ROBOTIC PROCESSING AUTOMATION | RPA
AI-RCM RISK CONTROL
Eligibility Verification
RPA uses AI to deploy software "bots" to mimic human behavior across digital systems to perform eligibility verification and routine data entry tasks.​​
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Understanding the entire RPA process empowers "Humans-in-the-Loop (HITL) to collaborate with AI and develop the skills to outperform it. Lead instead of being led!
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Charge Integrity
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RPA uses software bots to audit, validate, and reconcile billing data against clinical or contractual rules in real-time. This automation is supposed to ensure charge integrity and accuracy.
AI Needs Assessment
RPA has the capability to assist humans-in-the-Loop (HITLs) with performing AI Needs Assessments for RCM.
We can automate the collection of workflow data, identify repetitive, high-volume bottlenecks, map current processes, ​to a cognitive AI model to replace manual inputs with rule-based tasks. ​​​
Prior Authorization (PA)
RPA applies software bots to automate the prior authorization process. These AI Bots mimic human actions; they log into payer portals, extract patient data from electronic health records (EHRs), submit clinical documentation, and verify approval status.
AI in Medical Coding
RPA in medical coding uses software bots to automate repetitive, and rule-based tasks. It mimics human actions across EHRs and billing systems. These bots extract patient data from the EHR to assign, validate, and update ICD-10/CPT codes for medical claim submissions. ​
AI Project Oversight
Collaborating with RPA provides AI Project Oversight. The structured execution layer can be used to monitor, validate, and manage the lifecycle of AI models and their data inputs.
Because AI (the "brain") mimics, and RPA (the "hands") mimics, both can help us to set up audit trails that act as a safety net, ensuring AI is operating within the pre-defined rules, continuing to adhere to compliance standards, and maintaining data integrity.
Clinical Documentation Integrity (CDI)
​RPA provides comprehensive documentation support. It uses software robots to automate repetitive, rule-based tasks across various business applications (i.e., data entry, file organization, and report generation) ​
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Vendor Selection
RPA combined with AI is also being used to optimize and support Revenue Cycle Management (RCM) vendor selection. It analyzes vendor performance data and identifies automation gaps by capturing quality and compliance metrics. ​​
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BAAs and SLAs
Did you know that most BAAs and SLAs are considered legally "compliant" but operationally useless.
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If AI touches PHI, documentation, coding, billing, utilization and audits, both contracts need measurable AI quality + compliance controls.
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RPA can help us to automate BAA & SLA document reviews, track performance metrics, and manage quality and compliance workflows.
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