UiPath Automation in Healthcare: Transforming RCM 

Client Profile

Our client is a leading provider in the healthcare industry operating hundreds of hospitals and clinics across the country delivering outstanding patient care. While the company already maintained sizable revenue cycle management (RCM) operations in the U.S. and Asia, U.S. labor shortages and offshore challenges had it looking for a nearshore partner in Latin America who could support its healthcare process automation journey.

Like other healthcare organizations, the client’s RCM operations were ripe for automation: full of high-volume, multi-step, repetitive, and labor-intensive processes prone to errors and inefficiencies that can impact financial health and delay patient care.  

Interest in RCM automation is surging as staffing shortages, security challenges, and growing transaction times led to a 50% increase in healthcare administrative costs, a 2023 report from Council for Affordable Quality Healthcare Index (CAQH) Index found. When implemented properly, RCM automation and process improvement can save the medical and dental industries a combined $18.3 billion, the report states.

In addition, the frustrating, tedious nature of RCM work left the client’s U.S. operations struggling to attract and retain staff. More than 80% of RCM organizations struggle with labor shortages (2023 Becker’s Hospital Review and PwC “Healthcare Revenue Cycle Survey”). 

Automating RCM processes is projected to save healthcare providers 1.6 million to 3.2 million hours of work (UiPath “The Value of Automating Healthcare Administration Operations” workbook).  

The healthcare provider had established a Center of Excellence (CoE) to transform its business operations with cross-organizational healthcare automation – focused on enhancing efficiency, reducing administrative burdens, and speeding revenue recognition, with the end goal being to improve patient satisfaction without increasing operating costs. 

The client selected UiPath, the No.1 business automation platform, as the best solution for achieving its goals. But the tight labor market for automation talent in the U.S. convinced the client it needed a top-quality nearshore intelligent automation partner to help scale its extensive agenda – combining nearshore advantages like cost-effectiveness, real-time collaboration, and outstanding English proficiency with a deep pool of highly skilled AI and automation talent located in Latin America’s top tech markets.   

As a UiPath Platinum partner and pioneer of nearshore tech-led outsourcing, Auxis stood as the natural choice. The client had outsourced revenue cycle management work to  Auxis’ Global Delivery Center in Costa Rica after realizing its existing Asia-based delivery center lacked the right skill sets, geographic proximity, and cultural alignment to adequately perform complex healthcare activities.  

 The client’s leadership felt confident that Auxis had the knowledge, tools, and experience to successfully drive innovative, custom-built healthcare automation solutions across its enterprise – coming to the table with one of the most robust delivery platforms in Latin America, a proven track record navigating the complexities of healthcare process automation in the highly regulated industry, and deep experience customizing connections to insurance payor portals.

After the successful CoE built an appetite across the organization for automation, the client turned to Auxis to access a consistent pipeline of high-quality, cost-effective talent that would help it keep pace with accelerating demand.  

The Auxis team was tasked with building robotic process automations (RPA) for the client’s RCM processes spanning multiple business units, including payment compliance, health information management, dispute resolution, accounts receivable, patient access, etc. Auxis’ automation experts are involved in key phases of the client’s automation lifecycle, including: 

• Discovery/requirements: reviewing process documentation, filling information gaps, and testing to check feasibility.   
• Development: designing and developing solutions; Quality Assurance testing to ensure high-quality, reliable results; and moving automations to production. 
• Hypercare: a four-day period of close monitoring and support after a new automation is placed in production before it is transitioned to the ongoing support team.  

Many of the client’s existing RCM processes shared a common structure: manually extracting information from different sources such as emails, shared drives, applications, and internal databases, and then uploading that data into various internal databases and enterprise resource planning (ERP) platforms for processing. Such administrative repetitive tasks consumed much of its RCM staff’s working hours, creating inefficiencies and increasing operational costs and the potential for errors. 

While many robotic process automation providers only offer technical expertise, Auxis brings the business knowledge to reimagine how this work could be done – designing automations that improve healthcare processes to achieve efficiency and deliver faster, more accurate results. Before designing automation workflows, the Auxis team proactively contributes to process optimization – removing redundant steps and making processes more efficient and effective.  

To date, Auxis has leveraged Robotic Process Automation in healthcare to create dozens of automations aimed at speeding up the backend processes powering multiple RCM activities at the client.  

