Top 18 RPA Use Cases in Healthcare

Use Cases of RPA in Healthcare

1. Patient Scheduling

   Despite the prevalence of electronic medical record systems (EMRs), a significant number of doctors still manually schedule patient appointments using these systems. However, EMRs often struggle to display real-time appointment availability due to data synchronization challenges. Consequently, doctors find themselves manually entering appointment data into multiple systems, consuming valuable time that could be better spent on patient diagnosis and treatment.

   Robotic Process Automation (RPA) in healthcare offers a solution by automating the patient appointment scheduling process. These bots can be trained to follow a predefined workflow based on factors such as doctor availability, location, and diagnosis. Once a patient books an appointment, the RPA bot updates the schedule in the database and removes the corresponding time slot. Additionally, the bot can effortlessly communicate appointment details to patients through email and multiple channels for convenient access.

2. Patient Registration & Eligibility Check

   Patient registration is a repetitive healthcare process that often requires significant manual effort and results in lengthy turnaround times. It involves several tasks, including-

   • Gathering necessary information from patients as per the healthcare organization’s requirement
   • Conducting background verifications on the provided information
   • Integrating and updating all the records in the system.

   In the healthcare industry, where time is of utmost importance, there is a need for tools that expedite the registration process. RPA bots can be utilized at various stages, including account setup, history verification, information processing, and billing management, offering efficiency and effectiveness at multiple checkpoints.

3. Electronic Health Record

   Electronic Health Record (EHR) systems store patient health information in electronic format. These records typically include various crucial details, such as the patient’s

   1. Past medical history
   2. Relevant demographic data
   3. Insurance information,
   4. Drug prescriptions,
   5. Allergy information,
   6. Lab reports,
   7. Data from wearable devices
   8. Physiological parameters,
   9. Billing data
   10. Immunization dates.

   Healthcare professionals often receive EHR records from multiple sources in different formats, making the process of reading and extracting patient information time-consuming and repetitive.

   Robotic Process Automation (RPA) bots can assist in streamlining this process by continuously tracking records from various sources, downloading PDFs, and extracting medical details using Optical Character Recognition (OCR) technology. Additionally, these bots can ensure timely updates to patient charts, leading to improved medical examinations and decision-making for healthcare professionals.

4. Insurance Eligibility

   The process of insurance eligibility verification involves multiple steps and requires logging into various systems to cross-reference and validate patient-provided information. When done manually, this process can take anywhere from minutes to hours or even weeks, adversely impacting the organization’s referral rate. Service desk agents also find this procedure time-consuming and repetitive, potentially compromising the patient experience. To overcome these challenges, automation can be a transformative solution.

   
   RPA in healthcare has the potential to eliminate the need for manually sifting through different record systems, ensuring prompt care delivery and timely reimbursement. Intelligent document processing solutions can automate data extraction and verification of relevant insurance plan information, subsequently updating the Electronic Health Record (EHR) portal with accurate details.

5. Claim Management

   With the ever-changing landscape of the healthcare industry, there is an increasing need for effective management of medical costs and customer interactions. Additionally, the claims management process presents its own challenges, including:

   1. Managing large volumes of data input across multiple platforms.
   2. Ensuring error-free storage and processing of data with legacy or traditional systems.
   3. Handling appeals related to claims issues.

   Here RPA can help healthcare providers by autonomously filling insurance fields, applying relevant regulatory fields, preparing claims documents, and storing data in a centralized system.

6. Admission and Discharge Process

   The admission and discharge of patients currently rely on paper-based procedures, for this healthcare provider must navigate through a series of complex steps when admitting or discharging a patient, including verifying insurance eligibility, coordinating with available doctors, managing electronic health records, and ensuring follow-up for test procedures and reports after discharge.

   By automating these tasks with RPA, the end-to-end processes can be optimized and tracked effectively. After patient registration, an RPA bot can validate and upload medical records provided by patients into the Electronic Health Record (EHR) system. It can also share the health records with the attending physician for diagnosis and treatment purposes.

