Case Study: Multi-state Health System Doubles VA/Military Revenue

Challenge

A large, multi-state healthcare system operating several dozen hospitals experienced a common frustration. The situation involved managing the complex, arcane processes required for Veterans Affairs (VA) and other military insurance.

While qualified revenue cycle staff are in short supply across the board, those with VA expertise are especially hard to find. Like so many other organizations dealing with administrative burdens and resource constraints, the health system struggled to fully optimize VA claims and military insurance reimbursement. It needed to find a better way to manage the revenue cycle.

Solution

In its search for a strong revenue cycle partner, the health system selected R1. They implemented R1 Complex Claims, part of the R1 Acceleration Suite, to help improve VA claims management and increase revenue.

R1’s team of complex claims experts provided end-to-end services that spanned from eligibility and authorization verification to overturning denials. These experts also worked directly within the health system’s Epic environment, quickly becoming a trusted extension of the revenue cycle team. After implementing R1 Complex Claims at a number of hospitals within the health system’s Central Business Office (CBO), VA revenue took an immediate upward turn.

Results

Within five months of go-live, the health system’s monthly VA revenue jumped by 75% over its baseline average. The health system was so pleased with the initial results that it quickly added more hospitals from its CBO to the program and are exploring other complex claims for R1’s experts to support.

With those additional facilities online, monthly VA and military revenues have reached $3.2 million, effectively doubling the health system’s monthly VA and military revenue stream.