Automating processes in health care

Whether it’s scheduling a patient for care, collecting medical histories or billing, nearly every aspect of running a health care system is complicated. There are complex rules hospital systems must follow. There are many opportunities for human error. And much of the work that takes place behind the scenes, such as claims monitoring and data entry, is repetitive and time-consuming.

Advanced Analytics, a part of OSF Innovation, is working with various divisions of OSF HealthCare to create software that will automate these processes. Through a combination of digital tools such as Robotic Process Automation (RPA), Artificial Intelligence (AI) and Machine Learning (ML), automation can perform routine actions that don’t require human interaction.

At the same time, Advanced Analytics is building human-machine partnerships where people and bots can work seamlessly together. The goal is to help the Ministry use its resources more efficiently and expand capacity to support strategic priorities. Automation can also help ensure seamless patient experiences in key processes.

Revenue Cycle – a use case

With the job of billing, checking the status of claims and collecting payments, revenue cycle operations are well suited to benefit from automation technology. The Revenue Cycle division of OSF HealthCare is responsible for capturing, managing and collecting patient service revenue across the Ministry daily.

Many of these responsibilities are overseen by Mission Partners. But the department is working with Advanced Analytics to build automation into many processes to improve efficiency. This includes the practice of managing and resolving credit balances.

“This means Mission Partners don’t have to manually handle overpaid claims, reducing errors in the process,” said Mike Humphrey, director of Patient Accounts for the Revenue Cycle at OSF HealthCare. “More importantly, patients aren’t billed for services they’ve already paid for. And where necessary, individuals are getting reimbursed in a timely manner.”

The Credit Balance Resolution system, created by Advanced Analytics, has been live since March and has already produced a significant impact for the system.

“To date, the Credit Balance Resolution automation we’ve developed and implemented with Mike has created more than $1.6 million in bottom-line impact for the system,” said Chris Franciskovich, director of Advanced Analytics for OSF HealthCare. “This work is a really great example of the kind of impact automation can rapidly produce for a system like ours.”

Advanced Analytics is also working with the Revenue Cycle department on automating prior authorization status checking from insurance providers on behalf of patients.

More to come

Advanced Analytics is building automation services into everyday work, leading to the creation of human-machine partnerships where people and bots can work together seamlessly. The team is currently creating these human-machine partnership solutions for Financial Planning & Analysis, Accounts Payable and Home Medical Equipment.

Automation is seen as critical in the future state of health care. For OSF, there are about 80 projects in the queue to benefit from the technology.

“Using automation tools will reduce the heavy workload many of our teams face,” said Chris. “It also allows us to better leverage the uniquely human capabilities of Mission Partners to be empathetic, compassionate and creative as they work to provide the best service to our patients.”

Last Updated: May 28, 2024

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About Author: Denise Molina-Weiger

Denise Molina-Weiger is a Writing Coordinator for OSF HealthCare, where she has worked since March 2015. She initially came to OSF to write about the work taking place at the Jump Trading Simulation & Education Center, one of the world’s largest simulation and innovation centers and went on to become the Media Relations Coordinator for OSF Innovation which was developed to help the hospital system lead the way in transforming care.

Before joining the OSF HealthCare team, Denise was a reporter for Peoria Public Radio for ten years, writing on everything from politics, housing and transportation issues to hospital care in the region. She earned her bachelor’s degree in radio broadcasting from Western Illinois University in 2003 and received her master’s degree in public affairs reporting from the University of Illinois at Springfield in 2004.

Denise lives in West Peoria with her husband, son and two crazy dogs. In her spare time, she likes to snuggle on the couch with her family and watch cooking shows on Netflix. She loves taking road trips with her family and then complaining about it when they are over.

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Categories: Innovation