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Modern Revenue Cycle Management (RCM) necessitates digital transformation to overcome the hurdles of rising costs, staying financially healthy, claim denials and value-based care reimbursement. To thrive in this complex ever-evolving highly regulated ecosystem, providers and health systems need to re-evaluate operational strategies to maximize revenue and drive experience.

WNS’ RCMplify is a comprehensive solution that helps providers and health systems amplify revenue and boost process accuracy, efficiency and compliance. Our team of RCM specialists, coders and collection specialists, offer end-to-end RCM services from patient scheduling and claims submission to denial management and Appeals and Grievances (A&G). We leverage our domain expertise enabled by digital solutions to drive profitability and superior business outcomes.

 

99%

Accuracy in Medical Coding

15%

Reduction in Denials (Predict and Prevent)

90%

Clean Claim Rate

30%

Improvement in Collections

40%

Debt Reduction

19%

Increase in Allocated Cash

99%

Resolution and Closure Rate

99%

Accuracy in Medical Coding

15%

Reduction in Denials (Predict and Prevent)

90%

Clean Claim Rate

30%

Improvement in Collections

40%

Debt Reduction

19%

Increase in Allocated Cash

99%

Resolution and Closure Rate

Our proven track record includes

  • Managing over 2 million eligibility verifications
  • Handling 1,20,000 authorizations with precision
  • Coding and billing more than 8 million charts with >99% accuracy
  • Overseeing 7.7 million claims and efficiently managing 1,00,000 denials
  • Processing 50,000 appeals each year
  • Abstracting over 2.5 million charts

Experience Simplicity and Ease of Operations with RCMplify

Comprehensive solutions to transform and optimize Revenue Cycle Management (RCM) operations underpinned by extensive domain expertise and cutting-edge digital solutions

Front-End

Front End

Pre-visit

  • Scheduling and patient registration
  • Eligibility and benefits verification
  • Appointment reminders
  • Prior-authorizations

Visit

  • Patient check-in and patient pay estimates
  • Copay and deductible collection
  • Payment arrangements
Transaction-Processing

Mid-revenue cycle

Medical Billing and Claims Submission

  • Charge entry and capture
  • Medical Coding
  • Clinical Documentation Integrity (CDI)
  • Claims scrubbing
  • Claims submissions
  • Electronic Data Interchange (EDI) management
  • Electronic Remittance Advice (ERA)/Electronic Funds Transfer (EFT) processing
  • Payment posting
  • Cash reconciliation
Back-End

Back-end

Accounts Receivable Management

  • Claim status
  • Denial management
  • Appeals and follow-ups
  • Request for information
  • Patient statements inbound and outbound calls
  • Collection letters
  • Small balance write-offs
  • Payer and patient collections
  • Credit balance, recovery and bad debt
 

Differentiated Approach for Magnified Outcomes

WNS’s RCM strategy is designed to enhance care delivery and ensure accurate reimbursement through a balanced approach of people, processes and technology

  1. Streamlined Front Office Operations

    Implementing robust processes to ensure comprehensive documentation from the initial patient encounter through to billing submission.

  2. Optimized EDI Claims Management

    Leveraging advanced EDI platform experience in Availity, Emdeon and EPIC to achieve a high success rate in electronic claims processing.

  3. Cost-effective Exception Management

    Utilizing right shoring to manage back-office RCM functions, with performance measured by key metrics like cost per claim, clean claim percentage, net collections rate, gross collections rate, days sales outstanding (DSO), denials percentage and bad debt.

  4. Advanced Digital and Automation Technologies

    Employing sophisticated digital tools, robotics and machine learning for enhanced automation in claim status updates, cash applications and billing and coding, leading to accelerated collections.

  5. Enhanced Patient Experience

    Fostering clear communication with patients and expanding self-service options to improve overall satisfaction and engagement.

Differentiated Approach for Magnified Outcomes

The WNS Advantage

  • 20+ years of proven RCM expertise
  • RCM Center of Excellence (CoE) model and coding academy
  • Outcome-based pricing models focused on revenues (percentage of collections)
  • Certified clinical staff, including nurses, physicians and medical coders
  • Strategic right shore delivery centers for significant cost advantages and scale
  • Customized digital solutions, including intelligent automation, advanced analytics and platform capabilities