets and medical dictionaries to function effectively. Choose tools that have robust underlying industry-leading frameworks, that are being actively invested in and are evolving rapidly.
• Intelligent Bots. We believe that the word bot itself is a misnomer and undermines the capabilities of emerging technologies. Machine learning and artificial intelligence technologies are having a significant impact on the healthcare industry. With a large number of datasets and training on different use cases, machine learning technologies can mimic human actions and behaviors. Also, the term, Artificial Intelligence, is an overarching term Deep learning, Machine learning and Cognitive intelligence, which are complex technologies. Further, when used in combination with tools such as optical character recognition, or business rules, machine learning and artificial intelligence can give results of a different magnitude altogether.
• Do your research, choose the automation platform wisely. With thousands of start-ups in the world of automation, each of them trying to address a set of processes or business problems, choosing the right technology becomes difficult. Choosing an automation technology that has the backing of a large corporation with a significant investment in R&D, could be one way to ensure that the solution you deploy today continues to be relevant even with the evolution of technology. Further, relying on technologies that use industry leading process frameworks also offers some cushion from the threat of obsolescence.
Choosing an automation service provider
Choosing a service provider with deep industry knowledge will allow you to overcome challenges readily.
Every industry has its process complexities. Healthcare revenue cycle business processes, in particular, are extremely complex. Revenue cycle system nuances, specialty specifics, healthcare provider business rules, inconsistently deployed information interchange standards, and the variability of operating policies and procedures, all create unique challenges that can only be understood by an experienced practitioner. Trust a process automation service provider that knows your industry.
Ensuring automation is successful
Continued success is a feedback loop, the success of which hinges on robust measurement strategies.
Create a measurement model
As you achieve success on the automation agenda, create a mechanism to measure the success. Create dashboards that tell your story effectively with quantifiable results.
Collaborate and share with other teams
Sharing process implementation success stories along with business outcomes achieved, challenges encountered, and the learning from the implementation efforts in one process area or vertical with process leaders in another area or vertical will lead to the identification of replication opportunities.
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