Healthcare is undergoing significant change. The shift from fee-for-service (FFS) to value-based healthcare payment models demands out-of-the-box thinking to meet new challenges. Leading organizations are beginning to leverage technology by shifting resources from back office support to patient-facing positions. Vee Technologies uses innovative solutions to help organizations through the transition.
Vee Technologies analyzed the billing department’s workflows and scenarios for insurance eligibility verification and pre-authorizations. Recommendations were made for each scenario that could be supported by RPA and Bots were developed to verify insurance eligibility and obtain pre-authorizations when required.
As part of the workflow analysis, the RPA team created detailed, step-by-step workflow diagrams identifying the information required and the action steps taken throughout the workflow. Scenarios for different action steps and payors were created as the foundation for building each Bot. Each scenario involved logging on to the Practice Management System (PMS) and payor portals, evaluating the work queue, retrieving information from each scheduled patient visit, decisioning based on the retrieved data and taking appropriate actions. Appropriate actions included documenting in the PMS the eligibility status, co-payment information and the requirement for pre-authorization.
The RPA project led to a more streamlined workflow with increased accuracy, reduced eligibility denials, lowered costs and improved patient satisfaction. By leveraging Vee Technologies’ expertise with RPA, the practice freed time for their billers to focus elsewhere while achieving 100% accuracy on insurance eligibility verification. Eligibility denials were reduced by 70%, lowering the cost to investigate and resubmit claims. Rolling out RPA generated 25% in cost savings during the first year and the practice also saw a reduction in patient complaints.
Technology and innovation applied in conjunction with business process experts can make dramatic impacts on the bottom line of healthcare organizations. Technology, when used properly, is powerful. It can maximize accuracy, increase productivity, reduce costs, optimize revenue, allows staff to redirect efforts, and it can help to improve the patient experience.