The First Leg on The Journey

To RCM Innovation

Healthcare is undergoing significant change. The shift from fee-for-service (FFS) to value-based healthcare payment models demands out-of-the-box thinking to meet new challenges. Leading organizations are beginning to leverage technology by shifting resources from back office support to patient-facing positions. Vee Healthtek uses innovative solutions to help organizations through the transition.

Revenue Cycle Management (RCM)

Revenue Cycle Management (RCM) is complex and highly reliant on the accuracy of the information collected and documented throughout the entire process. Many organizations take a siloed approach to RCM, making it difficult to implement changes through process improvement initiatives. This approach can have an extremely negative impact on an organization’s financial health, with missed revenue opportunities and costly rework, resulting in challenges providing the best care for the population the organization serves. Applying technology alone will not solve problems and replicating bad processes with technology fails to achieve better outcomes. Vee Healthtek’ clients are receiving “best in industry” practices coupled with technology and innovation to achieve extraordinary outcomes.

When a large physician’s practice in the Midwestern United States used Vee Healthtek to improve their insurance verification and eligibility processes, the results were overwhelmingly positive. By applying Robotic Process Automation (RPA), the practice experienced an improved bottom line and an increase in patient satisfaction.

The physician's practice was unable to cost-effectively verify the insurance of its patients. Over 30% of denials were caused by patient eligibility issues, which led to high levels of patient dissatisfaction. The practice could not afford to continue going down this path and turned to Vee Healthtek for solutions.

Vee Healthtek analyzed the billing department’s workflows and scenarios for insurance eligibility verification and pre-authorizations. Recommendations were made for each scenario that could be supported by RPA and Bots were developed to verify insurance eligibility and obtain pre-authorizations when required.

As part of the workflow analysis, the RPA team created detailed, step-by-step workflow diagrams identifying the information required and the action steps taken throughout the workflow. Scenarios for different action steps and payors were created as the foundation for building each Bot. Each scenario involved logging on to the Practice Management System (PMS) and payor portals, evaluating the work queue, retrieving information from each scheduled patient visit, decisioning based on the retrieved data and taking appropriate actions. Appropriate actions included documenting in the PMS the eligibility status, co-payment information and the requirement for pre-authorization.

RCM Workflow Analysis

The RPA project led to a more streamlined workflow with increased accuracy, reduced eligibility denials, lowered costs and improved patient satisfaction. By leveraging Vee Healthtek’ expertise with RPA, the practice freed time for their billers to focus elsewhere while achieving 100% accuracy on insurance eligibility verification. Eligibility denials were reduced by 70%, lowering the cost to investigate and resubmit claims. Rolling out RPA generated 25% in cost savings during the first year and the practice also saw a reduction in patient complaints.

Technology and innovation applied in conjunction with business process experts can make dramatic impacts on the bottom line of healthcare organizations. Technology, when used properly, is powerful. It can maximize accuracy, increase productivity, reduce costs, optimize revenue, allows staff to redirect efforts, and it can help to improve the patient experience.

Mark Kausel

Meet the Author

Mark Kausel - Director of Client Services

Mark Kausel applies over 30 years of experience from healthcare operations, information technology, and sales and account management roles to deliver strategic solutions to client challenges resulting in positive outcomes with long-term relationships.