RCM Payment Posting Case Study

Industries: Healthcare, RCM
Systems: NextGen, Waystar

Challenge:

The posting of checks is an extremely complicated but mission critical process for healthcare providers.

A large provider with 16 Orthopedic Clinics and 49 surgeons had been struggling to keep up with the daily requirement of posting substantial amounts of payments. Timeliness is essential and the burden on the current staff was of major concern. After an exhaustive selection process, CampTek Software was chosen to build and provide continued support for the automation of this critical process.

Presently a staff of 20 people go through their daily work queues to make sure these remittances get posted in a timely and accurate manner. The process has a large amount of business rules and exceptions that need to adhere to and accounted for. Not only is this a challenging workflow but trying to maintain a fully trained staff to keep up with it was a problem due to the current state of the labor market.

As part of this daily process, Full Time Employee’s (FTEs) had to manually update NextGen with claim status from Availity. The average number of claims was 54,000 per month.

Process

The bot is automating the daily posting of the payments received by the insurance providers into NextGen. This involves interactions with Waystar, collecting payments from the customer accounts and finally adding line items into a shared insurance check/ERA details spreadsheet. Payments are posted in NextGen by the bot importing 835 files in Nextgen and then verifying every encounter using business rules and validation patterns for each and all of the exclusion codes. During the validation phase of this process, if there is a need to look at the PDF EOB, the bot then extracts the EOB details from Waystar and extracts necessary details from PDF. These details are also used to perform secondary adjustments, Interest Payments, multi-line payments and HRA/HSA payments. Finally, the bot confirms the payment is posted and a reconciliation report is generated. The statuses are calculated on daily bases and provided in a spreadsheet.

Solution:

CampTek Software was able to analyze, design, build and place this bot into production in a short time. The bot includes many business rules, exception handling and reporting functionality. The Bot is processing roughly 200 payments daily. Month end numbers can reach as much as 400-500 daily. These must be completed close of business on the last day of each month.

Savings:

Savings are now averaging 55 hours a day or 1,100 hours per month.

About CampTek Software

CampTek Software is a Full-Life-Cycle RPA SaaS Provider. With industry experience developing and supporting RPA Applications since 2005, we have the expertise to support any Automation initiative you can think of. CampTek will be with you on every step of your RPA Journey. With our unique background, we are qualified to develop and support any RPA Process. We offer Advising Services, Host Support and Bot Support for all production processes. Our unique hosted model offers many powerful advantages including a shorter time to market, 24/7 support and overall lower cost of entry.