RPA in Healthcare


As patient numbers grow, healthcare providers are challenged with managing levels of inventory, supporting digitization of patient files, optimizing appointment scheduling, and executing billing and claims processing. To help overcome these operational pain points, more and more healthcare providers are embracing **RPA** to alleviate these challenges and drive enhanced efficiency and growth.

Robotic process automation, or RPA, can virtually **automate any repetitive and manual task**, critical to the functioning and processing of healthcare. It can encourage a new workforce because of empowerment in terms of intelligent tools extracting relevant information from several sources, partner ecosystems, EHRs, finance systems, payer portal systems, and accounting systems.

RPA can help the healthcare industry **reduce costs**, **limit the occurrence of errors**, and **improve operational efficiency**.

### Scope of RPA in Healthcare

Studies estimate that healthcare industry collectively spends a stunning $2.1 billion each year on poorly performed and error prone manual tasks around provider data management alone! Likewise, insurance companies spend somewhere between $6 million to \$24 million annually to rectify poor provider data quality.

The systems in the healthcare domain that can benefit from RPA are highly inefficient, so much so that it has started impacting every aspect of the industry. From PDM and claims operations to customer support and billing. Every manual process has inefficient functioning, errors, and inaccurate data transfer.

Healthcare is predicted to have a **36% automation** potential. This means more than a third of healthcare tasks---especially managerial, back-office functions---could be automated, allowing healthcare providers to offer more direct, value-based care to the patient.

Ineffective healthcare systems still depend on **manual tasks** and processes, which are **unsustainable** and weak. RPA or robotic process automation can reduce unproductive processes and tasks by automating complex actions based on judgment. RPA can further offer a seamless execution of front office tasks such as:

- Billing and enrollment
- Claims management
- Finance and revenue functions
- Data management
- Administrative actions

### Use Cases of Robotic Process Automation in Healthcare

According to the Institute for Robotic Process Automation (IRPA), RPA in healthcare or automation in healthcare can improve workflows by automating rule-based tasks and processes. The bots used for automation can offer storage, data manipulation, process transactions, and system calibration abilities. Above all, automation in healthcare can improve results and reduce system errors caused due to poor functioning and manual processing. Below are some of the list of applications:

- Appointment Scheduling
- Account Settlement
- Claims Management
- Discharge Instructions
- Audit Procedures
- Healthcare Cycle

If you would like to explore how implementing AI can help your business, the we would be glad to help you. Please [contact us](mailto:info@feroniabillingservices.com) to explore our solutions.


FPR plays a major role in your reimbursement

First Pass Resolution Rate - KPI


Claims First Pass Resolution Rate, or First Pass Resolve Rate, measures the percentage of claims paid or transferred to patient responsibility on initial submission to the insurance payer. Claims that are not resolved on the initial submission cause significant rework for both the health insurance payer and healthcare providers (e.g., doctors/practices, hospitals, healthcare systems, etc.).

Poor inbound claims data (submitted by healthcare providers) is a common reason for claims rework. Missing claim information (e.g., no social security number, missing billing modifier, no plan code, etc.), duplicate claims submissions, and out-of-date submissions (i.e., claim not filed within required timeframe) can all trigger claims denials, causing significant rework on both ends (i.e., for the insurance company and healthcare provider). 

A high amount of rework in the claims process drives costs up, reduces employee productivity and negatively impacts customer experience.

#### Definition :
The total number of claims resolved on the initial submission (i.e., paid or transferred to patient responsibility) divided by the total number of claims adjudicated over the same period of time, as a percentage.

#### Calculation Instructions Claims First Pass Resolution Rate :
Two numbers are used to calculate this KPI:

1. The number of medical insurance claims resolved on the "first pass," and

2. The total number of medical claims adjudicated by the health insurance company over the same period of time. 

A medical claim resolved on the "first pass" should be considered any claim receiving a full or partial payment and/ or transferred to patient responsibility on the first initial claim submission (i.e., without need for subsequent data correction or resubmission). In the denominator for this calculation, do not include subsequent claims submissions following the initial submission (e.g., if a claims must be submitted twice to correct an error with the initial submission, count that only once in the denominator).

#### Formula :

``(No.of Claims Resolved on Initial Submission / Total No.of Claims Adjudicated) * 100``

Please [contact us](mailto:info@feroniabillingservices.com) to explore our solutions.

Decide between Redetermination vs Reopening

Medicare Redetermination vs Reopening


#### Reopening vs Redetermination

A Reopening is a process used to correct minor errors or omissions to a previously processed claim without using the formal appeals process. A reopening must be requested within **one year** from the date of the initial determination.

