How four health systems are using revenue cycle management robotics

Health system executives say that they were already using automation before the pandemic, and the pandemic led them to speed up the adoption process. Here are four examples of how health systems are applying robotic process automation (RPA).

Allina Health: A matter of survival

Allina Health in Minneapolis began a revenue cycle overhaul in 2019, focusing on centralizing functions, increasing efficiency and creating an automation road map. It has already automated many business office functions as well as coding, charge reconciliation, clinical documentation and level-of-care determination.

“If we hadn’t done this, we might not have survived the first wave of COVID,” said Motti Edelstein, vice president of revenue cycle at Allina. “In the beginning of the pandemic, a lot of people retired or moved into non-healthcare roles. We had a mass exodus, and it has become harder to recruit. I had to figure out how to reallocate work.” For example, automating underpaid claims review meant Edelstein could reassign 13 of the 15 employees who previously performed this task to denial management instead. Automating eligibility checks and prior authorizations meant he could move many of the more than 100 people who previously performed these tasks to patient access and registration.

“We still need clerical staff, but we don’t need to hire more people to do manual tasks,” Edelstein said.

Main Line Health: Using staff more effectively

Main Line Health in Philadelphia has used automation to move staff into more valuable roles, a decision that has paid dividends in recent years.

Main Line Health, which finalized its contract with an RPA vendor in 2019, didn’t see massive staffing shortages during the pandemic like much of the industry did. Johanna Weller, MBA, vice president of revenue cycle at Main Line, said automation could be one reason why.

“With automation, there’s a ripple effect in terms of employee engagement and motivation because it removes the boring, mundane tasks,” she said.

“As we’ve embraced automation, many people have moved from the back end to the front end of the revenue cycle,” Weller said. “Our philosophy is to get it right the first time, so we don’t need to chase claims.”

Henry Ford Health: A key component

At Henry Ford Health, headquartered in Detroit, revenue cycle automation is a key component of the health system’s long-term economic plan.

“We can’t afford to pay people to touch such a high volume of individual transactions,” said Steve Hathaway, chief revenue officer at Henry Ford. “We’re in a harsh economic climate and have been for many years. We need to be as efficient as possible.”

Changing demographics of the staffing pool offers another reason to embrace automation.

“We have an aging workforce in the coding world, and there aren’t enough coders with specialized knowledge to replace retirees,” Hathaway said. “We’re looking at automation — specifically autonomous coding — to offset this.”

With autonomous coding, a computer reads the medical record and assigns billing codes often without human intervention. Henry Ford is currently testing the technology with its coding for emergency department and physician bedside consultation services.

As part of the plan to move toward autonomous coding, Henry Ford has partnered with an offshore coding company to help it manage workload as coders retire.

“We are committed to minimizing impact on our employees” during these transitions, said Hathaway.

Sanford Health: Easing a big void, advice for rural hospitals

Coder shortages — particularly on the inpatient side — have been a challenge at Sanford Health in Sioux Falls, South Dakota, said Tony Morrison, vice president of revenue cycle. The health system budgets for 24 full-time inpatient coding positions, and at the end of 2021, all positions were full. In the beginning of 2022, 10 of those coders left.

“Losing 10 inpatient coders in an organization as large as ours is a huge impact,” said Morrison. “We have filled seven of the 10 positions, but it takes a full year to train them. We still have a big void.”

Sanford Health continues to outsource its coding, when needed, but Morrison said the cost is not sustainable. It’s also leveraging DRG validation software to help mitigate revenue loss.

Patient access has also seen a lot of turnover, and Morrison hopes automation will help. Sanford will soon begin using interactive voice response (IVR) in its call center. IVR technology allows patients to make payments and get basic information 24/7. IVR can also automatically queue up patient accounts so reps don’t spend time looking for records when patients call.

Many stand-alone rural and critical access hospitals might not be able to afford this type of technology and other forms of automation, Morrison said. However, he said that, like anything, it’s all about the cost-benefit analysis.

“Small hospitals really have to take a look at what’s available out there and then weigh it up against what it takes to keep your A/R [accounts receivable] current,” he said. “Sometimes the cost-benefit analysis is such that it’s probably way less expensive to have some of the automation.”