R1 Awarded ‘Best in KLAS’ Across Multiple RCM Categories for 2026

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Underpayment Recovery

Find the revenue you’re leaving behind

Most hospitals and physician groups lose .5%-1% of NPR annually to underpayments or more – equating to millions of dollars lost. Increasing payer complexity and resource constraints make it challenging for healthcare providers like you to stay ahead on your own.

R1 improves recovery for hospital and physician underpayments by finding and collecting revenue other solutions miss and strengthening your internal teams.

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Uncover more underpayments opportunity

We help you navigate complex underpayment issues with proprietary technology and deep expertise in payer reimbursement methods (including Medicare), contract management and analysis, and clinical coding and billing. The scope of our underpayment safety-net solution can be customized to closed accounts or include aging open balance inventory.

R1 Underpayment Recovery helps patient financial services and revenue cycle management leaders optimize their back-end revenue cycle. That leads to improved cash flow, with fewer underpaid claims and denials. Start today to minimize future underpayments.

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Maximize recovery using advanced technology

Our advanced rules engine is multilayered and targeted to uncover deeper underpayments opportunities. We leverage AI, machine learning, performance metrics and R1 expertise to monitor and continuously refine the rules engine to uncover and recoup what others miss.

Unlock decades of deep audit and recovery expertise

The depth and breadth of R1 experience and knowledge in audit and recovery work is unmatched. Leverage our nearly three decades of experience to identify and fix root issues, educate your staff, and implement process improvements to prevent future underpayments.

Get real results quickly

Speed matters

As litle as

75

days to revenue collection

Collect more

Positive ROI in

90

days

Safety net

Annual recoveries for clients

$700M

Improve continuously using detailed reporting and analytics

Empower your team to monitor progress in real time with intuitive dashboards. Leverage our transparent reporting to give your team insights on root cause so you can drive continuous improvement upstream.

Ranked #1 by KLAS

We’re proud to be recognized for outstanding performance and customer satisfaction excellence in the Underpayemnt Recovery Services category.

A-

Loyalty

A-

Operations

A-

Relationship

A-

Services

B

Value

R1 is ranked #1 by KLAS® in Underpayemnt Recovery Services

R1 RCM is really good at reporting. They do very good high-level analytics and reporting in terms of how their services are supporting us. I am a data person, and I like to see the underlying data, so when I want to see the accounts that are represented in the data and I want different analytics in what they are showing me, they are always 100% open to providing that additional information to me.”

Underpayment Recovery Services KLAS Report, August 2024

Director

R1’s biggest strengths are their proprietary databases, proprietary systems, and the way that they can extrapolate our data and then explain to us where we missed opportunities. R1 is responsive, and they genuinely seem quite passionate about the work they do.”

Underpayment Recovery Services KLAS Report, January 2024

Director

R1 is an excellent partner. I would call them a partner, not a vendor. They have been with us for a long time, and as technology grows, they grow with it. They are into global services and automation, and we really like the automation part.”

Underpayment Recovery Services KLAS Report, November 2023

VP/Executive

Medical Underpayments FAQs

Underpayment recovery is the process of identifying and rectifying instances where healthcare providers have been reimbursed less than the agreed-upon amount for their services. This involves analyzing underpaid claims and payment data to find discrepancies, appealing underpaid claims, and helping them collect correct payments. Effective revenue recovery helps healthcare providers maximize revenue, improve revenue cycle management, and maintain financial stability. By addressing underpayments, providers can focus on delivering quality patient care without the added stress of financial shortfalls.

Underpayments in healthcare can occur for a variety of reasons, but usually originate from either the payer (including Medicare) or the provider side. Payers may underpay claims due to errors they interpret related to contract terms, DRG downcodes, insurance company denials, policy changes or medical necessity disputes. Physician practices can also cause underpayments through inpatient or outpatient coding errors, mistakes in patient information, improperly documenting treatment or other billing errors.

When managing hospital underpayment recovery, a systematic and proactive approach will be helpful:

  • Verify the accuracy of claims submitted and address any discrepancies right away. Communicate clearly and directly with insurers and government agencies to resolve issues swiftly.
  • Review the details of your payer contracts and fee schedules before tackling denials or underpayments.
  • Maintain thorough documentation and appeal denied claims to enhance recovery rates for healthcare systems.
  • Implement robust billing software to help with contract management, as well as automate follow-ups and track payments efficiently.

By emphasizing accuracy, transparency, and persistence, healthcare systems can effectively manage and mitigate the impact of underpayments on their operations.

Healthcare systems should implement robust auditing and monitoring mechanisms to identify underpayments or overpayments. This includes leveraging advanced data analytics and machine learning algorithms to detect anomalies and discrepancies in medical billing and payment processes. Regular audits, both internal and external, ensure compliance with regulations and accuracy in financial transactions. Incorporating automated tools can streamline the identification process, reducing human error and improving efficiency. Additionally, continuous training for staff on knowing payer contracts, coding and billing practices can help minimize the occurrence of payment inaccuracies, ultimately safeguarding revenue integrity.

Underpayments are becoming more common, but you can take steps toward addressing underpayments before they happen. New tools that leverage AI and machine learning can help your teams document patient care accurately and thoroughly, creating a workflow that supports proper coding and billing. Regular staff training on the latest reimbursement rates, pricing, coding updates and insurance policies is essential. Establishing strong and open communication channels with insurance companies helps resolve issues quickly and efficiently helps prevent future underpayments, ensuring fair and accurate reimbursement for services rendered.

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