The Redetermination is the first level of appeals. A party who is dissatisfied with an initial determination may request a redetermination. Redetermination requests must be submitted within **120** days from the initial claim determination.

#### How To File a Reopening Request

- Calling the automated claim corrections via the IVR (Novitas)
- Submitting a written request using the Medicare redetermination and clerical error reopening request form
- Online claim corrections in the Novitas/CGS portal

#### When to submit a new claim

- No claim on file when checking claim status
- Claim is unprocessable (MA-130)

#### When not to submit a new claim

- Denied/finalized claim on file
- Claim data needs corrected/updated
- Duplicate denial

#### Important Links

[Novitas Guideliness](https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00134862),
[Redetermination Form](https://www.novitas-solutions.com/webcenter/content/conn/UCM_Repository/uuid/dDocName:00008291),
[Reopening Form](https://med.noridianmedicare.com/documents/10525/2052366/Reopening+Form)

[CGS Guideliness](https://www.cgsmedicare.com/partb/forms/pdf/reopen_vs_redet_jobaid.pdf),
[Redetermination Form](https://www.cgsmedicare.com/pdf/partb_redeterminationform.pdf),
[Reconsideration Form](https://www.cgsmedicare.com/partb/forms/pdf/partb_reconsideration_form.pdf),
[Reopening Form](https://www.cgsmedicare.com/partb/forms/index.html#Reopenings)

Please [contact us](mailto:info@feroniabillingservices.com) to explore our solutions.


Quality is an important factor when it comes to any product

Superior Quality & Service


Quality is an important factor when it comes to any product or service. Quality control is essential to building a successful business that delivers service that meet or exceed our client's expectations.

### Six Sigma methodology – DMAIC

Employing Six Sigma tools in healthcare does not only help to improve quality but helps to solve healthcare problems. The DMAIC approach – define, measure, analyse, improve and control – is a structured problem-solving technique widely popular in business.

#### Define

First of all, the identity of patients, as well as their needs and wants, will be clearly defined. In the same vein, the objectives of the process and its capabilities also require accurate definition.

#### Measure

Moreover, the performance of healthcare, based on the improvements, need to be measured. Changes or improvements can be measured by the level of patient satisfaction, service cost, the rate of clinical excellence and so on.

However, data and information collected for measurement should be clear and concise.

#### Analyse

Furthermore, Six Sigma tools should be used to analyse data collected for measurement to ensure efficiency. The analysis stage may involve complex statistical techniques to zero in on the actual cause of a quality issue.

#### Improve

During the Improve stage, the entire approach to patient care may need to undergo several changes and modifications. To track progress, effective monitoring of the performance of these improvements is an essential component of this stage.

#### Control

This stage consolidates the gains from previous stages. It may involve the introduction of new policies, protocols, etc, to ensure that care is provided at the high that has been achieved throughout the DMAIC processes.

### FMEA in Six Sigma healthcare management

FMEA (failure mode and effects analysis) is a proactive tool embedded within the Six Sigma method of quality improvement. It enables errors to be detected and prevented before they occur. Moreover, the primary goal of Six Sigma in healthcare management is to prevent defects that could be injurious to patients, their families as well as employees.

### DFSS in Six Sigma healthcare management

Design for Six Sigma (DFSS) is a Six Sigma tool used to design a product or service from scratch. The most popular design for this method is DMADV (Define, Measure, Analyse, Design, Verify).

Like all Six Sigma projects, this approach also requires that the customer requirements are well defined. The needs of the customers and the competitors should be measured and determined. The process options should be analysed and designed in detail to meet the customer’s needs. Finally, the performance of the design and its ability to meet the needs of customers must be verified.

Although Six Sigma is a very tedious strategy to implement in healthcare, the benefits far outweigh the risks.

Six Sigma is an effective tool that can help healthcare organizations rely on valid data that may help prevent managers from using personal judgement to make decisions. Thus, Six Sigma in healthcare management will reduce incorrect solutions. It reduces the cost incurred based on false guidance while ensuring accurate decision-making.

Also, Six Sigma encourages teamwork in an organization. Hence, it gives employees a sense of belonging. It makes them active rather than passive and motivates them to help the organization achieve its goals.

Furthermore, Six Sigma in healthcare helps organizations to understand the salient characteristics of patient services that have a high impact on patient satisfaction and loyalty. By so doing, patient’s satisfaction will increase and so will referrals, recommendations and profits.

