9 Things to Consider Before Automating Your Medical Billing Process

Medical and healthcare billing is still paper-based to a great degree. This creates cash flow complications that reverberate from the ER to the operating room to the recovery room. Patients returning from the hospital are often troubled with insurance and reimbursement failures; stories of people swamped by outstanding medical bills are painfully prevalent.

The lifeblood of every healthcare practice is billing. Like any other company, hospitals provide services to their clients (i.e., patients) and want to get paid in return. Cash collection enables hospitals to pay their operating costs and re-invest income to increase the standard of treatment they can provide their patients. Therefore, the medical billing process must be smooth, consistent, and accurate.

The buzz around the potential to automate the healthcare process, especially the revenue cycle processes, has increased dramatically over the last few years. Automation, however, has its risks and obstacles. 

In this article, we’ve addressed many considerations that companies must consider before automating their business processes.

1.Breaking Down the Process into Smaller Steps

Process automation can take two formats:

1) A fully automated process; or 

2) A process in which intelligent software programs execute only specific steps, generally referred to as bots. In contrast, a human agent executes other steps. 

To create a viable automation model, a deep understanding of the entire business process is needed.

2. Selecting the Automation Platform

Each function in the dynamic chain of revenue cycle processes — EDI, voice/web, processing of medical language, optical character recognition, and rules-based processing, to name a few — has different requirements. Let’s look at how the automation team manages multiple criteria for a series of work processes.

  • Front-end Processes: Rather than focus on automating a single channel, build a holistic, end-to-end human and bot-enabled approach since the patient communicates via multiple networks.
  • Medical Coding Services: Medical coding procedures require multiple elements, such as the knowledge of medical terminology and the ability to apply ICD and CPT, in addition to HCPCS and modifiers. With the aid of machine learning, automation will also make it easier for the coders to determine the correct codes for the diagnosis. 
  • Accounts Receivable and Denial Management: With thousands of healthcare payers in the United States, information sharing can be difficult. When evaluating the potential for automation, it’s crucial to determine the productivity and consistency of the automation processes in the workflow, and more specifically, the potential to make a real impact on business outcomes.

3. Platform Architecture and Framework

The platform architecture and the underlying infrastructure can help you decide the kind of approach you need to automate within the process ecosystem.

  • Tools with industry-specific applications are essential for the successful functioning of your business processes.
  • Intelligent bots can replicate human acts and behaviors. The convergence of new technology, including artificial intelligence, deep learning, cognitive intelligence, and optical character recognition, produces excellent results.
  • Choose an automation technology that is funded by a big organization with substantial R&D and can scale.

4. Insights from Workflows

The workflow application’s operating reports will include insights such as types of errors committed, routine tasks found, and non-value behaviors removed. Market rules and a microbots library also help define and deploy automation. They can generate a new level of business value.

5. Involving Medical Practitioners

Involving medical practitioners in defining options for automation will drive improved outcomes and better implementation and create a stable relationship between them and the automation team.

Keeping the medical staff in the loop throughout the automation process will smooth the process since the medical staff will be using the automated revenue cycle solution.

6. Creating a Scalable Automation Deployment Model

Bots that can work with each other need flexible implementation architectures. You may find it incredibly useful and conducive to your overall success if the medical billing company has a pre-built stack of industry-specific automation software.

  • Microbots and microservices can infuse scalability by developing a library of single-purpose bots (with the ability to transfer data) to construct process-specific automation resources on demand.
  • System Redesign: It is crucial to ensure that, through extensive use of the microbots and microservices architecture, the automation team can deconstruct and rebuild the work processes.

7. The Need for a Governance Framework

Quality Assurance: When more and more bots are introduced, a similar management model must maintain the efficiency and throughput of the automated processes.

In addition to offering governance and regulation, quality assurance provides insights to advance the automation agenda.

Managing bots with bots:

  • Build a control tower that tracks the running bots’ efficiency to identify places where the bots are successful.
  • Understand the areas in which they struggle.
  • Encourage the bots to penetrate deeper.

The solution must synchronize with process implementations to fully view the automation solution’s efficiency and throughput vis-à-vis, human agents.

8. An Ongoing Approach

Organizations with an ongoing commitment to finding opportunities by implementing automation strategies and methodology, designing reporting systems, and following a change management model would benefit from the sustainable benefits of automation far into the future.

9. Measuring Success

Measuring results through data and analytics is the last step in considering implementing automation in your medical billing process.

  • Design Analytical Method: Create dashboards that accurately tell your story with quantifiable data.
  • Collaborate and Communicate with Other Teams: Other teams can recognize the replication potential for automation within their business processes through cooperation and the exchange of process development success stories. They can measure automation possibilities through the business results delivered, difficulties faced, and learning opportunities.


Although they may be experts in automation programs, prospective automation service providers should also know your industry to satisfy your needs now and in the future. 
They should know the complexities of the revenue cycle process, special requirements, healthcare business practices, knowledge sharing requirements, and operational policies and procedures. PMBC is one of the renowned medical billing companies that seamlessly oversees your entire revenue cycle management process.


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