Case study

Enterprise Revenue Cycle Automation

How do we comprehensively automate the entire revenue cycle function for a behavioral healthcare provider?

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The Case

Problem

How do we comprehensively automate the entire revenue cycle function for a behavioral healthcare provider?


When looking at the RC department holistically, there are sub-groups within the organization that perform the following:

  • Primary and Secondary claims
  • Apply Patient Responsibility
  • Process and Send Invoices
  • Reconcile Zero Payments.

The processes don't run in parallel and have different sets of documentation and credentials, so an organized plan and delivery model was needed to successfully design and deploy a successful automation suite.

Solution

Thoughtful Automation designed 5 robotic workers to automate the entire process using an agile delivery model focused on time to value.

The robotic workers handle over 3000 clicks, 3 web-based applications, and organize 12+ spreadsheets into a thoughtful system. These robots are able to run 24/7/365 which ensures the organization doesn’t keep a backlog of claims and invoices.

Additionally, the back-end documentation is owned by the customer and is updated by them whenever changes come up. The robotic workers are designed to dynamically account for these changes.

Impact

The behavioral healthcare company has seen outsized impact across all 5 of the robotic workers but most notably:

  • Increased speed
  • Reduction in human errors
  • Continuous delivery.

These robotic workers take a lot of the burden off of the human workers and have cut runtimes by 70% in each process. Additionally, Thoughtful Automation found ways to streamline some of the customer's processes which remove documentation and unnecessary reviews for their employees.

3000
Clicks handled
Across 3 web-based applications.
100%
Runtime
The robots ensure the organization doesn’t keep a backlog of claims and invoices
70%
Time Savings
From 100% human time spend on processes to 30%

Systems Automated

Central Reach
Waystar
Microsoft Office 365

Overview of Each Robotic Worker

Claims

Primary & Secondary

Primary and Secondary claims are types of insurances used for patients to cover their medical costs.

Overview

Primary and Secondary claims are types of insurances used for patients to cover their medical costs. The primary acts as if it is the only insurance the patient is covered under, and if the patient has a secondary insurance (i.e. child is covered by both parents, Medicaid, etc.) the secondary will kick in if there are additional costs not covered by primary.

Outcomes

Reduced Human Error

The bot automatically maps to agreed rates and credentialed providers documents in shared drives and determines if the providers and rates match with what is in Central Reach.

Speed

Increased Speed

The bot reads the EOB in Waystar and populates all of the required information into Waystar from Central Reach and the EOB without having to go back and forth like a human would.

Continuous Delivery

All claims are processed during a specified date range run without human interaction and can run 24 hours a day with the defined parameters set by the customer

Applying Patient Responsibility

Applying patient responsibility comes up after the primary and secondary insurances have been paid.

Overview

Applying patient responsibility comes up after the primary and secondary insurances have been paid. The role of our automation is to check the parameters outlined in Central Reach and the EOB in Waystar, and mark the respective claims with their patient responsibility.

Outcomes

Speed

Increased Speed and Accuracy

The speed and accuracy of the bot is exponentially quicker than a human reviewing all of the claims manually. Additionally, with well-defined logic built into the bot, there are no errors over the hundreds of claims that get checked each week.

Continuous Delivery

The process is organized in a way that gives the customer the flexibility to set specific fields and parameters to run each time 24 hours a day.

Statements and Invoicing

At the end of each month, statements have to be sent to all patients with outstanding balances.

Overview

At the end of each month, statements have to be sent to all patients with outstanding balances. These statements must be reconciled and sent out to the appropriate addresses for each patient. In some instances, there has to be new invoices created for claims that still have insurances listed on them.

Outcomes

Speed

Increased Speed

The bot removes the need for a human worker completely and cuts down the time to run by 70%

Optimized Process

Before the bot was implemented, the invoices were split out by location and processed and tracked in a spreadsheet. The bot now processes each of the ~700 unique clients individually and removes the steps to track clients in another spreadsheet.

Reduced Human Error

When a human consolidates the numerous contact and billing spreadsheets, they manually have to remove columns and run formulas. A bot automatically consolidates the spreadsheets and runs the formulas which speeds up the run time and removes the potential for error.

Payments and Zero Pays

Each month, the client reconciles all of the claims that have outstanding payments or one’s that should be allocated as zero payments.

Overview

Each month, the client reconciles all of the claims that have outstanding payments or one’s that should be allocated as zero payments. There is a repository on Google Drive with all payments in the prior month that need to be updated in Central Reach and matched with the EOB in Waystar. After all payments have been processed, the zero payments are reconciled and updated in Central Reach.

Outcomes

Speed

Increased Speed

The bot can run this process right when the payments are uploaded to the spreadsheet which increases the efficiency and speed of the reconciliation process.

Reallocation of Workers

The claims that the bot processes do not require a human worker to review so it allows for workers to focus on other areas of the business that aren’t automated - removing the possibility of human error in this process.

"We've been thrilled with the product Thoughtful Automation has delivered! Prior to TA, we were always playing "catch up" to process our backlog of items in our revenue cycle. Now we are able to process claims as they come in without having to re-work any errors. TA is a great company to work with and an even better product!"
- Director of Finance, Leading Behavioral Health Company

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