Bots and Automation: The Future of Medical Billing
Automation and bots are rapidly replacing manual work in medical billing. Tech-enabled medical billing services have significantly improved revenue for healthcare providers. In a survey published by macami.ai, it was found that 61% of US adults would prefer to leverage AI for medical billing to avoid errors. Healthcare providers that leverage AI are now able to concentrate on making analytical decisions and are able to spend more time serving patients.
AI technology is not just limited to medical billing. It enables healthcare providers to increase revenue by streamlining medical coding and other RCM services. We have put together a compelling blog for you that will emphasize the role of bots and automation in medical billing.
Here's how automation is streamlining medical billing
Efficient Data Management
Successful medical billing is dependent on the optimum utilization of data. There are massive data sets like patient demographic information, medical history & treatment plan details, insurance details, payer details, and more when filing a claim. Automation can swiftly gather, sort, and organize this data efficiently which makes it easy to use properly and source it, resulting in a high clean claim submission ratio.
Nonfictional Data Entry
Manual data entry is time-consuming and prone to errors. Even the most careful billers can make errors. It is human nature to reverse digits of numbers, copy down the wrong UX code, inadvertently forget to enter the correct code(s) and modifier(s). Bots and automation bring down medical billing errors and provide accurate data entry. Precision in data entry will enhance productivity and revenue from claims.
Comprehensive Data Analytics and Reporting
With the automation of data collection and sorting, analytics and reporting have become comprehensive and accurate. RCM automation enables real-time data visualization and analytics that helps to illuminate the business's financial health. This also provides very clear data to track RCM efforts and the returns on investing into AI.
Reduce Human Dependency
Automation minimizes the need for humans and saves time on erroneous prosaic manual tasks. It also improves quality and drastically lowers operational costs. The automation tool functions round-the-clock and can smoothly replace human billers. Medical billers can use the saved time and effort to do complex tasks that are not repetitive and routine tasks. This provides a dramatic improvement in collections for healthcare providers.
Manage Patient Schedule and Records
Automation gives easy access to patients' old records and data, which helps to schedule appointments, check for eligibility & benefits, draft patient statements, remind patients about payments, and more. It significantly reduces staff workload and provides patient convenience, resulting in high patient satisfaction and retention. The global patient engagement technology market will rise at a CAGR of 10% and reach USD 27.9 billion by 2027. Patients who are managed well are happier. They will pay faster and are loyal to the healthcare entities that provide a good patient experience.
Collection from Payers
Payers demand high accuracy at the time of claim submission. They require proper documentation, data, and medical codes to process the claim. Slight errors in documentation or data entry while submitting the claims have a drastic impact on reimbursements. Automation can track all the requirements from the payers and matches them with the claims to detect errors and missing information. Bots can eliminate all the manual coding and medical billing errors, which increases clean claim rates and allows for faster reimbursement on submitted claims.
Automation innovates and makes the medical coding and billing process more efficient. Partnering with the best tech-enabled medical coding and billing companies like Plutus Health will give you complete freedom to dedicate time towards patient care and pass on all the billing and collection stress to their experienced billers and coders.
Are you looking to outsource a tech-enabled medical billing partner? Our team of RCM experts has designed a solution that can automate the medical billing processes and the staff to focus on analytical and more complex tasks. Connect one of Plutus Health's medical billing specialists, and you will get a deep understanding of automation in medical billing.
Key Takeaways:
- Medical billing and RCM automation go hand in hand.
- Companies spend billions on automation due to complex billing and claim submission requirements.
- Claims and patient data reporting and analytics are more comprehensive due to automation.
- Automating key medical billing processes saves considerable costs for healthcare providers and speeds up reimbursements for their services.
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FAQs


ABA providers are grappling with high staff turnover (up to 65%), rising burnout, administrative overload, and stagnant reimbursement rates. These challenges directly impact care continuity, clinical outcomes, and operational performance.


Operational inefficiency costs ABA teams up to 10 hours per staff member per week, contributing to burnout, denied claims, and longer accounts receivable (A/R) cycles. These inefficiencies ultimately result in reduced revenue and patient dissatisfaction.


Burnout leads to costly turnover, lower client retention, and decreased productivity. Recruiting and replacing a BCBA or RBT can cost up to $5,000 per hire, plus months of lost revenue and disruption to morale.


High-performing ABA organizations invest in clear career pathways for BCBAs and RBTs, align compensation with market benchmarks, and foster peer-led mentorship, flexible schedules, and wellness programs.


Automation tools like Plutus Health's Zeus streamline eligibility verification, denial management, and billing, reducing manual workloads by 5–10 hours weekly per clinician and improving clean claim rates by 95%.


Outsourcing revenue cycle management can improve collections, reduce denials by up to 30%, and free clinicians from billing-related admin tasks, resulting in better client care and financial outcomes.


One $200 million ABA network partnered with Plutus Health to automate eligibility and accounts receivable (A/R) processes. The result: $2M reduction in legacy A/R and a 97% Net Collection Rate.


By improving operational efficiency, investing in technology, and ensuring workforce stability, ABA leaders can align outcomes with reimbursement. Plutus Health supports this transition with scalable RCM and automation strategies.
FAQs


ABA therapy billing is the process of submitting claims to insurance or Medicaid for Applied Behavior Analysis services provided to individuals with autism or developmental disorders. It includes using correct CPT codes, proper documentation, and adherence to payer-specific policies.


Common CPT codes for ABA therapy in 2025 include:
- 97151 – Assessment and treatment planning
- 97153 – Direct therapy with the patient
- 97155 – Supervision and modification of behavior plan
- 97156 – Family adaptive training
- Always check with payers for any annual changes.


To bill Medicaid for ABA services, providers must ensure credentialing is complete, services are pre-authorized, and claims use the correct codes and modifiers. Medicaid requirements vary by state, so always follow state-specific billing rules.


Common ABA billing mistakes include:
- Incorrect or missing CPT codesplan
- Lack of documentation or treatment
- Uncredentialed providers rendering services
- Submitting duplicate or late claims


Without proper credentialing, providers can’t get reimbursed. Insurance and Medicaid require that BCBAs, RBTs, and organizations are credentialed and contracted. Delays in credentialing often cause revenue losses and claim rejections.
FAQs


CMS proposes a 2.4% increase in Medicare ASC payment rates, contingent on meeting ASCQR quality reporting requirements. Plutus Health helps ASCs meet these compliance benchmarks by integrating quality reporting data into RCM workflows, ensuring eligibility for full payment updates.


The ASC Covered Procedures List will expand by 547 procedures, including cardiology, spine, and vascular surgeries. Plutus Health supports expansion into new service lines by customizing RCM processes for high-acuity procedures, minimizing claim denials during the transition.


Site-neutrality narrows the payment gap with hospital outpatient departments, enhancing ASCs' cost-efficiency appeal. Plutus Health helps leverage this advantage in payer negotiations by providing performance dashboards and cost-justification analytics to secure stronger reimbursement terms.


Complex procedures increase denial risk and slow cash flow. Plutus Health's automation-first RCM model delivers 95%+ clean claim rates, reduces A/R days, and safeguards margins, even as your case mix becomes more complex.