Where to Start? Evaluating Which Healthcare Process to Automate First

There is no shortage of benefits to automating healthcare processes, which is why so many businesses are eager to dive in once they realize how much time and money they can save. The only question left is, “Where to start?”

When assessing new areas to automate, you’ll likely find several processes that robotic process automation (RPA) can help you streamline. In this article, we’ll teach you how to evaluate your processes and the effect RPA could have on them to determine which ones you should focus on first. 

Where to Start?

When determining the ideal areas for implementing automation in your business, it’s essential to consider a few key questions:

• Which process is causing the most problems?
• Which process costs the most money?
• Which process is taking up most of your team’s time?

Based on our experience working with various healthcare companies, we have identified several common problems that can be efficiently addressed through the implementation of RPA. By automating repetitive and mundane tasks, you can avoid overpaying for simple activities that can be easily handled by technology.

Claims processing 

Claims processing is a time-consuming process to manage. Even with claims processing software in place, thousands of claims are denied and your staff has to manually process them anyways. Consequently, significant administrative costs are incurred by your business. However, you can streamline and automate the entire process through RPA, resulting in time savings, reduced administrative costs, and accelerated processing.

There are large healthcare networks that run millions of claims each year, from a variety of sources, providers, and plans, some of which require adjudication and evaluation. Companies are striving for 100% auto-adjudication, where there is zero human contact in the process.

Achieving a fully automated process currently feels like a pipe dream, as there are always exceptions, errors, typos, etc., which inevitably require human intervention. However, we’ve found that the large sophisticated software solutions are sending exceptions back for manual processing that do adhere to clear logic and specific guidelines. In other words, the software should be able to easily handle those claims!

Most of the time all that is needed is a fix in the code. However, our clients have found that in cases with these larger companies, when a request for a code update is necessary, waiting for their implementation of bug fixes is a lengthy ordeal, and in the meantime, you’re losing money. Consequently, processors are forced to handle claims that should have been efficiently processed by the system.

This is where RPA comes in to bridge the gap! RPA plays a crucial role, particularly in scenarios where there is clear-cut logic. Although rare occasions may still require human intervention, when it comes to claims processing we have discovered that these cases are extremely infrequent.

Data entry and validation 

Efficient and accurate data entry is essential for healthcare businesses, encompassing both clinical and administrative functions. Clinical staff must input patient data into electronic health records (EHRs), while administrative staff utilizes and transfers this data for tasks such as billing and insurance verification.

Unfortunately, human errors in these tasks can lead to significant problems and require valuable time to rectify. However, by leveraging RPA, data entry, and validation can be performed with 100% accuracy and at a much faster pace than your human team.

Many smaller hospitals or care centers rely on nurses for clerical data entry, which can be both wasteful and inefficient due to their higher hourly wages. Additionally, this practice detracts from the time they could otherwise spend directly caring for patients. Nurses may be required to input data at the end of a long shift, increasing the likelihood of errors.

Outsourcing data entry to third-party providers can present security concerns. Entrusting them with your patient’s data raises questions about the reliability and integrity of their practices. There have been instances where third-party systems have fallen months behind on data entry, causing significant delays and complications.

Incorporating RPA into the data entry process can address these challenges effectively. It ensures accuracy, eliminates the need to rely heavily on nursing staff, and minimizes the risks associated with outsourcing data entry tasks.

Inventory management 

When it comes to managing a large medical inventory, businesses need to ensure accurate tracking of items and compliance with healthcare guidelines. Fortunately, Robotic Process Automation (RPA) offers effective solutions for monitoring supplies, maintaining stock levels, generating purchase orders, and facilitating communication with vendors. By automating the process of ordering supplies when levels are low, RPA proves particularly beneficial for larger hospital systems that require daily inventory management. With RPA, the risk of facing critical shortages is greatly reduced, enabling businesses to operate smoothly and efficiently.

Prioritizing Processes

While considering the implementation of RPA, it is important to recognize that it may not be suitable for every process. RPA is most effective for processes that are rules-based, repeatable and do not require strategic thinking. As you evaluate your business processes, you will likely identify multiple processes that can be optimized. It is advisable to create a comprehensive list of processes to automate and establish criteria to determine their priority. By organizing the list based on importance, you can systematically tackle the projects and drive the digital transformation of your healthcare business. Consider identifying the manual-touch processes that are the most time-intensive or with the highest volume and determining the root causes of failure. Claims processing is often a good starting point, as it typically yields a high return on investment and involves repetitive tasks that can lead to quick wins. Additionally, it is worth identifying areas where highly skilled medical professionals are spending time that could be automated.

Trying to decide which process to automate? Read our blog post on calculating RPA ROI.

Ready to Automate?

Are you ready to let automation relieve your stress and move your business forward? If so, then you’re in the right place. At EnterBridge, we specialize in creating RPA solutions for healthcare businesses. We can help you assess your current tech stack, find opportunities for automation and build custom solutions for your business.

If you need help determining if your process is a good fit for automation, reach out to us! We can help you decide if RPA will help or if another process would be a better solution.