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Which is best for your Revenue Cycle management, RPA or AI?

Every business, small or big can achieve an enormous benefit when taken the right advantage of automation of their business processes. Though it does not seem to be a very affordable technology that all businesses can invest in, a business can still enjoy the benefits of RPA and AI by implementing the same in some parts of their Revenue Cycle Management.

To understand how RPA and AI can be profitable for your RCM, it is crucial to know which technology would be suitable for which scope of RCM. This would require understanding the functions of RPA and AI and their differences. Let us first know what these two technologies’ intended purposes are; RPA refers to Robotic process automation that aids in the automation of repetitive tasks that have the exact same process every time it is performed. It works on a rule base logic or something that of a simple ‘if-else-if’ algorithm. AI on the other hand is a self-learning concept wherein the tasks are automated and performed based on the experiences of the software. Every time a task is performed by an AI tool it understands and memorizes the way in which the process was performed. Over a period of time, it uses its learning and resolves these tasks by itself in the most efficient way possible. It can also create new ways to resolve these tasks from its learning. To simply point out the difference, RPA uses logic that is pre-determined by humans to perform tasks while AI uses its own logic through self-learning

Now that we have established how RPA and AI work, let us discover what would be the better choice for the various scopes of Revenue Cycle Management.

1. Eligibility Verification:

Spending countless hours on calls and on payer portals trying to establish patient eligibility has been one of the major time-consuming tasks of the revenue cycle management process. RPA enabled tools can do this work for you. The software automatically enters into the payer portals and finds out the eligibility for you within seconds.

2. Coding:

We all do know the importance of fast and accurate coding in RCM. AI for coding has become a very common practice among Revenue cycle leaders. AI in coding helps the coding tool to read charts and then codes these charts from its understanding. The data on how to code is fed into the tool and over a period of time, the tool will possess its own knowledge and start coding on its own. For new or unique situations the tool will automatically suggest codes which however have to be verified and approved manually. The best part of AI in coding is that it can minimize coding errors by up to 70%.

3. Charge Entry:

Imagine being able to enter all patient information and coding information without having to switch into multiple tabs and never having to make the mistake of entering another 0 while filling the $ values. This is exactly what RPA in charge entry achieves. Automating your charge entry process in your revenue cycle management not only ensures faster claims transmission but also increases the must needed clean claim ratio for your business.

4. AR & Denial Management:

Most of the resources in the revenue cycle management process are deployed towards AR follow-up and Denial Management. Those long hold calls with payers and the never-ending need to send appeals can all be minimized when claims are allocated and worked on a priority basis. AI in AR and Denial Management acts as a guide to the resources in providing them with all the information needed for further action. An AI-enabled tool can interpret the EOB from the payer; for example in the case of a Coding denial the AI tool automatically finds alternative code for the same and re-submits the claim to the payer all within the TFL. If in case it does not have an alternative code it re-directs the claim to the coding team along with the TFL so as to ensure prompt action on the claim. It acts as a platform that contains all the necessary info to re-direct the claim or take the right action on the claim. With AI you can once and for all eliminate the need to write off claims due to wrong actions or late follow-ups.

5. Payment Posting:

The biggest challenge of the payment posting team is to ensure if the daily logs, your payments posted in the software and the bank statements reconcile with each other. RPA in Payment posting does this job for you. An RPA enabled tool will have access to your daily logs and your billing software and can find out even the smallest of discrepancies. With this, you can never miss even a single dollar of payment.

Both AI and RPA act as a guardian angel for your Revenue Cycle Management. The ultimate goal of any technology is to minimize time and reduce cost. Only when you have the knowledge about what technology to be used and in which way, you can be in a position of enjoying the maximum benefits of the same. Sometimes these advancements can be overwhelming and trusting the technology sounds easy than it actually does. The ignorance about these functions should never stop any business from savoring the most out of AI and Automation. Quintessence offers fully operational AI & RPA solutions along with our Revenue Cycle Management services. To know more about how our super affordable, software with a service opportunity work click here.

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