Some key healthcare process automations the Auxis team has built include: 

Provider licensing verification 

Challenge: Manually verifying the licensing status of non-privileged practitioners (NPPs) is tedious and time-consuming, requiring staff to search each covered state’s medical licensing board website, extract information, and update the client’s databases. With so many NPPs to verify across its facilities, the client’s team could only perform checks and update information for each NPP about once every three weeks – forcing the client to rely on outdated information.  

Auxis solution: A robotic process automation performs daily searches of each covered state’s medical licensing board website, assembling data into an output file for the client’s team to act on. With an average handling time of 1 minute per verification request, the automation can process hundreds of requests per day.

Denial escalation & legal resolution letter creation  

Challenge: The client needed to generate hundreds of letters per day notifying payors that it was initiating the negotiation process to resolve disputes arising out of denial of payment for services it had rendered. Creating each letter requires tedious information-gathering about the patient concerned and services provided. 

Auxis solution: A bot sources three documents from the client’s ShareDrive: EOB (estimate of benefits), payor form, and a letter. The automation merges these documents into a single file, enabling generation of a final letter that can be sent to the concerned payor. The touchless automation manages 3,000 transactions per month across 45 different payors.  

Supporting request responses for medical records 

Challenge: The payment compliance department struggled to manually generate thousands of responses to requests for patient records every month. The process required multiple letter templates and as many as 20 FTEs tasked with extracting data from different sources and creating letters responding to follow-ups, communications regarding missing information, request rejections, etc.   

Auxis solution: Automation extracts required information from multiple sources and inserts it into the appropriate database, creating each letter response. While the process previously had an average handling time of 6.5 minutes per letter, it is now handled by the bot in a single second! The bot currently handles 7,900 letters per month and Auxis is expanding the solution to incorporate nine additional types of letters.  

Generating Itemized Bills of Charges (IBCs) 

Challenge: When requested by patients or insurers, the client must provide itemized bills of charges. Previously, an employee manually created each IBC on the client’s payor integrity tool (PIT). The manual nature of the process left room for potential missed charges and underpayments.  

Auxis solution: Automation connects via an API to the client’s PIT to identify items and services rendered and generate IBCs, adding a note to the PIT that the IBC was created. Auxis’ automation accurately generates 10,000 IBCs per month, helping prevent underpayments. 

Creation of Notices of Negotiation for patients 

Challenge: The dispute resolution unit’s legal team must create thousands of Notice of Negotiation letters for outpatients and inpatients every month based on data collected on local files. Notices are then saved in a specific business location. 

Auxis solution: The automation creates letters in PDF format based on the stored data and moves it to the specified location. The automation creates 12,000 outpatient letters per month, reducing the time for creating each letter from 12 minutes to just 9.2 seconds. It also creates 782 letters for inpatients monthly, reducing the time for creating each letter from 12 minutes to 7.6 seconds.  

Updating canceled appointments in the Meditech EHR system 

Challenge: An FTE needed to manually close the Meditech accounts of patients who were contacted regarding scheduled appointments but did not respond. This decreased efficiency, increased administrative burdens, and led to lost revenue as time slots went unfilled. Additional resources were required to reschedule appointments, handle cancellations, or manage overbooked schedules to compensate for no-shows.  

Auxis solution: The bot accesses the electronic health record (EHR) system and changes the appointment status to canceled. A notification is also sent to the patient about the cancellation. The bot handles 9,000 cancellations per month, helping streamline appointment scheduling and minimizing patient wait times.

With 27 automations and counting, Auxis has become a critical partner on the healthcare provider’s automation journey – receiving recognition for its status as an extremely knowledgeable and integral part of the program. Its automations have streamlined high-volume, critical RCM processes across the client’s business units – increasing efficiency, productivity, cost savings, and more.  

Key benefits the Auxis intelligent automation team provided include: 

Doubled automation output  

Auxis’ highly skilled talent greatly augmented the client’s automation practice, alleviating talent shortages and expanding the team’s automation capabilities with deep knowledge of UiPath tools and features stemming from its status as a UiPath Platinum Partner. With Auxis functioning as a seamless extension of its CoE, the healthcare provider rolls out automations faster – with each developer working on three or four automations per month, up from one or two.  

Projected millions of dollars in benefit 

With each developer producing multiple automations per month, Auxis’ three-year automation agreement is expected to drive millions of dollars in benefit for the client – a significant advantage as many healthcare organizations scramble to reduce costs amid rising expenses and dwindling margins.  

Adoption of automation best practices  

Leveraging its deep experience implementing UiPath automation across a wide variety of enterprises, the Auxis team introduced best practices into the client’s automation program that further boosts productivity and accuracy. That includes: