In just two years, the collaboration between Allina Health and R1 recovered an impressive $22 million, showcasing their joint success in fortifying financial stability and operational efficiency. Through proactive strategies and optimized revenue solutions, Allina Health not only strengthened its financial standing but also fostered trust and collaboration. This successful partnership exemplifies how proactive measures and strategic alliances can significantly enhance healthcare institutions’ overall performance and success.
I wish every vendor would come to the table like this. Fix these challenges that we’re finding, and by the way, once you fix them, not only do [you] benefit from the revenue and costs and everything else going on, but we’re getting rid of problems for good. I think that has been a major win for us.”
Motti Edelstein
Vice President of Revenue Cycle, Allina Health
As a result of our partnership, Allina Health reviewed our spinal education tools and we reiterated with all the spine coders the level of specific detail needed to capture the correct codes. Many times, the documentation can be very easy to miss and can be as simple as just one sentence, so we were really able to elevate our training materials with that level of detail.”
Catherine Poirier
Coding Trainer, Allina Health
We’ve been very successful in this endeavor these past three years, collecting more than $13 million of our grand total since March of 2022. All that time, R1 has been there with robust analytics, finding these reimbursement opportunities. They are very knowledgeable, they are coders, they understand the work, and they can articulate and provide coding guidelines to correct the issues they find.”
Patricia Bower-Jernigan
Director of Clinical Revenue, Allina Health
Growing our partnership
Healthcare facilities: 12 hospitals, multiple clinics
Annual patient encounters: nearly 8 million
Net patient revenue: $3.2 billion
Services: DRG Validation, Charge Capture (Hospital and Professional Billing), Underpayments, Denials Management
Benefits: financial and operational enhancement
September 2020
Hospital Underpayments
Revenue recovery initiative
June 2021
DRG Validation
Improved billing accuracy
August 2021
Hospital Charge Capture
Enhanced revenue capture
May 2022
Professional Charge Capture
Increased professional billing accuracy
October 2022
Professional Underpayments
Addressed professional billing gaps
August 2023
Denials Recovery
Successful denial resolution
Results
$22M
in additional revenue since partnering with R1.
Challenge
Like all healthcare providers in 2020, Allina Health strove heroically to manage the overwhelming caseloads of the COVID pandemic. Meanwhile, in the business office, the revenue cycle team addressed the financial strains plaguing the balance sheet and identified underpayments as an area of opportunity. Allina Health kicked off its underpayments project in September 2020. While reviewing patient claims with a closed balance, R1 uncovered a significant number of underpaid claims and identified spinal fusion surgery coding as one specific area for improvement.
Solution
In addition to Underpayment Recovery work, Allina Health began leveraging the coding-specific reporting capabilities within DRG Validation. The enhanced technology R1 built with insightful feedback from clients like Allina Health enables the DRG review to spot a multitude of coding trends that are opportunities for upstream education; this transition provided continued confirmation that miscoding of spinal-fusion procedures was negatively impacting revenue.
Coding leaders from Allina Health and R1 worked jointly to educate staff on the proper capture and coding of spinal-fusion surgeries to recover missed revenue opportunity from payers on these cases and prevent future revenue leakage.
Results
By reviewing their spinal-surgery coding issues through the lenses of both underpayments and DRG Validation, Allina Health has more than halved spinal-fusion findings with a 52% overall reduction. To date, Allina Health has realized more than $22 million in additional revenue since partnering with R1.
