RCM Automation in Healthcare for a Better Patient Experience

Client Profile

Our client is a leading medical supplier in the healthcare industry, specializing in products and services for individuals with mobility limitations. It also provides maintenance and repair services for its equipment. Founded more than 20 years ago, it has grown to 150 locations across the U.S. and 3,100 employees supporting more than 300,000 customers.

When the client’s patients are waiting for mobility products, order delays can have serious consequences – impacting their ability to work or participate in everyday life. Supply chain or manufacturing dependencies out of the medical supplier’s control are often a factor in delays.

But the client’s cumbersome, manual insurance verification and claims processes also contributed to extremely long order delivery cycles, often stretching as long as 90 days.

The client was committed to minimizing the impact of revenue cycle management (RCM)-related delivery delays on its customers’ quality of life. It also needed to solve significant operational challenges triggered by its highly manual insurance processes.

Before it can fulfill a customer order, the medical supplier needs to submit supporting documentation and request prior authorization in the insurance payer’s web portal. Payer response time varies between two and seven days, and comes without warning of status change – which created multiple inefficiencies:

• Overwhelming, tedious workloads distracted staff from more important work. With no other way to check payer responses, dozens of the client’s employees had to manually enter the web portals of its three highest-volume insurance providers thousands of times daily to check the status of more than 300 orders.
• Delays registering a payer’s approval or denial stretched the order cycle. The medical supplier’s staff checked for prior authorization response three days after each submission. After that, they only had bandwidth to perform follow-ups every three to five days, often causing days to pass before a response was registered.

Lengthy order delivery cycles also increased the likelihood of impactful changes to a patient’s provider or plan coverage, especially for patients who risked loss of employment and related insurance coverage. Not only was that situation terrible for the patient, but it further delayed equipment delivery as the client was forced to restart verification of benefits (VOB) and prior authorization with a new payer if the insurance lapsed during the process.

To avoid payment issues, the insurance eligibility verification process had to be repeated at various stages throughout the order cycle up until delivery to ensure patients’ coverage and deductibles had not changed – creating more work for the client.

The client consulted with Auxis to determine the best approach for reducing cycle times to customers and improving the accuracy of its revenue cycle processes. Together, they decided to improve process steps that required the most manual effort – a frequent source of delays.

Auxis applied a combination of UiPath Robotic Process Automation (RPA) and application programming interfaces (APIs) to increase efficiency in the medical supplier’s verification of benefits, prior authorization submission, and prior authorization follow-up activities. Automation is a proven strategy for optimizing revenue cycle management functions fraught with time-consuming steps and frustration, with the Council for Affordable Quality Healthcare Index recently asserting that fully automating nine common revenue cycle management transactions in areas like claims and insurance verification can save the U.S. healthcare system $16.3 billion.

“Implementing RPA solutions into our order process has truly allowed us to refocus our team’s time to more meaningful tasks. This has allowed us to reduce processing cycle time while improving order accuracy and gaining significant efficiencies.

Chief Operating Officer
Healthcare Provider Company

Auxis combines more than 25 years of business transformation experience with an elite status as one of only 26 providers in the U.S. to achieve both Platinum and Certified Professional Services accreditations from the #1 intelligent automation platform, UiPath. Auxis’ intelligent automation team came to the table with the tools, best practices, and expertise the client needed to streamline operations and significantly improve productivity in its revenue management cycle processes.

Auxis focused on automating process steps that did not require analysis and decision-making from human staff. To maximize efficiency, its automation team worked with the client to design and deploy unattended robots capable of using information within the supplier’s proprietary systems to determine if the bots could work an order or needed to reassign it to a person for further review.

Bots were also designed to take over the time-draining task of logging into the web portals of various insurance payers to review patient insurance information pertinent to coverage and check order status.

1. Automated insurance verifications

Bots pull data from a work queue within the medical supplier’s patient and order management databases, using the information they collect to review customers’ insurance policy and coverage details in their insurance payer’s portal. Based on a series of predetermined validation rules, the bot decides how to proceed with each order, updating the client’s system accordingly.

Below are some examples of tasks that Auxis’ automation performs to advance orders to the next stage in the healthcare revenue cycle management process:

• Validates key customer details including first name, last name, and DOB.
• Validates policy details, including active status. Confirms customers do not have existing conditions or other claims that might impact coverage.
• Checks deductible amounts, out-of-pocket maximums, and other details that might impact the amount a customer is required to pay.
• Adds order notes detailing work that the bot performed.
• Reassigns the order to a person for review if certain validation criteria are not met.

2. Automated prior authorization submissions

After the initial verification of benefits is complete, bots collect all documentation needed from healthcare providers to request pre-authorization from the health insurance company. This step must be completed before medical devices are ordered.

Below are some examples of tasks that Auxis’ prior authorization automation submissions perform to advance orders to the next stage in the revenue cycle process:

• Pulls additional details for each order. 
• Populates needed details in payer web portals.
• Uploads required documentation and submits prior authorization requests.
• Adds order notes detailing work that the bot performed.

3. Automated prior authorization follow-ups

The ability to review payer responses promptly during the prior authorization process directly impacts the duration of the order delivery cycle. Beginning three days after a prior authorization request is submitted for a customer, a bot logs into the insurance provider’s web portal to check if it was approved, partially approved, or denied. The bot continues to check twice daily until the payer responds.

That way, responses can be acted upon as soon they are received – decreasing the duration of the end-to-end order process.

With Auxis’ automation solution running smoothly, the medical supplier has been able to process a significantly higher number of orders every month – reducing the average delivery time to patients by 15 days.

Not only did faster delivery create a competitive advantage, but it also significantly increased customer satisfaction – better supporting the client’s mission of helping people with disabilities live with greater independence.

Key benefits include:

Nearly 20% reduction in order cycle time