This is our story of collaborating with a leading cancer center to transform its Revenue Cycle Management (RCM) operations. We streamlined fragmented processes, enhanced quality and scalability, and leveraged Artificial Intelligence (AI) and analytics to drive operational efficiency, reduce costs and improve care delivery.
As we know…
The healthcare industry faces mounting pressures to balance rising operational costs with the demand for high-quality, patient-centric care. RCM is a critical component in this equation, encompassing clinical and non-clinical functions like coding, medical transcription and quality management. However, fragmented processes, inconsistent quality and reliance on manual interventions often hinder operational efficiency and compliance, making it challenging for organizations to scale effectively.
Therefore, it’s paramount for healthcare providers to embrace next-generation technologies and domain experts to streamline processes and drive transformative outcomes.
The challenge for the client was…
It faced several industry-wide hurdles in its RCM operations, compounded by unique internal complexities. It sought to optimize processes and strengthen capabilities in the following areas:
As the domain expert and transformation partner…
WNS enabled a holistic, end-to-end overhaul of the client’s RCM operations, leveraging technology, process optimization and clinical expertise. Key aspects of the solution included:
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Process Re-design and Consolidation
Streamlined operations and reduced redundancies to enhance efficiency, minimize errors and lower operational costs
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Workforce Optimization and Analytics
Leveraged data analytics to optimize workforce allocation, ensuring effective resource utilization and driving improved productivity and performance
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Robotics, AI / ML for Automation
Automated repeatable tasks using advanced robotics and Artificial Intelligence (AI) / Machine Learning (ML), accelerating processes and enabling human resources to focus on complex, value-added activities
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American Academy of Professional Coders (AAPC):
Deployed a team of highly skilled, AAPC-certified coders to deliver superior accuracy and ensure compliance with healthcare coding and billing standards
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Expansion into Inpatient and Emergency Response Services
Demonstrated flexibility and a comprehensive approach by expanding from outpatient coding to inpatient and emergency response coding services, addressing a broader spectrum of client needs
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Coding Audit Services
Introduced an additional quality control layer through coding audits, ensuring adherence to regulatory standards and identifying improvement opportunities
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Clinical Expertise
Leveraged a workforce with deep clinical and transcription expertise to enhance coding accuracy and minimize the risk of errors
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Remote Process Migration
Facilitated efficient migration to remote processes, ensuring business continuity and operational flexibility, especially in dynamic environments
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Specialized Training
Delivered in-house training programs to equip staff with the skills and knowledge required to align with organizational standards and practices
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Volume / Quality Baselining and Documentation
Established robust baselines for volume and quality, enabling ongoing monitoring and continuous improvement
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Auto-upload Capabilities
Simplified integration with client applications through automated upload solutions, reducing manual errors and increasing operational efficiency
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Standardized Quality Tools
Employed in-house tools to maintain consistency and reliability in quality assurance processes
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Health Insurance Portability and Accountability Act (HIPAA) Compliance
Ensured strict adherence to healthcare regulations to protect patient data and maintain trust, supporting secure and compliant operations
The transformative solution…
Delivered significant operational efficiencies and measurable business benefits for the client, including:
Clinical & Non-Clinical Functions
percent productivity improvement through electronic data interchange adoption
percent productivity improvement through streamlined upstream processes
Medical Coding
percent accuracy at the chart level and 96 percent at the evaluation and management level
percent TAT achieved, completing batches two days ahead of the deadline
Increased the pool of AAPC-certified medical coders
Medical Transcription
Provided customized prioritization and classification of records
Enabled seamless auto-upload from WNS systems to client applications
Prior Authorization
+ prior authorization cases processed annually
percent of cases reviewed and initiated within a 24-hour TAT
percent+ accuracy in processing