A billing company owner asked me recently whether or not automation—specifically software automation and robotic process automation—will wipe out the medical billing industry. This is someone who owns and runs a billing company and even implements some automation themselves. They have in-house engineers working on relatively simple automations, though not the more complex things. It’s an interesting question, especially posed by someone within the industry who is concerned about this.
There’s often a lot of hype around new technologies. The ChatGPT craze, for example, has driven me bonkers. Interestingly enough, OpenAI recently saw a drop in new downloads of their application for the first time. Sometimes, when things are overhyped, reality catches up. But it’s worth thinking about and asking: Is automation coming? How much is already here? How should we think long-term about these developments? Is it going to wipe out an industry?
The Role of Automation in Medical Billing
Some types of automation are really just replacing things that have existed for decades. For example, a company like PatientlySpeaking does automation by pushing data from one system into another, primarily using robotic process automation. This is essentially replacing interfaces and APIs. In the past, to do that, you built an interface from one system to another, pushing information from the original system into the new one. That was a form of automation, but it wasn’t robotic process automation. It wasn’t emulating a human’s actions; it was submitting data through an API, HL7, or other types of technology. Robotic process automation, on the other hand, emulates a human doing those tasks but does it much more quickly.
Some of this automation is replacing older methods, but it’s also slower in some respects. Robotic process automation is often slower on a per-record basis, even if scaled up massively in parallel, compared to an interface. So, while it’s a type of automation, it’s not entirely new—it’s really just a modification of older methods.
Lessons from Offshoring
If I go back to the 2000s when outsourcing to India for the RCM industry was becoming popular, whether through back-end BPOs or offshore captive operations for billing companies, there was a lot of concern that offshoring to India would wipe out the U.S. billing industry. It has not. It has changed the industry significantly, but it hasn’t wiped it out in any way, shape, or form.
Today, U.S. professionals are not doing charge entry and payment posting like they used to. That work has mostly gone offshore, although it still exists in smaller percentages, especially in in-house billing departments. For example, massive systems like UCLA or UPMC may still have people filling out billing forms, but much of that work has been offshored, either in-house or through BPOs.
As an industry, most of the U.S.-based roles left are for collectors, people handling patient calls, customer service representatives, and those doing analysis—essentially more complex, higher-level tasks like problem-solving. While not universal, we see a trend where simpler tasks are offshored more quickly. This trend is likely to continue with automation. Routine, rote tasks like charge entry and payment posting that are easily automated will likely be automated in the short term, although we’ll discuss what “short term” means in another podcast. Even in the medium term, we won’t move much beyond that.
Futurists and the Reality of Technological Change
Futurists—those who think about what’s going to happen over time—often underestimate long-term change. What will happen over a 30-, 50-, or 100-year timeframe is often massively underestimated. For example, at the turn of the 19th to 20th century, very few would have predicted the advent of flight, even though it was only a couple of decades away. Massive changes like international jet travel were not easily predicted.
Conversely, futurists typically overestimate short-term change. Less than 20 years ago, in the early to mid-2000s, I was working in electronic medical records software, and many of us in that industry thought we would completely eliminate the medical billing or revenue cycle management industry. We believed that our software applications would make the entire field obsolete. We even dismissed medical billing companies as potential business opportunities because we thought the industry wouldn’t exist in five or ten years.
Well, 20 years later, we were obviously wrong. The industry is thriving, and it’s clear that the dire predictions didn’t come to pass. The moral of the story is that there’s often a lot of hype and expectation around new technologies that are supposed to eliminate entire industries. The reality is that, over very long periods—whether it’s decades or 50 years—some things are indeed eliminated. But even in those cases, it doesn’t happen as quickly or as completely as expected.
The Future of Automation in RCM
Don’t assume that automation is going to wipe out revenue cycle management, certainly not in the short term. It’s partly a bit of hype, and while we’re going to see a lot of change as a result of these advancements, it won’t eliminate the industry.
Why has automation been so slow to take off? We’ll talk about that in our next podcast.
