The ideal way to create value through revenue cycle transformation is to optimize it holistically, from end to end. In a co-management partnership, we’ll partner with your revenue cycle operations team to optimize operations from scheduling and patient access through claims and reimbursement.
By partnering in this way, we’ll not only optimize each revenue cycle process together; we’ll optimize the interface points between processes, where we fundamentally believe the most value can be achieved.
R1 Revenue Integrity Solutions leverage advanced technology and analytics, a proprietary rules engine and extensive project management and healthcare expertise to help provider gains accurate reimbursement for the care provided.
Analysis of payer contracts and chargemaster to identify opportunities for improved compliance and consistency in billing structure with management of any corrections or rebills necessary.
Identification of incorrect coding and missing charges, and review for net revenue potential. Analytical insights influence process change to reduce or eliminate future occurrences.
Analysis of managed care and government payer contracts, and creation of scenarios modeling the revenue impact of changes to insurance contracts, charges, coding and pricing
Analysis of patient accounts and claims to determine proper use of CPT and HCPCS codes and DRGs.
Evaluation of all transfer-eligible accounts to identify potential missing reimbursement and management of the rebilling process with Medicare to receive appropriate payment.
Identification of accounts that have been incorrectly reimbursed or denied, and management of the appeal process to gain correct payment.
Analysis of the chargemaster, payer contracts and market competitiveness to identify areas of pricing opportunity and to create pricing scenarios aligning with strategic goals.
R1 has helped find additional dollars in net revenue for our health system. Projects such as CDM optimization, coding/charging review, and TDRG have generated over $10M in additional net revenue since their start. Those projects are projected to produce over $3M in net revenue again in 2018, which is over a .4% lift on our NPR.
The revenue integrity projects R1 has worked on for us are expected to generate $6.5M, which is over a .9% lift of our NPR. I would recommend R1 to any hospital system looking to boost their performance in the revenue integrity space.
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