Automation in Revenue Cycle Management: Where It Delivers Real ROI (Not Just Hype)

For years, automation in revenue cycle management (RCM) has been talked about as “the future.” That future has arrived. Between workforce shortages, rising denial rates, and tighter margins, health systems are no longer asking if they should automate, but where and how much.

The good news: the ROI is no longer theoretical. Industry data now shows clear financial and operational gains when automation and RPA are deployed thoughtfully in RCM.

What the Numbers Say About RCM Automation ROI

Several recent studies and case examples paint a consistent picture: automation cuts costs, speeds payments, and reduces denials.

• A survey of healthcare financial leaders found organizations using automation in the revenue cycle had an average cost-to-collect of 3.51% vs. 3.74% for those without automation. On a $5B health system, that difference equates to ~$11.5M in annual savings. (AKASA)

• Research cited by AHIMA notes that RPA can reduce revenue cycle costs by 25–40%, with nearly double the productivity improvement compared to outsourcing alone. (AHIMA Journal)

• One report showed healthcare organizations using RPA in billing processes can cut costs by around 20% over five years, with some automating up to 70% of back-end billing workflows. (medicalhealthcaresolutions.com)

• A case study of a large physician group that automated claims and denial management reported a 35% drop in denial rates and an 18% increase in net collections within a year. (TSI)

• In prior authorization, automated electronic submissions have been shown to save 7–9 minutes per auth, increase auto-approval rates by 25%, process 53% more cases, and cut decision time to under two minutes. (AGS Health)

• A KLAS study of automated prior auth solutions found 78% of organizations reported improved financial performance, largely due to fewer denials and faster approvals. (KLAS Research)

Taken together, the trend is clear: when you remove manual touches from repetitive RCM tasks, cost-to-collect drops, throughput increases, and denials become more manageable.

Where Automation Delivers the Biggest Wins

1. Front-End & Patient Access

• Eligibility & benefits checks

• Prior authorization routing and status checks

• Patient estimates and notification workflows

Automating these steps reduces delays, improves upfront collections, and prevents avoidable denials later in the cycle. Multiple case studies show that prior auth automation alone can shrink turnaround time by 50–70% and materially reduce denial rates. (KLAS Research+1)

2. Mid-Cycle: Coding & Charge Capture

This is where AI and “deep reasoning” tools start to shine.

Traditional RPA excels at structured, rule-based tasks: moving data, clicking buttons, updating fields. But coding and charge capture involve clinical nuance, documentation interpretation, and guideline logic. This is the layer where tools like CareCodeAI come into play:

• Deciphering long, complex notes across multiple specialties

• Suggesting CPT, ICD-10, and modifiers based on context, not just keywords

• Surfacing potential undercoding/overcoding risks and documentation gaps

Used together, RPA and AI can create a powerful mid-cycle workflow:

1. RPA bot pulls encounter data and notes from the EHR.

2. The note is safely processed through CareCodeAI, which strips PHI before model interaction and returns structured codes plus rationale.

3. RPA then writes the codes back into the billing system and updates work queues.

This pairing turns what used to be a heavily manual task into a high-speed, high-compliance pipeline, while still keeping a human coder in the loop for oversight.

3. Back-End: Billing, Denials & Cash Posting

On the back end, automation is already delivering measurable ROI:

• Bots that post payments and adjustments from standardized remits

• Automated workqueues that prioritize denials by recoverability and dollar impact

• RPA that submits reconsiderations or corrected claims at scale

Real-world examples show denial processing time reductions of up to 60% when RPA is applied to routine denial tasks. (GeBBS Healthcare Solutions)

Why Automation ROI Is So Strong in RCM

The revenue cycle is uniquely well-suited to automation:

• High volume, repetitive work: claims, payments, denials, status checks

• Rule-based decisions: payer rules, edits, policy-based routing

• Data-rich environment: structured fields ideal for RPA and AI

Industry analyses highlight that AI and automation in RCM consistently:

• Reduce administrative costs

• Increase clean-claim rates

• Shorten payment timelineswhile maintaining or improving compliance and accuracy. (Notable Health+1)

RPA + CareCodeAI: A Practical “Better Together” Example

Many organizations are starting to think beyond point solutions and ask: How do we combine tools for compound ROI?

One emerging pattern is pairing:

• RPA for the mechanics (logging into systems, moving data, updating statuses), and

• CareCodeAI for the thinking (interpreting clinical documentation, suggesting accurate codes, flagging risks).

In practice, this can look like:

1. RPA gathers daily encounter lists and associated notes.

2. CareCodeAI processes each note, returning suggested CPT/ICD-10/modifier combinations and compliance checks—without sending any PHI to the underlying AI models, thanks to its de-identification workflow.

3. RPA posts approved codes back to the EHR/billing system and advances the claim to the next step.

The result is 3–5x faster coding throughput on complex, multi-site outpatient encounters, while freeing coders to shift into higher-value roles like denial prevention, audit, and provider education—multiplying the ROI beyond simple “hours saved.”

How to Build a Business Case for Automation

If you’re trying to justify investment in RCM automation, start with a focused, data-driven approach:

1. Baseline your metrics

   • Cost-to-collect

   • Denial rate and avoidable denial categories

   • Days in A/R

   • FTE hours per task (e.g., prior auth, coding, denials)

2. Choose 1–2 high-friction processes

   • Prior authorization

   • Denial management for a specific payer

   • Outpatient coding for a high-volume specialty

3. Model the impact using industry benchmarks

   • 20–40% cost reduction ranges for RPA in RCM AHIMA Journal+1

   • Time savings and denial reduction from prior auth/coding automation

4. Run a 90-day pilot - Track actual gains: hours saved, denials prevented, faster cash, reduced backlog.

5. Use the pilot to scale - Once ROI is proven in one process, expand automation to adjacent workflows.

The Bottom Line

Automation in RCM is no longer experimental—it’s a proven lever for:

• Lower cost-to-collect

• Higher net collections

• Faster reimbursement

• Reduced burnout for billing and coding teams

RPA handles the clicks; tools like CareCodeAI handle the thinking. Together, they turn the revenue cycle from a manual grind into a streamlined, data-driven operation that actually moves the needle on margin and mission.