Providers and insurers have to talk quite a bit. Does a procedure require a prior authorization? Is a claim approved or denied? What is a patient’s eligibility for services? Providers have a great many questions for payers every day, questions that directly affect their revenue streams.

St. Francis Hospital in Columbus, Georgia, was buried in the day-to-day manual processes of dealing with payers. But then it adopted web-bot technology to query payers and everything changed. Before the web-bots, St. Francis’ annual point-of-service collections totaled about $1 million in 2012. That figure doubled in 2013, the first year with web-bots. It grew to $3 million in 2014, $4.2 million in 2015 and $4.9 million last year.

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“That is directly a result of being able to give patients fast, accurate answers via the web-bots on what they will owe for services,” said Linda Glass, patient access director at St. Francis Hospital. “And hospitals must have that ability now that patients have become ‘payers’ too.”

The web-bots, from Recondo Technology, replace manually sending out one-by-one queries to payers with instant transactions that immediately find the information a provider seeks.

“We use web-bot technology to automate much of the communication it requires to get answers from payers on a range of questions, such as a patient’s eligibility for services and price estimates based on the patient’s real-time coverage levels,” Glass said. “Recently, we’ve also begun using web-bots to query payers to obtain authorization numbers for procedures. The web-bots paired with rules-based engines get highly accurate answers.”

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For example, if St. Francis needs information on a patient’s eligibility and financial responsibility, the web-bot logs into the appropriate payer’s website on St. Francis’ behalf, using St. Francis’ credentials. It then pulls the patient’s contract in readable form so St. Francis can search to see what is covered and for how much.

Or, for instance, if St. Francis needs an estimate of a patient’s cost for services, the web-bot compares the patient’s eligibility for services, as reflected in the payer contract, with St. Francis’ chargemaster, and then it creates the estimate.

“My staff used to kick off every morning by grouping all our queries in stacks according to each payer,” Glass recalled. “So we’d have our Cigna stacks, our Aetna stacks, and so on. Then we’d work our way through them. This would involve calling the insurance company, which usually had a three-query limit per call. So even if we had been on the phone for 30 minutes already, we would still have to call back if we wanted answers on the next three queries.”

When payer technology got a little better, St. Francis was able to log on to payer websites and get information, but the hospital still had to manually input patient insurance information, which was time-consuming.

“Now it’s just a matter of inputting a field or two in the web-bot and it pulls eligibility and patient financial responsibility on its own,” she said. “It also automates most of the authorization query process.”

Glass said the technology has completely changed workflow and that she and her team are at a performance level that is well above best practice standards for revenue cycle management.

“No longer do we have to slog through all the daily stacks; the web-bot solution does much of this interaction with payers instead, at a fraction of the time it used to take us,” she said. “So we haven’t had to increase our staff or contract out with a third party; one of which we would have had to do at some point without web-bots.”

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com