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7 Steps to Automate Medical Billing Operations

Robotic Process Automation (RPA) is transforming the way we do business in the medical billing industry. By automating mundane and repetitive tasks, RPA can significantly reduce costs and improve efficiency. In this blog post, we’ll discuss how to use RPA to automate 7 steps of the medical billing process:

How RPA Can Increase Profits in Medical Billing

Step 1: Patient Registration

The first step in the medical billing process is patient registration. RPA allows our clients to automate the collection of patient demographic information such as name, address, phone number, date of birth and insurance information. This data can be collected from various sources such as online forms, emails, or text messages and stored in a secure database. Bots are designed to easily enter this data into the appropriate applications and take additional actions.

Step 2: Treatment Authorization

Once the patient’s information is collected, our automations can be used to verify the patient’s insurance coverage and determine if pre-authorization is needed for certain treatments. Automation is also used to automate the pre-authorization process by collecting and analyzing data from the insurance company to determine medical necessity and coverage.

Step 3: Coding Compliance

RPA can be used to assign the appropriate codes to the patient’s medical services. This includes assigning ICD-10 codes to diagnoses, CPT codes to describe procedures, and HCPCS codes for supplies and medications. RPA can be used to match the correct codes to the patient’s services and automatically enter them into the system.

Step 4: Claim Submission

Once the codes are assigned, bots can be used to submit the claim to the patient’s insurance company. This can be done by automatically gathering all the necessary information about the patient, the services rendered, and the codes used and submitting them to the insurer.

Step 5: Insurance Denial Management

If the insurance company denies the claim, our clients can use our bots to review the denial and take the appropriate action. This may include logical automation designed for appealing the claim, filing an additional claim, or submitting a different code set. Smart bots can quickly analyze the denial and take the necessary steps to resolve the issue.

Step 6: Payment Posting

Once the claim is approved by the insurance company, RPA can be used to post the payment to the patient's account. This includes calculating any deductibles, copays, or coinsurance that the patient is responsible for and updating the patient’s account accordingly.

Step 7: Patient Billing

Once the payment is posted, RPA can be used to generate a patient statement and send it to the patient. This statement can include information about the services rendered, the amount due, and the payment options available. RPA can also be used to automate the billing process by sending out reminder emails or text messages to patients to remind them of their payment due dates.

Also, Medical Credentialing

Credentialing is a process used by medical billing companies and health care organizations to verify the qualifications of healthcare providers such as physicians, nurses, and other practitioners. The credentialing process is an important step in ensuring the quality of care and protecting patient safety. It includes the following steps where RPA can also be applied to automate specific aspects of the credentialing process:

1. Verification of Credentials: Credentialing involves verifying the qualifications of a healthcare provider. This includes verifying the provider’s education and training, board certifications, malpractice insurance, and any other relevant qualifications.

2. Background Checks: Credentialing also includes conducting background checks on healthcare providers. This includes checking the provider’s criminal and financial history, as well as their professional history.

3. Site Visits: Credentialing may also involve site visits to the provider’s office or clinic to verify that they meet all the necessary standards. This includes ensuring that the office meets all safety and security regulations, as well as any other requirements.

4. Pre-Credentialing: Before a provider is credentialed, they must submit a pre-credentialing application. This application includes the provider’s qualifications and other relevant information.

5. Credentialing Reviews: Credentialing also involves periodic reviews of the provider’s qualifications. This is done to ensure that the provider continues to meet all the necessary standards and requirements.

Credentialing is an important part of the medical billing process. It ensures that healthcare providers are qualified and have met all the necessary standards. It also helps to protect patient safety and ensure the quality of care.

By leveraging RPA, medical billing companies can significantly reduce costs and improve efficiency. By automating the mundane and repetitive tasks of the medical billing process, RPA can help companies save time and money while providing their patients with a better overall experience.

To learn more about our work with medical billing companies, please check out other resources.

About Forward Vision Technology

The FVTech leadership group has deep roots within the RPA and process automation space. With over 20 years of combined RPA SaaS development experience, and over 100+ RPA development and deployment projects under our belts, we can ensure our clients experience an optimized delivery service and achieve maximum ROI on automation projects. Because automation is in our DNA, we provide expert process guidance when designing digital workers for our clients. We've deployed digital workers within healthcare, real estate, insurance, banking / financial services, and dozens of other industries so we know what works, and what really works. Our motto is, "let's get it done", and we exist to help align your processes with forward vision.


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