RPA for efficient RCM management of Billing Companies.

RCM is highly repetitive, amenable for operating procedure often managed manually. Hence, RCM suffers human errors, absenteeism, and inability to scale up and down depending upon the demand. McKinsey & Company has reported that more than one-third of tasks in the billing industry could be automated, enhancing efficiency. With recent developments in AI, and machine learning companies are realizing Robotic process automation (RPA) as the panacea to transform revenue cycle management,

How does RPA work is the next question? It unites an organization’s systems, including electronic health records, billing, patient payment portals, and credit card processing applications, working with them the same way individuals would, while automating functions. This automation is idyllic for rule-based, repeatable processes that leverage the organization’s key systems, including claims follow-up and payment posting. To follow up on a particular case, a biller without RPA would go to the payer’s website, research the case status and plug in various bits of information on the page into the practice management system and then resubmit the case with the next batch. This is time-consuming, burdensome work that robots could effortlessly perform. Robots can connect to the website, capture the response and follow it up with data that the payer needs to complete the revenue cycle, places it into the practice management system, and resubmits the claim without human intervention – saving significant time and resources.

Benefits of Exdion’s RPA include:

•    Speed and efficiency: RPA empowers eight times the amount of work to be done per minute than could be attained manually. Additionally, human error is eliminated, enhancing the accuracy of data entered.

    Consistency:  The Automation solution for a particular process which is implemented in one location can be extended across the complete organization, regardless of the number of locations.

    Increase in collections and revenues: More efficient and quicker billing means that practices get paid faster and more often. More precise information also improves collections.

•    24/7 workforce: RPA creates a 24/7 workforce, driving efficiency and increasing cash on behalf of clients.

Schedule a call with us to know what processes to automate and how to roll out RPA to realize substantial, company-wide benefits.



For billing companies, right tools and process accurately and efficiently bill patients for the service availed is a huge challenge. Often, companies face revenue leakages due to human errors, inadequate controls, broken process and ineffective operations.  Companies have not put to use new technology development to manage the standardized process. Recent developments in AI (Artificial Intelligence) make it extremely suitable to manage and scale highly routine repetitive process. AI techniques such as machine learning, rule based engines and learning agents have found great use in transaction heavy environments such as billing, configuration and process led command and control systems.

Given that RCM is a transaction heavy process driven activity, AI tools deployments will usher in greater efficiency and scalability.  AI tools can be used to standardize, automate, manage (rule based approvals and exceptional handling) and systematic learning of new rules. These improvements can reduce human resources requirements to manage repetitive boring environments. These tools can also blow away the limitations of time zones and scalability challenges across segments and geographies as personalization costs can be abysmally low.

Revenue cycle management in healthcare is accountable to AI automation due to many activities which are moderately transactional. Here are four reasons why AI could make a considerable change in Revenue Cycle Management (RCM):

  1.  Total Cost: A significant part of RCM costs is labor. By automating the RCM process using Robotic automation, Machine learning, Agents and Chatbot and other tools of AI, companies can reduce total cost of revenue cycle management.  AI can effectively manage about 50% of the whole process, there by offering huge savings in people based service delivery.
  2. Quality: AI tools such as rule based engines, knowledge routines can discover exceptions likely to happen much before it is likely to happen. Quality focus can shift from quality control to assurance there by eliminating rework, leakages and waste.  Higher predictability in accuracy, productivity, and performance will rise as AI algorithms can learn using both inductive and deductive logic.
  3. Analytics: Automation and AI will provide greater transparency and visibility on a real-time basis to exceptions that are occurring in the revenue cycle, such as denials and credits.  Patterns identifying revenue slippages would be completed on a real time basis with the help of AI
  4. Reliability: Automation and artificial intelligence will improve the quality and increase confidence in the revenue cycle management process. Right now the revenue cycle management is marked by volatile performances, inaccuracies and low productivity due to the manual tasks. When an automated system is programmed correctly performance will remain consistent which is a key component of the Revenue cycle management.

