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Looking to accelerate reimbursement and streamline administrative tasks, a leading provider of anesthesia services implemented robotic process automation (RPA) programs, enabling it to achieve significant cost savings.

Challenge

As part of its innovative and forward-thinking culture, an anesthesia provider sought to utilize the best technology to improve performance and deliver greater value to its customers. With more than 26 million patients across the country, the office staff manages a sizable volume of clinical documentation. Looking to make the administrative processes more efficient and improve revenue cycle with cost savings, leadership decided to explore RPA.

Approach

Huron collaborated with organizational leaders and stakeholders to identify opportunities for automation, prioritize the opportunities based on return on investment (ROI), implement three diverse pilot automations and expand automations post-pilot. Additionally, Huron worked with leadership to develop a road map for the organization to design and implement future automations on its own.

Vetting automation opportunities. Huron and organizational leaders began by examining all administrative functions within the revenue cycle, including billing, charge entry, cash posting, coding and credentialing. To determine the viability of RPA for each use case, the team calculated the projected financial ROI of each opportunity and weighed that against the technical and organizational complexities involved. If RPA was not an ideal solution to the business challenge at hand, Huron recommended other improvement opportunities, including streamlining workflows within current systems, optimizing technical infrastructure or implementing reporting solutions.

Creating the road map. After identifying the top RPA use cases, the team created a road map for implementing automation programs, including timelines and recommended governance structures, to ensure the organization could achieve long-term sustainable success designing and implementing its own automation programs.

Designing and implementing three pilot automations. Using UiPath RPA software, Huron developers implemented three pilot automations, including explanation of benefits (EOB) retrieval, documentation denial resolution and charge correction.

• Previously, every business region of the organization downloaded the EOB files manually from various payor portals. The EOB retrieval pilot focused on developing automation for one region and five payor portals with the highest average volume. By making the automation program modular, it was easier to expand the scope to other regions.
• Many denials were the result of the payor organization not receiving required documentation. The documentation denial resolution pilot focused on automating one region, one payor and several rejection codes corresponding to missing records. Using optical character recognition (OCR) technology to read patient medical records, the organization was able to parse out the required records, resolving many outstanding denials while creating a more efficient process for the future.
• Invoices that require a charge correction remain unpaid until the correction is made, often a time-consuming and manual process. The charge correction pilot made charge corrections faster to do and easier to identify within the invoice by concentrating automation on the three most common types of charge corrections: payor corrections, provider corrections and location corrections. The modular automation made it easy to expand the program to include other charge corrections beyond the initial three.

The organization featured in this case study is a large physician-owned provider of anesthesia services, operating in more than 1,000 healthcare facilities across the U.S.