A Large Network of Hospitals providing Emergency Services Reduced 90+ AR days to 28 days using Automation

The Client

A large network of hospitals spread across 36 states providing emergency services.

Challenges Faced

• 90+ AR balances leading to huge revenue loss
• High claim denials
• Reduction in financial flow
• Delay in claim processing
• Aging claims

Plutus Health Plan

Plutus Health's team started this project to automate the current RCM processes. Our RPA experts thoroughly analysed the current process and detected the issues that needed immediate attention.  

Issues detected

• Significant manual process involved generating AR reports from various medical billing systems and converting raw data into clean formatted data for further analysis.
• Time consuming to log into various portals to check the claim status and maintain manual updates in various excel sheets.
• Significant delays in handling denials as the agent has to manually look into the denial codes, collate all the missing documents from various sources and  upload/fax to the payor.
• Agent Dependent on processing claims
• Ageing claims growing due to high volumes

Plutus Health Solutions

Plutus Health utilized the UiPath framework with a combination of VB scripts to automate the revenue cycle management process by building an attended bot.

Our experts leveraged Zeus to streamline the RCM process. Zeus is a family of 60+ RPA bots for charge entry, cash posting, claim status check, eligibility verification, medical record capture, analytics, reporting, and more.  

• Generate AR reports from various medical billing systems
• Extract data for different payors
• Log into the payor portal and check the claim status
• Take action depending on the claim status
• Assign exceptions to agents for manual processing
• Generate MIS reports

Results & Benefits

• Reduced day in AR to 25 days
• Elimination of Human error
• Decrease Turnaround time for claim submissions to <48 hours
• Boost clean claim percentage to >98%
• Learn from and effectively manage denials to bring them <5%
• Slash Ageing Accounts Receivable
• Bots available 24x7 to check the claim status