Billing organizations are experiencing thinning margins and need to operate as lean as possible. AI provides insight to drive incremental revenue into such organizations, enabling them to realize additional revenues faster, while freeing their staff to pursue new opportunities that aid the organization.


When you receive multiple quotes from Exdion, rest be assured about providers’ ratings or financial standing. We provide the snapshot with a comparison of various carrier quotes. So it’s easy for review and you get the coverage information in quick glance. Here are a few guidelines to help you efficiently compare small business insurance quotes and select the policies that suit you best

Know the premium cost

For small-business owners with lean budgets, it can be enticing to make a purchasing decision based solely on the “bottom line.” Maybe minimal out-of-pocket spending is your top priority. Or maybe the price is the fastest way to make a choice.

But before you make a decision based on premiums, keep in mind that you’re purchasing insurance is to protect your business. So while one policy may cost a little less, be sure you know why it is rated that way. Does it leave out coverage you may want later on? Are the limits high enough to comply with client contracts? Try to look beyond dollar signs and sift through the details that differentiate one policy from another.

Pay attention to inclusions and exclusions

Some of the defining details of each policy are inclusions and exclusions. Take note of these items because they determine the terms of your coverage. For instance, when reviewing Commercial Auto Insurance quotes, you’ll want to see the level of coverage each policy offers for bodily injuries, property damage liability, collision coverage, uninsured motorist coverage, and personal injury protection. No matter the kind of policies you’re reviewing; never accept that the coverage involved in all quotes is the same. The last thing you want to do is by chance purchase a policy because you thought it had the protection it actually doesn’t offer.

Review policy limits and deductibles

Your policy limits are the stated amount that your insurance provider will pay for a specific event, instance, or claim. Therefore, your limits eventually decide the extent of protection your business receives for liability lawsuits and other losses. You’ll want to take the limits that can adequately shield you from a devastating claim.

Your deductible is the amount you pay before your insurance benefits cover the rest of the claim. Usually, the higher the deductible, the lower your premium. However, when reviewing your deductible options, only accept an amount you could comfortably spare without jeopardizing your finances.

Policy that can grow with your business

When you compare small business insurance quotes, remember that your business could rapidly grow in one year. So when reviewing limits, inclusions, and exclusions, take into account details of a sudden increase in business. Take your existing insurance policy into account.

If you already have a similar insurance policy in place, compare your quotes to your existing plan. What did your previous plan lack? Do these new policies fill coverage gaps that were making you nervous? Your current insurance policy can be a useful calculating stick to determine whether you’re getting the coverage for a fair price.

One of the biggest pluses of working with Exdion is that they can help you make sound decisions and guide you through the comparison process.


A modifier provides the means to report or indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code.

Modifier 22 is for ‘Increased Procedural Services’ – which indicates that the procedure was much complicated and complex due to unusual anatomy, excessive bleeding, extensive scarring, or any other problems that require considerable additional time, effort or skill. Thus whenever any procedure requires more effort and additional time than the usual one, it is necessary that physician should be credited with additional reimbursement by reporting modifier 22 on the specified procedural code.

As the description indicates, modifier 22 should only be reported with procedure codes and not with the Evaluation and Management codes. Also, it should be reported with procedure codes having the global period of 0, 10 and 90 days.

Documentation Requirement:  

An operative report attached to the claim during initial claim submission can avoid denials and also chances of getting additional reimbursements are high.

Consideration and Key points for Modifier 22:

·         Documentation must clearly support the substantial additional work and the reason for the additional work like increased intensity, additional time, technical difficulty, severity of patient’s condition, physical and mental effort required.

·         Key points like – Increased risk; difficult; extended; tedious; complications; prolonged; unusual finding; hemorrhage; blood loss over 60cc adds weightage to the documentation.

·         Morbid Obesity which complicates the procedure.

·         Difficult surgical approach.

