{"id":38516,"date":"2021-02-17T15:30:53","date_gmt":"2021-02-17T20:30:53","guid":{"rendered":"https:\/\/statescoop.com\/?p=38516"},"modified":"2021-09-03T09:09:12","modified_gmt":"2021-09-03T13:09:12","slug":"healthcare-agency-reduce-fraud-waste-claims-abuse-with-rpa","status":"publish","type":"post","link":"https:\/\/statescoop.com\/healthcare-agency-reduce-fraud-waste-claims-abuse-with-rpa\/","title":{"rendered":"How healthcare agencies can tackle fraud, waste and abuse with RPA"},"content":{"rendered":"

State and local agencies are still feeling the strain of the COVID-19 pandemic on government health services \u2014 particularly as it pertains to processing claims.<\/p>\n

Though the Coronavirus Aid, Relief, and Economic Security Act \u2014 or CARES Act \u2014\u00a0established a reserve for state, local and tribal governments to pay for testing and treatment of uninsured citizens, it also created payment channels different from normal daily claims. Errors with new coding requirements resulted in a mountain of backlog claims.<\/p>\n

\"RPA\"<\/a>

Read the full report<\/a>.<\/p><\/div>\n

That\u2019s why many state health agencies turned their attention to robotic process automation (RPA) tools to help with the growing pile of documents.<\/p>\n

RPA automatically flags improperly coded claims, verifies enrollment status and benefits, scans forms and submits claims to proper payment channels, according to a new report, produced by FedScoop and underwritten by Blue Prism, Bits In Glass and Red Hat.<\/p>\n

Through rapid automation of manual rules-based, back-office administrative processes, RPA unburdens overwhelmed administrative staff in an already strained system. The new report\u00a0dives deeper into the benefits of RPA technology.<\/p>\n

Unprecedented demands during the crisis<\/strong><\/p>\n

When the pandemic hit last year, millions of Americans lost their jobs, prompting citizens to reach out for government assistance. That spike in Medicaid and Medicare claims caused a disruption in claims processing, especially for those states which still depend on legacy IT solutions and manual processes, according to Anna Twomey, senior solutions advisor and healthcare solutions architect for Blue Prism, in the report<\/p>\n

She explained that with these delays, to the outside world, it looked like the money was not there, even though Congress had appropriated funds through the CARE Act to help.<\/p>\n

Because the management of claims still uses manual processes, that creates a lot of backlog during spikes in demand, explained Josh Painter, RPA consultant with Bits In Glass, Blue Prism\u2019s integration partner.<\/p>\n

\u201cThese backlogs can be cleared when Blue Prism\u2019s automation platform takes action on a document, and moves it into a system for verification, processing or reimbursement submission. It\u2019s a simple way to make a big impact on the business,\u201d he said in the report.<\/p>\n

IT leaders across several states quickly sought out RPA as a cost-effective and secure solution to handle sensitive medical data, said Twomey in the report. Right now, Blue Prism\u2019s RPA software platform is fully embedded in about 10 states, including New York, California, Georgia and Texas.<\/p>\n

Long-term benefits for RPA implementation<\/strong><\/p>\n

The report looks at several of the benefits to using RPA, including reduce waste, protect from fraud and better streamline workflows. For example, Twomey says that automation helps to uncover loopholes in processes which previously created unseen waste.<\/p>\n

\u201cYou see people interacting with what you thought was a well thought out process, but instead there are gaps in places that cause waste, loss or fraud. That is one area that RPA can be used to mitigate risk,\u201d she said.<\/p>\n

The report highlights other advantages of RPA over more traditional computerized workflows, including:<\/p>\n