   Additionally, the RPA bot collects reliable data to monitor the progress of patients, identifies any missing tests, and highlights high-priority discharge cases. Even after discharge, the RPA bot can track the progress of patients and send follow-up reminders as necessary, ensuring continuity of care.

7. Audit Management

   Conducting regular quality audits is crucial to ensure optimal quality standards in healthcare. However, the traditional paper-based approach and the management of extensive audit trails pose significant challenges and consume valuable time for healthcare professionals. Leveraging Robotic Process Automation in healthcare regulatory compliance (RPA) can greatly simplify and enhance the audit management process for healthcare staff.

   RPA offers a range of benefits, including real-time dashboard analytics, a user-friendly interface to design predefined audit questions using drag-and-drop functionality, and the ability to capture data through multiple channels. Additionally, RPA facilitates easy categorization, grouping, rule-based calculations, and database updates, streamlining the overall audit management process.

8. Testing Reports and Request Management

   RPA can be programmed to automatically generate testing requests by extracting relevant information from patient records and populating the required forms. This eliminates the need for manual data entry, reducing the chances of errors and saving valuable time for healthcare professionals.

   Moreover, RPA can automate the process of generating test reports. The bots can collect test results from various sources, integrate the data, and generate comprehensive reports in the desired format. This automation not only speeds up the report generation process but also ensures consistency and reduces the risk of data discrepancies.

9. Verifying & Credentialing Physicians

   Verifying and credentialing physicians is a critical process in healthcare to ensure the competence and qualifications of medical professionals.

   With automation in healthcare, organizations can automate the verification and credentialing procedures for physicians. RPA bots can collect and analyze data from various sources, such as medical boards, educational institutions, licensing authorities, and professional organizations. These bots can cross-reference the provided information with databases and validate the credentials of physicians, ensuring compliance with regulatory standards.

   RPA with AI can also automate the verification of licenses, certifications, work history, malpractice claims, and other necessary credentials. By leveraging AI and machine learning algorithms, RPA bots can identify any discrepancies or red flags, enabling organizations to make informed decisions during the credentialing process.

10. Revenue Cycle Management

    This healthcare process is a crucial aspect of healthcare operations that involves various administrative and financial tasks. RPA bots can be programmed to perform activities such as patient registration by extracting and validating data from registration forms, verifying insurance eligibility through integration with insurance databases, and generating and submitting claims to insurance providers electronically.

    Furthermore, RPA can assist in claims processing by automating the validation of claim data, identifying coding errors or discrepancies, and ensuring proper documentation is included. This helps minimize claim rejections and denials, ultimately improving revenue collection.

    RPA can also automate payment posting and reconciliation by extracting payment information from remittance advice, updating patient accounts, and reconciling payments with outstanding balances. Additionally, automated revenue cycle management can also facilitate the generation of reports and analytics related to revenue cycle management, providing insights into key performance indicators, revenue trends, and areas for improvement.

    

11. IT Service desk

    One area where automation can make a significant impact is incident ticket management in healthcare. RPA bots can be deployed to automatically receive, categorize, and prioritize IT support tickets. These bots can perform initial troubleshooting and provide self-help solutions to common issues, thereby reducing the workload on service desk staff and minimizing response times.

    Additionally, AI-powered chatbots can be integrated into the IT service desk to provide instant support and responses to user queries. These chatbots can leverage natural language processing (NLP) capabilities to understand user requests, provide relevant information, and guide users through troubleshooting steps.

12. Electronic visit verification

    EVV is a system that helps ensure accurate billing, monitor patient care, and comply with regulatory requirements. RPA bots can automate various tasks involved in EVV, starting from data collection to verification and documentation. These bots can extract relevant information from scheduling systems or appointment databases and match it with the actual visit data captured through electronic means, such as mobile devices or wearable sensors.

    Using predefined workflows, RPA bots can validate the captured data against specific criteria, such as time, location, and caregiver identification. They can also cross-reference the information with patient records and validate the services provided during the visit.