·         Documentation should be submitted with claim

·         Any additional fees should be charged upfront to payers, which are unlikely to raise fees on their own just because modifier 22 is appended.

Lack of documentation can end up in denials and commonly seen denial codes are:

·         Claim Adjustment Reason Code 232 – An attachment/other documentation is required to adjudicate this claim/service. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT)

·         Claim Adjustment Reason Code 16 – Claim/service lacks information which is needed for adjudication. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)

·         Remittance Advice Remark Code N102 – This claim has been denied without reviewing the medical record because the requested records were not received or were not received timely.

Neither CPT guidelines nor the CMS (Center for Medicare and Medicaid Services) has specifically defined the efforts that should be involved in increased procedural service. It is generally considered as at least 25% additional effort than the usual procedure. However overuse of modifier 22 can trigger Medicare audit, so it is necessary to check the complete medical record before assigning modifier 22.

Don’t assign Modifier -22 if –

1.       There is no supporting documentation to substantiate the increased procedural service.

2.       There is an existing ‘add-on’ code available

3.       There is average amount of lysis or division of adhesions between organs and adjacent structures.

4.       Another CPT code more accurately describes the performed procedure

5.       Use for re-operations

6.       Unlisted procedures.

Reimbursement rate:

Modifier 22 will attract additional 20-30 percent reimbursement than the actual allowed amount if the requirements are met. If the Operative report does not substantiate the use of modifier 22 then additional 20-30 percent payment will be denied.

As modifier 22 invites additional payment, most of the insurance company would like to see the medical record for the complexity of the procedure and accordingly payment will be approved or denied.  Initial submission of claim with medical record will increase the chances of getting paid for modifier 22. This cannot happen in case of Medicare insurance as initial submission should only happen electronically. If a claim is denied for additional information for Medicare insurance, submitting with Medical records and an appeal letter with detailed information for increased procedure will help to get the payment.

Below are some of the instances which define the appropriate usage of modifier 22. Always medical record will have a concise statement (like below instance) that explains the nature of complexity with supporting portion of the report.

Appropriate use

Inappropriate use


Colosigmoid resection took apprx 1 hr of additional operating time utilizing increased mental energy by the operating team as well & complex intraoperative decision making to mobilize the rectosigmoid junction out of the pelvis for resection. Additional operating time was utilized by the operating team to mobilize the rectosigmoid junction out of the pelvis for resection. Additional operating time will not justify for modifier 22, it has to explain the approximate additional time and the complexity of the procedure (in this case mental effort and instant decision to mobilize rectosigmoid junction)
Mastectomy was difficult because of the hidden scar nipple sparing approach with a procedure with increased risk, increased time & increased complication rate due to Morbid Obesity, additional 45 min of operating time was necessary to complete the procedure. Mastectomy was performed utilizing additional time due to patient’s habitus. Documentation should clearly explain the approach, approximate additional time and reason for complication (In this case Morbid Obesity)
Small bowel resection procedure was complicated; this case took an extraordinary long time, very slow tedious 6.5 hrs dissection of the deep pelvis because of the patient’s multiple pelvic operations & history of radiation therapy to the pelvis 2 years back. Small bowel resection procedure was complicated as it took extraordinary long time to complete the procedure due to patients previous history Extraordinary long time will not justify for additional reimbursement, it should explain approximate additional hours and the complication of previous history (in this case multiple pelvic operations and radiation therapy)



Failure to use modifiers properly can badly affect reimbursement. Medical coders can help Surgeons maximize the reimbursement by assigning modifier 22 as per the documentation. Thus more detail the provider provides, more likely the additional service will be approved

It is also advisable to submit the claim with medical record during initial submission which can overcome denials. If still claim gets denied, we need to appeal with medical record with complete explanation for the increased procedural service.


As businesses grow, one of the challenges they face is the mountain of inbound documents and mails they receive from partners, clients and others. Processing them in a timely manner is required to ensure quick information access and response thus leading to better business decisions and excellent customer service.

