R1 Insurance Discovery Recovering More Than $150 Million for Leading Health Systems

Situation

Effectively managing missing or hidden insurance coverage remains a challenge for revenue cycle leaders, including R1 operators. Despite the rapid evolution of technology and advancements of AI, most insurance discovery solutions have remained unchanged. Many solutions exist, but each has challenges such as limited reach, dated technology or inefficient workflows.

Our customers chose R1 Insurance Discovery to access a cutting-edge search engine, higher-quality findings, and access to free coverage loading.

Solution

R1 Insurance Discovery: Leading technology and expertise drive immediate revenue gains

R1 Insurance Discovery finds coverage on self-pay, Medicaid, Medicare and commercial accounts. Additionally, R1 finds valuable secondary coverage that contributes to fee-for-service cash, DSH eligibility and Medicare dual-eligibility bad debt, and monitors patient accounts for retroactive Medicaid coverage. The intelligent search engine is tailored to find more valuable coverage by considering factors such as your region, payer mix and variations in patient data. For instance, R1 can identify missed coverage even when a patient provides a nickname instead of their full name.

Results

R1 Insurance Discovery recovers >$150M annually for our health systems post discharge

Early adopters of R1 Insurance Discovery replaced existing coverage discovery solutions and saw an increase of more than 10% in recoveries. This allowed clients to maximize reimbursement and reduce fees to secondary or tertiary vendors. Each client had their own unique internal processes and payer mix, and R1 tailored delivery to drive increased recoveries in a matter of months for all.