RPA Use Case in Payment posting and reconciliation

1. RPA USE CASE IN PAYMENT POSTING AND RECONCILIATION www.billingparadise.com

2. INTRODUCTION Receiving payment from insurance companies is 90% of revenue generation for all hospitals and health systems. Only 10% percentages come from patient out-of-pocket expenses. Healthcare organizations still face problems maintaining payment records of all payments received from insurance companies or they miss to post the paper checks and other paper documents issued by the payers. Given the fact that most payments are received through electronic modes, they still struggle to maintain full accountability of claims paid and denied. Well, that’s where robotic process automation (RPA) comes into play, with RPA-enabled payment posting you can have each and every dollar accounted for future references and present those records to your superiors or external audits from IRS. After careful research by our RPA and RCM experts, we have identified the use cases for payment posting and reconciliation RPA. www.billingparadise.com

3. RPA USE CASE FOR PAYMENT POSTING AND RECONCILIATION Hospitals and health systems believe that once payment is received that’s the end of the RCM process, well that’s false. The complete process ends when the last patient liabilities are collected and the account, the claim, or encounter has been zeroed out and closed. Even after that, consolidating the received payment in a month is a hectic process as every cent and dollar needs to be accounted for in order to tally the books. Here are a few RPA use cases for payment posting and reconciliation. CONVERTING PAPER DOCUMENTS TO ELECTRONIC FORMAT Almost all insurance companies use electronic payment methods through EFT and provide the payment data through ERA by using clearinghouse integration. A PMS or EHR can download the ERA into its system and provide payment information. Not all payers use electronic payment methods, around 40% of insurance companies still use paper documents to send payment information such as EOBs, paper checks, virtual credit card documents, correspondence, and letters. These paper documents are usually neglected by the mail room, or even if the mail room staff send these documents to the respective departments of RCM they still take time to post them or miss the documents completely. www.billingparadise.com

4. Using robotic process automation (RPA)for payment posting and reconciliation is a benefit as it converts scanned payer documents to electronic 835 formats using its optical character recognition (OCR) engine. After the conversion to 835 formats, the RPA bots carefully check the respective patient encounter or claim in the EHR or PMS system and upload the document. The next step RPA bot does is to post those payments using the auto-post feature in the EHRs and PMS systems ensuring complete accountability for all payments, requests for additional information, or denials. AUTOMATED PAYMENT RECONCILIATION Paper payment documents like checks or virtual credit cards are hard to keep track of. Most of these paper payment documents should be sent for encashment or the virtual credit card must be directed to your bank account that has been linked to the hospital or health system. If there is a delay in using these paper documents for receiving payment the check or virtual credit cards can expire and the response from the bank sometimes gets delayed as well. Utilizing robotic process automation (RPA) not only for paper documents but for all EFT payments would result in smooth payment tracking from the banks, if the check or virtual credit card payment status is pending or missing, the RPA bot will access the respective payer portal or through manual methods like emailing or faxing will ve carried out by the bots asking the bank and the insurance company status on the issued payment. RPA bots will ensure that no payment is unaccounted for. It creates logs and KPI metrics on the net and gross collection ratios, denial ratios, AR days, etc. Simplifying the entire payment reconciliation process. www.billingparadise.com

5. SOLVING MAJOR PAYMENT ISSUES Payment issues are common in health care and as a matter of fact, it happens 60% of the time when dealing with issues underpayment, duplicate payments, etc. Insurance companies issue refund requests in the next payment batches that most of the payment posting teams miss out on, the penalties given by the insurance companies for not refunding might be a major threat to a healthcare organization’s financial performance. like an overpayment, Robotic process automation (RPA) enabled payment posting and reconciliation will provide deeper insights and detailed reports on the exact claim or encounter the insurance companies overpaid. Also for underpayment, the RPA bots can access your fee schedule and analyze each payment whether they are paid according to contracted rates. These features help healthcare leaders like CFOs and healthcare providers to estimate the number of refunds and payments to their actual collection ratios and plan their budgets accordingly. www.billingparadise.com

6. MULTI-APPLICATION NAVIGATION In the manual payment posting process, a payment posting staff needs to check various applications like EHRs, PMS, clearinghouse, payer portals, etc. Navigating through these various applications takes up a lot of time and effort and reduces productivity. Leaving this job to an RPA bot will reduce time significantly as the bot’s multitasking technology for accessing various applications at once gives your healthcare organization a better rate of productivity and quality of the work done. Robotic process automation (RPA) bots not only access these applications but also read and write data in the preferred fields where you want the payment and claim data to be entered, this completely encloses the payment posting and reconciliation process leaving you a crystal clear payment data management. www.billingparadise.com

7. REDUCING COST AND TIME Using payment posting staff for healthcare organizations that receive thousands of dollars as payment every day can take a lot of time processing those payments. Manual entries of the paper documents take more resources and time. An average payment posting staff can post a claim payment with 3-5 line times in the claim can take anywhere from 10 – 20 mins depending on whether all the line items are being paid or few being denied. They have to capture all the payment and denial information leaving your practice hiring more payment posting staff costing you $60k-$100k per month. Implementing robotic process automation (RPA) for the payment posting process would reduce costs and time significantly. Investing in RPA will only cost your healthcare organization once and considering the multitasking, reading, and writing data along with consolidated logs and reports at the end of the day the ROI of one bot compared to many payment posting staff is higher than average. In the end, robotic process automation (RPA) for payment posting and reconciliation process use cases can benefit thousands of hospitals, health systems, and clinical groups in terms of productivity, quality, cost, and time efficiency and many of our clients have benefited from it. www.billingparadise.com

8. BillingParadise and our team of RPA and RCM experts strive to create better RPA systems for healthcare organizations to simplify their day-to-day operations and allow them to focus on their core business function which is quality of patient care. Leaving most of the RCM operations on RPA bots combined with staff to monitor it is the best way to step into the future of modern healthcare. What other questions have arisen after reading our use cases? Our certified RPA experts are waiting for you to schedule a free consultation and explore more! www.billingparadise.com

9. CONTACT US EMAIL ADDRESS inquiries@billingparadise.com PHONE NUMBER +1 888-571-9069 LOCATION BillingParadise 24x7 INC 53 Emerald Road, Robbinsville, NJ 08691. United States.

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