Healthcare and Home Infusion Process Outsourcing

Delivering world-class results across the entire healthcare business process spectrum

Over a decade-long presence in the healthcare space has given us deep insights into the industry’s very interesting patterns and emerging trends, which we use to build our world-class solutions.

Learning from thousands of interactions every day, R-Regulus has deep experience in the healthcare sector. R-Regulus has supported leading global healthcare organizations, helping them run highly agile and value-enabled operations while constantly creating shareholder returns and exceptional patient experience. Our solutions combine all the best of analytics, technology, and the skills our people have to offer. More importantly, we constantly engage with our partners to build healthcare processes with greater focus on non-touch and right first-time approach.

We put forth continuous efforts to strengthen our expertise across the healthcare ecosystem. We have created long-term strategic partnerships and have helped clients turn challenges into competitive advantages, enhanced revenues, and cost reductions.

Putting the “Care” in Healthcare: Our Tech and Solutions

    • Outcome-driven people and innovative technology solutions across both payer and provider functions optimizing costs constantly

    • Decades of cumulative experience in the healthcare industry

    • Managing processes for global clients, including Fortune 500 organizations

    • Delivering services and intelligent automation products across the entire spectrum of Revenue Cycle Management

    • In-house Lean, Six Sigma, COPC, Analytics, and RPA teams that offer sophisticated solutions to clients constantly

Provider Value Proposition

Provider Value Proposition

    • RCM Front End/Patient Access

      • Intake management
      • New and existing enrollments
      • Eligibility and coverage
      • Patient records management
      • Payer changes and reverification

       

    • RCM Mid-Office

      • Diagnostics coding
      • Procedural coding
      • Charge capture

       

    • RCM Back-Office

      • Billing/suspended billing
      • Denials resolution and prevention
      • Appeals management
      • Payment posting
      • Refund/credit processing

Our solutions leverage healthcare support workers, including coders with credentials from CPC, CPC-H, CCS, and CCS-P from AAPC and AHIMA.

Business Impact Delivered

  • 100% of diagnostics coding for a hospital billing company
  • 35% reduction in turnaround time in coding process
  • Encore Coding Academy in Chennai that provides a steady flow of trained coders
  • 24-hour payment application Turn Around Time (TAT) improved from 64% to 96%
  • 50% improvement in first-time resolution in patient inbound calls
  • Enhanced Medicare collections to 90% paid rate (an improvement of 23%)
  • 98% Customer Satisfaction for a Fortune 500 major healthcare benefits provider
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All processes are strengthened with Lean, Six Sigma, and transformation capabilities and supported by specialized tools spanning the RCM cycle.

Healthcare Landscape: Provider

Payer Value Proposition

    • Member Acquisition and Retention

      • Quote generation
      • Correspondence
      • Enrolment and eligibility
      • Record management
      • Member loyalty program
      • Member query management

      Provider Operations

      • New provider onboarding and registration
      • Provider authorization
      • Provider data management

Operations and Administration

  • Billing/suspended billing
  • Claims indexing
  • Claims processing
  • Claims review
  • Claims adjudication
  • Claims editing
  • Fraud and abuse detection
  • Payment adjustment
  • Receivable management
  • Correspondence
  •  

Business Impact Delivered

Plugged revenue leakages of $2.1 mn by implementing DMAIC projects in Quotes process

Invoice processing referrals reduced from 13% to 1.8%

Overall TAT reduced from 4 days to 24 hours

FTR improvement from 68% to 88% using Six-Sigma and Lean processes

 
Integrated, unified, and scalable platform for managing end-to-end revenue cycle management services.

Our Clients

Driving technology for leading brands
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R-Regulus can help you redefine care through powerful innovation. Let our healthcare solutions elevate your business results.