An innovative approach to finding coverage
In the wake of the pandemic, ongoing staffing shortages have only intensified the revenue and cost pressures health systems face year after year. A portion of providers’ losses stems from the arduous task of finding and billing unknown or missed insurance coverage for patients. The traditional methods, which often involve employing multiple vendors, are not only costly but also require trained staff that health systems currently lack and may not acquire in the foreseeable future.
R1 has launched a new insurance discovery solution to help healthcare providers improve revenue recovery by leveraging advanced technology that streamlines the identification and billing processes of insurance coverage and reduces operational burdens to optimize reimbursement for health systems.
R1 Insurance Discovery reinvents this critical healthcare revenue cycle function. It employs intelligent search technology that surpasses typical strategies, 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 this new solution 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.
However, finding more coverage is only half the battle. R1 Insurance Discovery stands out as a differentiated solution by its loading of insurance information into the customer’s EHR. This feature finds more coverage and streamlines downstream processes by updating the EHR with the coverage details required for billing. That will become a fully automated process in an upcoming release, according to Albert.
R1’s Insurance Discovery solution is designed to transform the way health systems recover revenue. Early customers are already seeing a 10% or more increase in annual recoveries as compared to incumbent solutions, and we expect higher results over time. By combining intelligent automation with deep-data analytics, R1 is providing a much-needed solution to a longstanding challenge in the healthcare industry.
Learn more about R1 Insurance Discovery or speak with an expert on your specific coverage discovery need.
