How Automation is Revolutionizing Eligibility Verification in RCM

As healthcare systems grapple with workforce shortages and staff burnout, maintaining a delicate balance between operations and the revenue cycle is becoming a mammoth task for them, especially when their processes are mostly labor-intensive. Adding to their woes are payer denials and eroding margins, often resulting from front-end inefficiencies during patient eligibility verification and prior authorization. The situation is, thus, prompting providers to pivot toward technologies like artificial intelligence (AI) and robotic process automation (RPA) for revenue cycle management (RCM).

Explore this blog to uncover industry insights into RPA adoption; challenges associated with manual eligibility verification; benefits of implementing automation at the front-end process of RCM; and how Jindal Healthcare’s RPA-powered patient eligibility verification solution can help providers improve patient access.

What industry insights tell about RPA adoption

The 2021 survey by Becker’s Healthcare on RPA adoption among healthcare leaders revealed these interesting insights:

1. RPA adoption among 51% of the respondents
2. The technology being applied to RCM areas, especially eligibility (59%) and authorization (57%)
3. Key benefits of RPA remained increased labor efficiency (58%) and improved revenue (45%)
4. Over 89% of health leaders admitted preferring vendors with RCM expertise

The survey highlighted front-end operations – patient eligibility verification and pre-authorization – as the biggest pain point for providers owing to their high dependence on manual processes, which often leave room for errors and, eventually, denials that ultimately impact the financial health of their system.

Additionally, the survey indicated that RPA implementation in these areas is helping providers automate repetitive administrative tasks, thereby reducing inefficiencies and expediting coverage and benefit verification for a seamless patient intake. This also allows them to redeploy their resources to high-value tasks requiring their intervention and expertise.

Why labor-intensive eligibility verification falls short

Staff burnout: Patient eligibility verification, if manually done, can take a huge toll on the existing staff, since the process is time-consuming and can also be overwhelming if the system is already struggling with staff shortages. Moreover, eligibility checks require absolute precision, which can eventually result in reduced productivity, further impacting other processes.

Error-prone: Manual checks are more prone to errors and inaccuracies. Even a single episode of sharing erroneous patient information to the payer may lead to a claim denial or necessitate rework, delaying reimbursements and impacting the financial health of the system.

Inconvenience: The brunt of inaccurate or incomplete documentation must be borne by the provider and the patient. Time-consuming patient eligibility verification may lead to unnecessary delays in treatment, adding to the woes of the patients. Moreover, they may also have to bear out-of-the-pocket expenses if they are not informed of their financial responsibility in time, further impacting their experience. Besides, long wait times can result in underutilized medical staff, adding to the expenses of the health system.

How RPA can be a game-changer in optimizing patient eligibility verification

Patient eligibility verification is a crucial but exhaustive RCM process that requires checking and cross-checking patient information on numerous payer portals for confirming insurance coverage, benefits, coinsurance, and other critical details before delivering care. When labor-intensive, the process can be time-consuming with a high potential for errors. With front-end staff spending countless hours verifying patient information, any delays and errors in it can significantly impact the patient and provider experience.

RPA can prove a game-changer here for providers, as it can speed up the verification process while ensuring efficiency and accuracy, thereby reducing not just treatment and payment delays but also payer denials, staff burnout, and cost to collect.

The technology functions on software bots that execute eligibility verification tasks within a matter of seconds as opposed to humans who might take up to hours to process the same information.

By leveraging these bots to automate repetitive administrative tasks related to eligibility checks, healthcare providers can enhance their operational efficiency while reducing turnaround times and costs. These bots seamlessly integrate within providers’ workflows, electronic health records (EHRs), and electronic medical records (EMRs) to connect with payer databases and retrieve updated patient information in real time, thus reducing the burden on the staff and aiding in quick information checks for smoother patient access.

The perks of automating patient eligibility verification

1. With RPA drastically improving verification efficiency and reducing the information retrieval time, providers get the opportunity to allocate their resources to other critical tasks, offer better care to their patients without long wait times, and reduce their staff burnout and operational costs.
2. Accuracy and compliance achieved by RPA-assisted eligibility checks help providers maintain their financial stability with reduced denials that are caused at the front-end of RCM.
3. Besides providers, patients get to benefit from streamlined automation-powered patient eligibility verification due to quick documentation, reduced waiting time, transparent communication on their financial responsibility, and in-time treatment delivery, thus enhancing their experience with the provider.

Unlock the automation advantage with Jindal Healthcare’s RPA-assisted eligibility verification

Given the rise in staff shortage and burnout and constantly increasingly revenue cycle complexities, opportunities for the adoption of RPA are galore and its potential is waiting to be tapped into. However, providers need to follow a strategic approach toward the technology implementation, factoring in crucial points while settling for a technology vendor or outsourcing patient eligibility verification.

Among key factors to be considered are seamless technology integration (into existing workflows), operational scalability, and staff-friendly interface. Care must be taken while developing and using these bots, particularly with respect to making website interface changes, ensuring data security through encryption, and avoiding input errors during dictionary setup. Besides, it’s important for the provider to have real-time database access and dedicated assistance from their RCM partner.

At Jindal Healthcare, we empower providers to streamline their RCM and improve their cash flow with our revenue cycle optimization solution suite. Our patient eligibility verification services are powered by AI and RPA and backed by the subject-matter expertise of our RCM experts to ensure smooth patient access and financial experience.

Our RPA-assisted eligibility verification solution automates up to 70% of the verification process with expert intervention in areas where the technology falls short, to ensure quick and accurate coverage verification for smooth patient intake, timely care delivery, and improved patient and provider financial experience. We leverage programmed bots with unparalleled automation capabilities along with the support of our RCM specialists to capture dynamic payer behavior and trends and retrieve updated information from their databases while ensuring compliance and maximizing productivity.

Our solution seamlessly integrates into client SOPs and workflows to create accurate documentation that expedites the patient intake and reduces the risk of denials at a later stage, thus helping providers improve their costs and accounts receivable (AR) while offering better care and financial experience to their patients.