Most companies consider outsourcing option as a solution to manage the avalanche of documents and paperwork. Outsourcing of mail room frees investments in people to manage the task, reduced time and errors allied with opening, managing and distributing inbound documents. Outsourcing provides an opportunity for the employees to focus on what is key to their business and stay with the core.

Mailroom outsourcing models range from people based, or technology based or a mix of both. With the advent of IT solutions including document management system, cloud solutions for storage and access, technology led solutions are emerging as a low-cost effective approach to mail room management.

Exdion’s has offered mail room support services to clients across geographies and each of them has benefitted from following:

•    Instant access to information, letting for more effective collaboration, enhanced communication and swifter business decisions

•    Streamlined compliance of regulatory requirements, like  HIPAA, Credit reporting including state mandates

•    Back-up/redundancy for disaster recovery

•    Elimination of duplicate procedures, lost documents and the need to photocopy

Outsourcing mailroom processes could give a firm the advantage it needs to stay on top and keep its focus where it belongs – on its core competencies. Smart businesses realize where to prioritize and focus on, bringing in partners who support them in peripheral activities.


Policy Checking is a process wherein a renewed policy is checked to guarantee that it matches against the proposal/prior term policy that was generated before renewal. If any variance exists these are noted by the Brokers to avoid any potential Errors &Omissions claims that may arise later. Policy checking helps in identifying issues and gaps in the coverage so as to reduce the E&Os.

Despite being a critical insurance Brokers and agents, quality of checks suffer because of business pressures, human errors and multi-tasks resources are addressing to. Hence from a mandatory comprehensive process policy checking ends up as a cursory activity.  Players may not have invested in standardized procedures for policy checking leading to variations and human errors.  For instance, an agency moving one of its accounts from company A to company B, may not have considered the existing policy coverage. In the likely event of any claims emerging, there could be a potential loss occurring because of the costly omit. It is also possible that customer is issued duplicate coverage.

Hence it becomes imperative that whenever a policy is received from another carrier, it needs to be reviewed comprehensively to ensure that all things are in order. While the policy should be reviewed based on what the proposal stated, it is critical that a comparison to the policy it is replacing be done.

At Exdion, we follow a unique approach to streamline insurance checks and accelerate the complete process. We have AINS and CPCU certified team members who are experts in property & Casualty Insurance. We are Proficient in checking insurance policies for precision. As part of our offerings, our specialized team detects omitted information or discrepancies in the policies and highlights the variances in a checklist. Apart from basic policy checking, we have skilled team members who perform detailed coverage checking which could take away substantial time from Brokers. We can help brokers invest the time and resources efficiently and effectively in their core operations.

Exdion supports Carriers, Brokers, MGA’s and Program Managers all the way from application processing to issuance. We have a full policy review team who do a thorough check before the policy is prepared and sent to customers.

Policy Checking Services by Exdion:

•    Review of customer documents, checking missing details

•    Verify vital details like Premium, Limits, Deductibles, Forms & Exclusions

•    Identify discrepancies and Fill variances in the checklist

•    Expanded Coverage checking – Specialized team to verify the Policy information, terms & conditions.

•    Verify terminology that might have changed from the previous to the subsequent year- Auto Renewal insurance policies

How Brokers can set themselves to compete better?

Last few years have seen quite a disruption in the insurance market. Direct insurance players have used emergent technologies to not only increase their market reach but also disintermediate brokers, particularly in the personal lines business. Today, less than 50% of premiums in personal lines are handled by brokers and it is expected to drop significantly in coming future.  Corporate brokers have been moderately unaffected by the direct insurance industry as they have morphed from insurance facilitator to that of a risk advisor.

However, corporate brokers continue to face cost pressures, especially due to enhanced compliance costs.  From the Broker’s point of view, this situation has been intensified by the fact that many Corporates are now employing their own risk managers, many of whom were brokers in their former lives so have the same skills. Also, the identification and management of risk have become extremely complex and technical that often the broker is quite simply unable to explain the risk.

