West Tennessee Healthcare enlisted CampTek Software to help develop new UiPath RPA. The results have been impressive, saving time dealing with claims, reconciling billing, and improving accuracy.
West Tennessee Healthcare is a not-for-profit healthcare system with 19 locations serving the Tennessee residents between Memphis and Nashville. The healthcare provider offers a diverse range of services for every health need, and, like all medical businesses, must cope with an inordinate amount of patient and insurance paperwork. The administrative team is continually seeking out new ways to increase operating efficiency and reduce overhead, including using robotic process automation (RPA) to augment Cerner Revenue Cycle software for healthcare providers.
Cerner software supports the clinical, financial, and operational functions of healthcare providers and seemed to be the perfect candidate to benefit from RPA, especially for managing insurance claims and patient billing. Following the installation of Cerner Revenue Cycle in May 2018, the administrative team started experimenting with administration automation using RPA.
Early RPA Initiatives Offer Mixed Success
With the Cerner software in place, West Tennessee Healthcare decided it was time to experiment with RPA using eligibility and claims management as a starting point. The healthcare provider did not have the in-house capability to build their own RPA, so they started working with contract automation experts to address specific business challenges.
One of the first projects was to address back-scheduling in conjunction with their Cerner system. After acquiring software licensing and programming services from their legacy RPA vendor, they were able to build a bot to move 12,418 scheduled appointments from the legacy scheduling system to Cerner. Since there were few errors and exceptions, the migration was fast and effective, saving staff hundreds of hours of data entry time. By comparison, the previous year, West Tennessee Healthcare had to manually migrate appointments for ambulatory care appointments - substantially fewer than 15,000, and the process took a dozen Patient Team members three weeks, including working nights and weekends. The back-scheduling RPA application was a tremendous success.
"We used our legacy RPA service provider and bought licenses for the software and then purchased programming knowledge with the intent to build up our internal resources," said Wade Wright, Executive Director of Patient Financial Services for West Tennessee Healthcare. "We realized that there was a future in RPA."
The next test for RPA came shortly after the Cerner implementation. In June 2018, West Tennessee Healthcare acquired three more hospitals, including a facility in Jackson where they already had their flagship hospital. It was necessary to consolidate billing and accounts receivable management, another logical candidate for RPA. The idea was to pull charges from the acquired hospital's legacy system for claim processing and resolution, and consolidate in Cerner. Due to data inconsistencies and other issues, the RPA process failed, and it proved easier to replace the legacy system with Cerner. But the exercise did provide some important insights into RPA.
"It made us rethink how we were approaching RPA," said Wright. "In the midst of all the acquisitions and changes, it was apparent that our internal information technology resources were already stretched. I knew we had specific things in Cerner Revenue Cycle where RPA was a fit, but I didn't have the IT resources to build out the functionality."
Wade Wright, Executive Director of Patient Financial Services
We realized that there was a future in RPA.
West Tennessee Healthcare
Tapping UiPath to Extend Cerner Value
For the next phase of its RPA journey, Wright and his team engaged CampTek Software, a consulting firm that specialized in UiPath RPA. Working with Peter Camp, West Tennessee Healthcare commissioned a proof of concept with three Cerner RPA processes:
1. Posting adjustments at the encounter level, primarily for self-pay balances and adjustments.
2. Applying Action Codes at the encounter level, including the encounter code, Action Code, and text comments, as well as importing other data as needed.
3. Identifying work items at the encounter level, such as mapping insurance eligibility to remove an account from collections opening claims.
"Those three bots are in production every day and we have subsequently added two more servers that are either implemented or in process," said Wright. "We're constantly looking for things that benefit from RPA, asking the questions, 'Can the bots do it?' A lot of times the answer is 'Probably,' and we love having a partner that helps you leverage the technology, realize speed-to-value, and implement ideas into action very quickly."
Working with CampTek to develop new RPAs has revealed several important lessons:
1. If a process is complicated for humans, then it is too complex for RPA
2. If there isn't a consistent process upstream that produces consistent results, then you cannot expect consistent output from a robot.
3. RPA cannot fix deficiencies in people and processes, but it can support good processes.
4. You can't build effective RPA processes based on exceptions. Start with the 80% of RPA scenarios with the greatest chance of success first, then address the 20% with exceptions.
5. Everyone involved in the process to be automated needs to be on board and aligned.
6. Leadership must highlight and reiterate project successes so you overwhelm any negatives with the positive.
With help from CampTek, West Tennessee Healthcare continues to develop new RPAs to augment Cerner. The latest bots include automating the manual process of adjusting non-covered charges for Medicare, and adjusting debits and credits to claims to zero-out those with small balances and remove uncollectible claims from the ledgers.
"It's definitely a process where you have to show those successful business case scenarios and then build on top of that," Wright said. "Not every project that we've tried has been successful, but almost every project has had some level of success and RPA continues to prove its value."
We love having a partner that helps you leverage the technology, realize speed-to-value, and implement ideas into action very quickly.
Executive Director of Patient Financial Services, West Tennessee Healthcare