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What are some of the challenges that healthcare entities face when it comes to streamlining their RCM operations?
Most healthcare providers perform tedious and repetitive revenue cycle tasks manually. These include activities such as patient intake, insurance verification, prior authorizations, claims submissions, patient responsibility collection, and payment posting. One of the most burdensome tasks healthcare providers have to deal with is managing their accounts receivables (AR), checking claim statuses, and ensuring all payments are collected and posted correctly. Another problem is data integrity with regards to patient and claims information, resulting in unnecessary denials and delays. Other complications come with the billing process, such as pre-bill scrubbing, ensuring accurate coding, and supporting documentation. All this administrative burden is further compounded by the existence of multiple payers, increasingly burdensome regulation and compliance, and a fragmented technology landscape. As a result, the routine processes carried out tend to be highly inefficient and error-prone, resulting in serious operational losses and rampant revenue leakage.
What is the process in place in identifying the requirements your clients have and implement the right solutions for them?
Simple Fractal collaborates with subject matter experts and works closely with their clients to establish an in-depth understanding of the processes to be automated and how they fit into the organization as a whole. If existing processes are flawed, we fix them before automating them. Importantly, we carry out an assessment to prioritize the areas with the most addressable ROI. For instance, if outstanding AR is increasing and aging, and it is unsustainable to increase the headcount proportional to expected growth, then payment posting might be the first segment to automate. Once we have shortlisted promising initiatives that are well-defined and where success would be meaningful to our clients, we conduct an in-depth discovery to thoroughly document the processes via handbooks, representative examples, and visual screen flows, giving a detailed picture of the business logic and how the processes should be propelled with digital labor.We then take it a step further and diligence the rules on the underlying software platform to ensure that the bots we put in place can indeed perform the actions necessary to drive the business process on an ongoing basis.
Our software robots are tailored to the business process, without the limitations of an off-the-shelf tool
All of this enables us to provide our clients with complete cost transparency in terms of building and maintaining our bot solution.
How do you help clients go up and running with your solutions?
To minimize overhead and the need for talent acquisition for our clients, we build, host, and deploy our bots on our cloud platform. We offer annual maintenance agreements to clients, so they don’t have to worry about setting up and maintaining the infrastructure. If more flexibility is required, we also offer support on a time and materials basis, which can be helpful when the level of maintenance required is unclear.
When it comes to familiarizing ourselves with our clients’ systems, the process of deep discovery comes into play, following extensive collaboration with our client to fully understand the processes that require our bot solution. Here, we get access to the client software platforms that are bots will be operating, where our engineers do a deep-dive to diligence all the business rules to confirm the feasibility and optimize our approach.
To ensure our bot solutions are smoothly integrated, we work with our clients to enact effective change management within the organization. We go in and make sure the human workflows adapt to our RPA implementation, to successfully move to an exception-based workflow, where our bots can perform the vast majority of the work and bring attention only to exceptions that require human creativity and judgment.
What are some of the factors that differentiate Simple Fractal from other key competitors?
Apart from RCM, are there other processes Simple Fractal is looking at?
We have been talking with hospital systems to automate activities such as bed assignments, where every in-patient needs to be assigned a vacant bed in the right hospital unit, depending on their diagnosis. This process, like other human-driven processes, is prone to error, where mistakes are expensive and negatively impact patient outcomes. Another aspect is the routine processes that need to occur prior to surgery, where automation can increase efficiency, reduce error, shorten wait times, and improve insurance reimbursement. Physician referrals is another process waiting to be automated. Our company is also exploring automated billing and clinical documentation. Aided by our software bots, the healthcare organization would gain a holistic understanding of the patient, including her diagnosis, medical history, and insurance information, to determine the procedures that are required, how to code them, and how to bill them. We believe intelligent automation, the combination of RPA and AI, can make a huge difference in this area in the next few years.
How has the recent past been for Simple Fractal, and where do you see the company in the future?
I can proudly say that we have built a strong track record of success over the years. We wish to keep growing with our existing clients while expanding our client base and extending our solutions to more providers in the healthcare industry. We are optimistic about leveraging our RPA solutions beyond RCM, into operational and clinical processes as well. In conclusion, many of the inefficiencies and errors in the healthcare industry can be mitigated with the aid of digital labor. Tailored software robots reduce costs and plug revenue leakage while unlocking the full potential of human talent, ultimately resulting in better healthcare.