Continued survival and relevance of brokers depend on their ability to innovate their business model. Brokers need to embrace technology to reduce the cost of delivery, but also personalize services across various customer segments.

Towards achieving market relevance and stay competitive, insurance industry players must:

  • Benchmark client coverages and programs; increase client deliverables and carrier relationships.
  • Recognize new business and growth opportunities across the portfolio.
  • Drive insights using analytical tools customized to individual roles and responsibilities.
  • Acquire continuously enhanced intelligence on carrier appetite, client information, and associate expertise.
  • Learn to manage both structured and unstructured data; provide quotes online and send and electronic policy.

Amongst the several benefits that will accrue to the insurance players, nothing will weigh more valuable that real-time visibility and quick response. This will help them not only to boost new sales and increase retention but also effectively manage business relationships.


Automate Revenue Cycle Management with RPA

Effective Revenue cycle management is key to sustainability and profitability of healthcare organizations. Billing companies bear the most brunt on revenue cycle leakages. Billing service providers do not have the process to prevent denials from falling through the cracks. Not just billing companies, even hospitals suffer revenue losses because of poor follow-up process, communication gaps amongst various departments, and lack of root cause analysis to eliminate payment denials. Today, technology platforms play a role in assisting providers, payers, and consumers communicate and interact more efficiently.

Information technology is expected to remove data losses, eliminate errors and provide a seamless integration across the complete revenue cycle supply chain. With the availability of information across devices, applications, and platforms, service providers can carry out insightful analytics. Root cause analytics of denials, causes and codes can help providers improve revenue recognition and manage their margins.

Amongst the gamut of technology solutions available for RCM improvement and effectiveness, Robotic process automation (RPA) has a lot of promise.  RPA is the application of technology that allows configuration of computer software or a “robot” to handle high volume, highly repetitive, SOP led activities so that losses due to human errors and attrition challenges could be eliminated.  RPA offers dramatic improvements in accuracy, cycle time and productivity gains in transaction-heavy processes like RCM, while elevating the nature of work of people by removing them from repetitive tasks.  RPA tools mimic the steps of a rule-based, objective driven process without compromising the existing IT infrastructure. RPA allows easy scaling up or down of IT infrastructure to meet the demand.

Some areas where healthcare providers that can employ RPA to gain process standardization, elasticity of demand and improve the quality of employees include:

Data entry and migration: Instead of being dependent on paper charts, providers are digitizing patient information so that it can be stored electronically accessed online by other doctors and the patients themselves. In order to accelerate the process and not be reliant on employees to transfer these records manually, RPA can be used to automate this transfer of data between paper files and legacy structures to the new system. This will also substitute enhanced levels of customer service to the patient through transparency and ease of access to their medical histories.

Billing and claims processing: Billing and claims processing is of particular prominence for the healthcare sector. A patient visits the doctor, an insurance claim is filed, a patient is billed for the remaining amount, and accounts receivables are monitored to confirm the patient makes the payment. These tasks can be very time-consuming and prone to errors. Deployment of RPA decreases human error, increases efficiency and time-management and improved control or custody of billings and claims as these tasks progress across the value chain.

Automated monitoring of accounts payable/receivable: By careful monitoring of accounts payable and receivable, software robots are able to lead to an enhancement of billing efficiency and a reduction in write-offs. Payments will be made and received in a faster and more effective manner than if monitored by a human employee. As a result of debt decline, this utilization of RPA is another improvement to the financial performance of healthcare providers.

Decrease of errors in digitization of patient records: RPA software robots radically decrease the amount of error in data migration and replication tasks and the digitization of paper documents is no exclusion. The augmented accuracy from the use of RPA will allow healthcare providers to maintain up-to-date and accurate records, which is particularly important when considering a patient’s medical information and history consulted during the course of treatment.

