Fee Schedule Automation is here! We have released a BOT to automate fee schedule updates to workorders. This week we are starting with the Medicare Fee Schedule updates. This means that when a Fee Schedule updates and impacts more than 100 orders, the BOT will make the updates to the open orders, so we don’t have to and can spend our time on more critical tasks. This is a big win!

It’s an exciting time at NSM as we pilot new tools to help that utilize both Robotic Process Automation (RPA or BOTs) and AI:

Pilot 1: We are using a BOT to retrieve payer decisions via Availity for 12 specific payers and downloading the responses into a shared folder. The AGS Pending team reviews the folder daily, significantly reducing the time spent manually logging into Availity to locate payer response. The next phase of the automation process will allow direct uploads of responses into workorders in MA.

Pilot 2: We are using AI to review medical documentation for HCPCS E1161, K0005, K0856 and K0861 to ensure it meets Medicare coverage criteria. The goal is to decrease denials/deferrals by ensuring accurate documentation is on file, while also reducing the time it takes the funding team to review and validate documentation. A big thank you to pilot teammates Kent Phillips, Linnae Farrugello, Sarah Kirchoff, Vivian Sena!

Pilot soon to come: We are working on using Ushur AI to send text messages to our clients after submission and before PPQA, confirming their insurance, address, and place of residence hasn’t, or will not change, in hopes of limiting equipment we purchase that cannot be delivered due to one of these reasons.

We are also working on the following larger system enhancements:

Client Responsibility Collection Improvement - Create process and system improvement for client responsibility communication and collection which includes summary screen update and automation.

Crossover/Supplement Payer Improvement - Improved process that will introduce automation of the payer submission/authorization dates to mirror primary when we’ve identified a payer is a true crossover or supplemental payer.