Revenue Cycle Managed Services

Hospitals and health systems are facing operational and financial challenges due to labor and resource shortages, shrinking reimbursement, increasing technology costs and the push to implement automation.

Established in 2002, PwC's Revenue Cycle Managed Services offer revenue cycle solutions, including standalone point solutions and customizable full-function outsourced services. PwC specializes in providing business process services across various functions (patient access, financial clearance, coding, insurance billing/follow-up and self-pay collections) for hospitals, medical groups and payers in a surge, partial or full-function outsource capacity.

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Best in KLAS

With an emphasis on quality, PwC’s Revenue Cycle Managed Services was recognized as being #1 in KLAS’ independent review for Extended Business Office Services in 2011, 2014, 2017, 2018, 2021, 2022 and 2023.

We've out-ranked our competitors as rated by consumers, in terms of satisfaction of services provided and exceeding expectations more months than any other vendor for the last thirteen years.

klasresearch.com

We focus on addressing your biggest challenges

Today’s issues faced by revenue cycles leaders:

  • Managing high volumes of data to drive decision-making
  • Preparing to consistently upskill workforce to match future capabilities
  • Evolving from a work queue-driven model to an adaptable, predictable and automated model with analytics as a backbone
  • Staffing shortages and high turnover rates
  • Low availability of qualified or experienced staff

We help improve your business outcomes

Automation and artificial intelligence

Aim to deliver cost-effective, high-quality outcomes by leveraging claims status, automated note entry, telephony AI, accounts prioritization powered by machine learning and process mining.

AR Command Center performance reporting

Provide unparalleled transparency through our secure online portal, AR Command Center, allowing your leaders to see the overall performance of your A/R inventory at any given time. We offer a variety of views, filters and data points to enable complete transparency and collaboration among our teams.

A global workforce to deliver value across the revenue cycle

Serve nationwide clients of all shapes and sizes across 100+ facilities and professional settings, using a global workforce to deliver value across the revenue cycle. We bring together solutions that span strategy through execution to help you manage and operate your core business functions.

Issues logs and root cause trending

Share insights and trends to help you fix systemic issues that are increasing your days in A/R. We do all this through our JIRA enabled issues logs and weekly project health check meetings.

Complimentary accounts receivable analytics

Offer a no-cost analysis of your A/R using our proprietary tools as a first step to understanding opportunities related to your accounts receivable.

Our offerings

PwC's Revenue Cycle Managed Services team has onshore and offshore staff ready to support you with a suite of services customized to your needs.

Legacy accounts receivable run-down

We can help manage your legacy run-down, while your team focuses on new EMR (electronic medical record).

Staffing backfill

Our trained staff can step in and cover the revenue cycle spectrum, if you’re experiencing staffing challenges.

Analytics

Our data analytics team can provide comprehensive analytics to help you identify performance and payer issues.

Full outsourcing/managed services/end-to-end revenue cycle

We have both onshore and offshore staff covering the full revenue cycle continuum, and can work to build the team that best fits your needs.

Financial clearance (insurance verification, prior authorization, etc.)

Our onshore and nearshore representatives can work with your patients and payers prior to appointments.

Coding support

We can support you with production coding or coding denials.

A/R follow up

We have a trained team ready to assist you with all of your A/R needs, including small balance, aging, hospital and professional.

Denials management

We provide comprehensive denials management including a team of certified coders, nurses and data analytics.

A virtual workforce that delivers efficiencies for your organization where you need it most.

What makes Revenue Cycle Managed Services unique?

PwC is a professional services firm that is committed to the individual success of each client.

  • 20+ years experience
  • Best in KLAS results, consistently ranking among the top providers for extended business office services
  • Scalability for any size project with access to a large pool of on- and offshore resources

  • Internally developed technology and automation, leveraging the latest tech and automation, including automated note entry, accounts prioritization powered by machine learning and process mining
  • Consultative wrap around approach, embedding consultants to optimize people, process and technology
  • Significant experience working with third-party payers, including Medicaid and Medicare

Our products

Resolution Queue

Our 20-year old automated work-driver tool for healthcare, third-party accounts receivable remediation and a variety of other business processes.

Resolution Queue is our proprietary workflow software that queues accounts to staff based on workstreams assigned by supervisors and tracks employee productivity. Its algorithms provide workable inventory that is actively refreshed and reconciled as it controls and distributes worklists, providing flexibility to track, categorize, prioritize and report on the status of accounts in real-time, on demand.

Instilling Quality

Our dynamic quality assurance tool that monitors work quality and automates flagging for added support.

Instilling Quality monitors the quality of our work, signaling where additional support may be necessary and helps us maintain a high-quality of work through effective communication with our clients. It’s a methodology coupled with an intuitive technology designed to objectively select and quantify the accuracy and completeness of staff follow-up actions on accounts.

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Contact us

Joshua Cahn

Principal, Revenue Cycle Managed Services, PwC US

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