Get an innovative approach to finding coverage
Staffing shortages continue to increase the pressure on health systems, constantly making it harder to balance revenue and costs. A significant piece of the problem comes from the time-consuming work of tracking down and billing missed or unknown insurance coverage. The traditional approach of juggling multiple vendors and relying on specialized staff is not only expensive but also unsustainable for many health systems. The fact is, they simply don’t have, and likely won’t have, the people they need.
R1 helps healthcare providers improve revenue recovery with an insurance discovery solution that leverages advanced technology to streamline the identification and billing of insurance coverage while reducing operational burdens and optimizing reimbursement for health systems.
R1 Insurance Discovery reinvents this critical healthcare revenue cycle function. It uses next-gen intelligent search technology, seeking out government and commercial coverage on self-pay, Medicaid, Medicare and commercial accounts. It also monitors patient accounts for retroactive Medicaid coverage and uncovers valuable secondary coverage that can contribute to fee-for-service cash, Disproportionate Share Hospital (DSH) eligibility and Medicare bad debt eligibility.
Automation and analytics revolutionize discovery
Steve Albert, executive vice president and chief product officer at R1, is enthusiastic about AI and its ability to help providers achieve financial health.
“We created this innovative solution to directly address a long-standing healthcare challenge,” said Albert. “Our Insurance Discovery solution is a unique blend of intelligent automation and deep-data analytics that revolutionizes the process of finding missing insurance for health systems.”
At the heart of R1 Insurance Discovery is an AI-enabled search engine tailored to deliver optimal coverage by considering factors for each health system. These can include region, payer mix and variations in patient data to improve accuracy and reduce false positives. For example, the solution can identify missed coverage even when a patient provides a nickname instead of their full name.
But finding more coverage is only half the battle. What sets R1 Insurance Discovery apart is how it loads insurance information directly into the customer’s EHR. This not only uncovers more coverage but also makes downstream processes smoother by automatically updating the EHR with the details needed for billing.
R1 Insurance Discovery is changing the way health systems recover revenue. Customers are seeing recoveries grow by 10% or more annually compared to incumbent solutions, totaling more than $150M in recoveries since launch, and the results are only expected to get better. By bringing together intelligent automation and deep-data analytics, R1 is helping tackle a challenge the healthcare industry has struggled with for years.
