COVID-19 has prompted health care executives to analyze their spending more carefully to ensure a healthy profitability. 78% of executives plan to transform current manual processes to more digital and automated processes, allowing for the strategic use of human capital elsewhere. The automation of current manual workflows within the revenue cycle decreases processing time and overall cost while improving quality.

What Are Workflows?

According to Carol Cain, Ph.D. and Saira Haque M.H.S.A, workflow is defined as “the set of tasks—grouped chronologically into processes—and the set of people or resources needed for those tasks, that are necessary to accomplish a given goal.” Due to the complexity of revenue cycle tasks, automating these processes have been very challenging. As a result, manual workflows have been used for years, although they are expensive and error prone.

There can be an abundance of workflows for each step of the revenue cycle such as eligibility verification, medical coding, coding audit, lockbox processing, A/R follow-up, payment posting and denial management, with specialists designated to complete specific steps of the process.

Manual workflows can take an inordinate amount of time and cause a ripple effect when an error is made because each step of the process is dependent on the completion and the correctness of the preceding task.

For example, to process Explanation of Benefits/Payments (EOB/EOPs) to create an EDI-835 data stream requires specialists to manually sort and key in data. This is an expensive proposition, but the industry so far did not have an effective way of automating this process, as EOBs come in various formats from payors because of a lack of standard.

How Automation Helps

Data-Core Healthcare Practice is developing several tools for automating workflows.

For example, the manual task of turning EOB/EOPs into EDI-835 files mentioned above can be automated using neural networks to specifically identify which EOB/EOP goes into which que in the workflow and which region of those documents need to be extracted, followed by the use of optical character recognition (OCR) to extract the specified data. This is exactly what Data-Core is doing.

Although the need for staff to intervene in the process is dramatically decreased when workflows become automated, their roles haven’t disappeared just merely altered. Specialists are required to be trained on the system’s functionalities to validate the results of the automated processes and make corrections as necessary. The reduction of human intervention throughout the workflow allows staff to focus on other mission-critical tasks while reducing the chance of error and time to completion.

Automation of revenue cycle workflows is the key to ensuring a healthy profitability for healthcare Providers.


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