Improvement in patient experience: A positive patient experience is vital to the success of healthcare providers. By automating long and repetitive processes, such as appointment scheduling, data digitization, and inventory tracking, doctors will have more time to offer value-based care for their patients. In addition, patients will benefit from having a shorter wait time for appointments and will have the capability to easily access their health records and bills online.

While considering partners for RPA, healthcare organizations must not only consider their expertise and experience but also how tool agnostic are their applications and the depth of their solution framework.  Healthcare organizations benefit most by partnering with organizations that not only provide advice and consulting to select the right tool but also in deployment and scaling of their RCM capabilities. Partners with deep domain expertise, strong process modeling expertise and bring a repository of best practices help healthcare organizations gain a competitive advantage not just for short term but long term too.

As MACRA Implementation Proceeds, Changes Are Needed

The Medicare Access and Chip Reauthorization Act (MACRA) was signed into law on April 16, 2015. The legislation, as originally perceived, had three fundamental goals. The first goal was to rescind the Sustainable Growth Rate (SGR) physician payment formula, a major source of uncertainty and instability for more than a decade. This legislation did that. The second objective was to alleviate physician payments to give providers respite from the annual and at times more frequent, threats of substantial cuts to their reimbursement. The legislation technically stabilized payments, although due to the diffidence of payment updates, physicians are probably to see their inflation-adjusted income drop substantially over the next several years.

The third and much more challenging goal was to transform to a better and more stable payment system that wouldn’t have policy makers back at the table in a few years discussing the same issues. This means transitioning away from traditional fee-for-service (FFS) into what has become a catch-all term, “alternative payment models” (APMs). Basically, MACRA attempts to attain this transformation by making FFS increasing unappealing, while concurrently developing and implementing APMs for providers to transition into.

Ina recent notification the Annual Call for Measures and Activities for the Merit-based Incentive Payment System (MIPS) track of the Quality Payment Program (QPP) has stated that it is accepting Quality and Advancing Care Information measure proposals through June 30, 2017 for the 2018 program year; measures submitted beginning July 1, 2017 will be considered for the 2019 program year.

The vital infrastructure for the future Medicare physician payment system, according to MACRA’s Quality Payment Program, comprises two payment options. The Merit-Based Incentive Payment System (MIPS) is a multifaceted pay-for-performance system based on traditional FFS. The other choice, participation in an Advanced APM, is in reality not currently an option for the mainstream of providers.

Therefore, the main issue currently confronting providers in MACRA when full implementation arrives, MIPS will make FFS unsustainable at a much quicker pace than the development and execution of feasible APMs. This means unless there are changes, a large number of providers will not be eligible under FFS and over the cliff before they have a safe place to land.

There are fundamentally two methods to address this challenge. The first being is to make MIPS less arduous. The second one is to greatly quicken the development and execution of viable APMs. Policy makers should consider doing both.

Decrease the Burden in MIPS

The expectation that health care providers should be accountable for the care that they provide is apt. In fact, many physicians support performance measurement, and some even report wanting to have their incomes more carefully linked to the quality and efficiency of their care, provided that the measures are meaningful and the reporting process is reasonable. However, given the current scarcity of meaningful health care performance measures, the reporting burden in MIPS should be considerably reduced.

Greatly Expand Access to APMs

Evidently, there is a need for the timely development and application of more innovative APMs. Presently, physicians face the challenge of being exposed to MIPS or playing a part in an Advanced APM that requires them to substantially change their delivery of care, make investments in the necessary infrastructure for APM participation, and take on “more than nominal” financial risk, often for things over which they have no control.

The Challenge Ahead

As execution proceeds, substantial changes are required to attain meaningful payment reform and avoid presenting physicians and other providers with an untenable choice. CMS encourages clinicians, measure stewards, organizations, and other stakeholders to identify and submit measures and activities.  Driving the quality, advancing care Information, and sustaining improvements in future years is going to be a major challenge.

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