    Furthermore, RPA bots can generate electronic visit reports or summaries, consolidating the collected data into a standardized format. This ensures accurate documentation.

13. Medicare Payment

    The Medicare Payment process is complex and time-consuming for healthcare providers. Challenges include managing high-volume records, transferring claims payments, and calculating insurance rollout periods. RPA bots can streamline this process by downloading weekly Medicare payment reports.

    They validate primary plan service lines and check payment posting dates. If the primary plan payment is older than 45 days, responsibility is transferred to the secondary payer. If there is no response from the secondary payer after 90 days, the bot checks for changes in responsibility to the patient. If there is still no response after 180 days, the bot writes off the balance and generates an audit report.

14. Patient Referral Update

    Referral updates in healthcare involve providing updated information regarding a patient’s referral to a specialist or another healthcare provider. Typically, patients receive referrals from their primary care physician or a doctor at a hospital. Referrals are based on the perceived necessity for specialized care.

    To ensure timely patient care, healthcare providers evaluate and analyze referral decisions, classifying them as accept or reject.

    Instead of manual intervention, an RPA bot logs into the healthcare application and populates the available referral information. Subsequently, the bot updates the patient application status in the database. After updating the status, the RPA bot initiates an audit of the patient referral application. Once the audit report is generated, the bot sends it via email as an attachment.

15. Remote Patient Monitoring

    This healthcare process involves collecting and monitoring patient data from a distance, enabling healthcare providers to track patients’ health conditions remotely.

    Intelligent bots can be utilized to automate various tasks involved in remote patient monitoring. For instance, these bots can extract patient data from various sources, such as wearable devices, mobile apps, or electronic health records. The bots can then process and analyze the data, identifying any anomalies or critical readings that require immediate attention.

    Moreover, RPA bots can automate the generation of alerts and notifications based on predefined rules or thresholds. When specific parameters deviate from the normal range, the bots can trigger alerts to healthcare providers, enabling them to take timely actions and provide necessary interventions.

16. Account Settlement

    On a typical day, healthcare providers handle a significant number of patients, requiring healthcare agents to generate bills for each individual. These bills encompass various charges, such as test fees, prescription costs, medical bills, and other expenses incurred by different patients. Compiling the necessary information for a large number of patients can be challenging for healthcare agents, as it is prone to errors.

    However, leveraging RPA bots and automation can greatly assist in reconciling and aligning the bills with the services provided. These bots can also identify discrepancies and alert healthcare staff accordingly. As a result, the implementation of RPA reduces errors, minimizes turnaround time, and mitigates payment delays.

17. Asset Management

    As a healthcare provider, it is crucial to ensure that your healthcare staff does not have to struggle to locate essential equipment like infusion pumps and wheelchairs while patients are waiting. Efficient asset management is necessary, from assigning devices to employees, managing registrations, and handling onboarding/offboarding processes.

    RPA can streamline these workflows by recording new devices, allocating and deallocating assets, managing returns, and generating email alerts for upgrades or damaged assets. Implementing RPA in asset management simplifies the process for employees, leading to improved patient satisfaction and better medical outcomes.

18. Staff onboarding- offboarding

    Staff onboarding and offboarding processes in healthcare can be time-consuming and complex as it involves various tasks such as creating user accounts, granting access permissions, provisioning equipment, and managing documentation.

    RPA bots can automate the onboarding process by generating user accounts, setting up email addresses, and creating login credentials for new staff members. They can also automate the provisioning of necessary equipment and software, ensuring that new employees have everything they need to start their roles promptly.

    During offboarding, RPA bots can assist in revoking access permissions, disabling accounts, and retrieving any issued equipment. They can also help in managing the transfer of responsibilities and documenting the necessary information for HR and compliance purposes.

[Also Read : Top 5 Healthcare Systems to Automate Using RPA and AI]

Conclusion

Healthcare automation solutions have been changing the face of healthcare industries in many ways. Right from adding value to patient care to streamlining the healthcare process, automation technologies have taken it all over. Hence in the age of instant resolution and quick service, leveraging automation in healthcare is the smart move that healthcare.