INDUSTRY LANDSCAPE: Reform driven healthcare provider industry is expected to undergo significant IT and operational changes as The Patient Protection and Affordable Care Act(PPACA) is set to overhaul the entire healthcare system. The rise in healthcare claims submission, increased consumer driven health plans, Medicare reimbursement cuts by ~ 8%, performance linked payments by payers, mandatory IT augmentations such as EHR, HIPAA 5010, is resulting in a paradigm shift in the functioning of healthcare provider industry.

In order to optimize payments for their services they are focusing on improving quality and outcome of patient care, directing funds towards IT enhancement and driving operational efficiency to cut costs. The healthcare provider industry is focusing on what they do best, that is providing qualitative patient care and relying on other vendors for support in driving business and operational excellence.

WIPRO INDUSTRY SOLUTIONS: Wipro BPO is one of the pioneers in providing healthcare provider industry solutions. Our services and solutions address administrative, non-clinical and clinical work functions, which enables healthcare providers to provide quality time to patient care. Our focus is on developing an Extended Service Partner model to address major back-office functions such as Revenue Cycle Management, Medical Records Retrieval, and Clinical Process Services. With unique propositions like dedicated business support units, Six Sigma, Kaizen and Lean methodology, Wipro is committed to providing transformational business outcomes and value creation for its customers. Wipro ensures execution excellence across customer engagements through its three tenets - People, Process and Technology. These tenets have helped our customers achieve process and cost efficiencies, and enhance overall customer experience.

WIPRO INSIGHT

Revenue Cycle Management- We have extensive experience across the Revenue Cycle. To battle out decline in reimbursement rates, Healthcare Providers will have to look into the efficacy of revenue/ charge capture and which is fuelling the greater integration of pre and post intervention services. Wipro’s highly experienced team of Billing specialists will carry out extensive review of Patient’s medical records and carry out Charge integrity review to identify and resolve discrepancies in charge capture process to improve billing efficiencies

Patient Access Management- Healthcare reforms and focus on core business would lead to increase in Pre-Intervention services. Wipro provides a Patient Access Portal for scheduling appointments, registration, updating information and bill payment besides Real Time Web link with Payer network to check eligibility during registration/ scheduling. We have Patient Financial Counselors to assist patients in understanding the complex payment systems

Medical Coding- Medical coding in the Healthcare Providers arena would remain as the most significant individual service element. Impending shortage of ICD-10 certified coders is driving increased adoption of coding BPO as a discrete service among all buyers within this segment. Wipro has certified coders for Coding of ICD-9, HCPCS and CPT-4 codes and automated workflow enhanced by computer assisted coding. Records review and intimation provided to providers on need for / lack of documentation. We handle over 200, 000 cases annually with an accuracy of >95%.

AR and Denial Management- Urgency for increased revenue capture will boost adoption of traditional methodologies such as A/R outsourcing among the Financially Distressed segment. Wipro has a pool of highly experienced, trained, and certified resources to handle A/R management center. We have an automated workflow to manage allocation, handling of exceptions and reporting

Customer Contact Center

Wipro is one of the leaders in the Customer Contact Center space with over 13,000 FTEs handling over 23 million calls every month for 40+ global customers in 20 different languages.

Wipro offers Customer Contact Center Services that include inbound and outbound call Centers, e-mail and correspondence response and chat support services to Healthcare Providers.

Corporate Business Services- Wipro offers integrated suite of services for the corporate back-office that includes finance and accounting, human resource management and a source to pay that will be enabled by a proprietary workflow solution Base)))TM . Wipro has over 6000 resources delivering these services to our Global clients in a multi-shore delivery model.

Clinical Process Outsourcing- Teleradiology and 3D image reconstruction is an “extreme” professional service with widespread usage of approach. We have a team of radiologists performing the activity of 3D reconstruction; radiology perspective enables them to understand the anatomy. Wipro expertise in the area of Clinical process spans across 3D reconstruction & Processing Services for MR Angiographies and CT, collaborative reporting and Treatment planning for Oncology and Orthopedics. We have HIPAA compliant facility, which can provide 24 x 7 x 365 coverage.

Remote Health Monitoring- In order to improve the Quality of Care providers are resorting to increased adoption of Telemedicine. Wipro’s capabilities in the area of remote health monitoring include:

  • Remote Patient Monitoring
  • Disease Management/ Wellness Counseling
  • Customer Contact Center
TOOLS / ENABLERS

Workflow and Workforce Management Tools: To facilitate claims inventory management, calls management, capacity planning, agent rostering and real-time agent monitoring

E-SPECTRUM: A web-based proprietary knowledge management tool that disseminates information such as business rule updates, state mandate updates etc to all the claims processors on the floor in a single instance

CLICK TO CHAT: A virtual chat solution that has the ability to respond automatically to 80% of the customer inquiries and reduces contact center staff by over 50%.

Speech Analytics Tool: A web-based analytics tool that aids in analyzing the pattern and reason for repeat calls, calls with high AHTs and root causes of irate customer calls which will in turn help our clients to identify and introduce mitigation measures to stem customer attrition and improve CSAT scores

Global Listening Platform: A combination of third party Social Media Monitoring tools coupled with Wipro's robust analytical process to analyze and report customer perceptions on Social media to enable proactive corrective actions by Wipro's clients

BUSINESS IMPACT
  • Wipro Reduced Length of Stay of patients by 30% (from 72 hours to 48 hours) and Reduced costs by over 60% by adopting a flexible Pay-per -Case pricing model for a leading teaching hospital in US
  • Wipro has efficiently coded a volume of 200,000 visits per annum for a Healthcare Provider at an impressive CSAT score of > 95% for a Leading provider of Kidney care and Dialysis Services company in the US
  • With Wipro’s Automation of call list we were able to increase Contacts/hour by 68% together with achieving a Quality Target of 97.62% as against a target of 90% for A Leading US based Community Voluntary Health Organization for Cancer
  • For queries and better understanding of our services offerings, please mail: healthcare.bpo@wipro.com

 
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