How Robotic Process Automation is revolutionizing medical billing in healthcare
Artificial intelligence (AI) is the leading disruptor of healthcare, but not all stakeholders and executives in the medical field understand what it is and how it can help. AI technically pertains to the ability of a machine to imitate a human’s way of communicating, making deductions, and sensing things. Healthcare practices have yet to include machine learning algorithms and natural language processing into their daily workflow. But robotic process automation or RPA is getting their attention—particularly RPA in medical billing.
RPA is a transformative technology that reduces labor costs and the time required to complete tasks. Adopting RCM solutions with robotic process automation will help mechanize rule-based, high-volume, and repetitive processes to reduce cycle time and errors, streamline operations, and boost efficiency.
RPA in medical billing is revolutionizing healthcare as it eliminates human error in rule-based and repetitive tasks. Moreover, it frees up staff to focus on other non-standard and more complex activities that require their attention. RPA uses intelligent bots that work 24/7 on behalf of the in-house staff but without errors. They help improve the efficiency of aggregating information from multiple sources and integrating other requisite tools without costly interfaces.
RPA in RCM solutions leads to better employee satisfaction and enhanced patient experience. Automating tasks like scheduling, appointment reminders, claim management, and billing can improve a healthcare facility or practice’s ability to deliver better patient care every time. It may even enhance regulatory compliance and security to protect patient data.
Experience RPA in medical billing with the revenue cycle management solutions from Plutus Health. We specialize in providing end-to-end RCM solutions that are HIPAA compliant, which makes us trusted by US healthcare providers. Our process combines robotic process automation and machine learning to address your most frustrating issues so you can improve your percentage of clean claims and boost your revenue. Get started with a free revenue health analysis.
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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.