Moreover, a number successful implementation of Six Sigma in healthcare examples exist to confirm the effectiveness of Six Sigma in health. By embracing Six Sigma methods, many hospitals have saved or made millions of dollars in profits.

Feronia implements six-sigma methodologies to improve the quality and enhance our customer experience. Please [contact us](mailto:info@feroniabillingservices.com) to explore our solutions.


Increase your ROI with superior RCM Service

Revenue Cycle Management Best Practices


What are the best practices for [Revenue Cycle Management](/solutions/revenue-cycle-management) (RCM) ? Each pratice has their unique challenges. However, every practice is unique, with specific billing needs and a few simple steps helps all practices boost revenue, decrease payer rejection and underpayment on claims, and reduce the number of days claims remain in accounts receivable (AR).

- **Insurance Eligibility Verification** should always be done at the time the patient checks in. This simple step will not only verify that the patient has insurance coverage, but also indicate the amount of the co-payment that should be collected.

- **Daily Claims Submission** is crucial to the regular cash flow of your practice. It ensures that claims do not become unmanageable.  Keeping up with this practice daily fosters more detail-oriented processing and submission.

- **Prompt Follow-Up on rejected and underpaid claims** is essential to a healthy practice. By following up immediately to determine the reason for the rejection and how to correct it, timely filing deadlines will never be an issue.

- **Semi-Annual Code Review** allows you to verify that your coding practices are up- to-date and in line with current guidelines. It also ensures that your practice stays ahead of the curve and is not surprised by a sudden glut of rejections from outdated coding.

- **Monthly Reporting** may be the single most important practice to put in place. It allows you to obtain high-level transparency into your practice's finances, and charting simple trends over the course of the year can lead you to other billing problems you may not have noticed before.

These five areas can significantly improve your bottom line and make sure no claims slip through the cracks. Implementation will take time and dedication, but they will surely improve your practice's financial health. Please [contact us](mailto:info@feroniabillingservices.com) to explore our solutions.


India has moved from being just a cheap outsourcing

Outsourcing Healthcare Advantages


India has moved from being just a cheap outsourcing destination to one that provides high quality service outsourcing partnerships to companies around the world who are not looking just for cost cutting through outsourcing. Healthcare BPO outsourcing to India is one such sector, which has gained a lot of seekers in the recent past and even now. Though primary driver of outsourcing is significant cost reduction, it is important to note that there is a lot more what healthcare outsourcing brings to the table.

Let's take a closer look at the key benefits of healthcare outsourcing:

- **Increased Profitability:** Aforesaid, one of the most lucrative advantages of healthcare outsourcing is that it helps companies save approximately 30% and 60% of the costs that would be otherwise spent on local resources. Access to low cost manpower and infrastructure through outsourcing, is one of the main reasons that bring in huge savings and help healthcare institutions/hospitals/clinics increase their profit margins.

- **Access to Skilled Workforce:** Biggest advantage of outsourcing apart from cost is the availability of large skilled workforce, which is ready to take on projects of any size and complexity. This has worked most to India's advantage as compared to other outsourcing destinations, as we have a surplus pool of professionally trained workforce. Skilled medical personnel in India ensure that client's requirements are best taken care without any administrative hassles.

- **Focus on Patient Care:** Outsourcing allows medical practitioners to eliminate the tedious yet necessary job of managing administrative tasks. It brings medical practitioner's focus back on providing quality patient care, because their outsourcing partner assists with all non-core administrative functions.

- **Reduction in Staff Acquisition and Training Costs:** Cost of acquiring excess staff and training them goes down to a great extent because outsourcing partner handles a team of professionals on your behalf. Moreover, you don't need to worry about employee acquisition, training and retention as all these are handled by the outsourcing services provider.

- **Improved Patient Experience:** Healthcare outsourcing lets you concentrate on patient care while leaving non-core tasks to the outsourcing vendor. This ensures positive experience for your patients and results in goodwill for your organization.

- **Reduce Administrative Overheads:** Administrative overheads are inevitable and suck up a lot of money, if not handled with care. Direct benefit of outsourcing is financial surge, as it drastically reduces excess administrative costs. The saved money can then be reinvested into core functions such as proper patient care.

- **Expand Practice Offerings:** Outsourcing drives one to be competitive and gives an international outlook to your business operations. Many companies that have taken the outsourcing route have used this as a tool to expand healthcare BPO offerings to multiple locations locally and internationally.

Our hub, Chennai, India; has the highest concentration of highly trained medical billing professionals per capita anywhere in the world. Please [contact us](mailto:info@feroniabillingservices.com) to explore our solutions.

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