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R1 RCM: One Stop Partner for Comprehensive Revenue Management

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Abhijeet Pawar,Country General Manager

Abhijeet Pawar

Country General Manager

In the US, healthcare providers continue to face declining reimbursement rates, rising operating costs and fierce competition for patients – all resulting in compressed profit margins. 2017 was a record year for not for profit tax status hospital bankruptcies and the outlook for this year and next are no better.

Amid all of this, the U.S. healthcare industry continues to strive to improve not only healthcare quality outcomes for patients but also how providers are paid for their services. Specifically, to improve getting paid the correct amount and receiving payment in a timely manner after services are provided.

Adding on to how they get paid, hospitals are also trying to improve the patient’s financial experience. As more of the burden falls on the patient with copays and deductibles, there are now more ways the revenue cycle can touch the patient and have a positive impact on their experience.

Diverse Models of Revenue Cycle Management
One way innovative hospitals are approaching this challenge is by

outsourcing their revenue cycle operations. Just like hospitals outsource laundry and other services, many have realized that they aren’t experts in those areas and that it was just taking time away from what they are experts at providing care. Whether partnering with firms to manage their entire process or utilizing modules for specific areas of need, hospitals are relying on partners like R1 RCM to free them to spend time on what matters most the patient.

"R1’s service offering consists of end-to-end RCM, where R1 takes responsibility for achieving improved performance as measured by agreed upon metrics and scores"

Based out of Chicago, with offices in India across Gurugram, Noida and Hyderabad, R1 RCM has been providing revenue cycle services to healthcare providers across the United States to help them transform and manage their revenue cycle operations so they can focus on delivering great patient care.

End-to End Outsourcing
R1's service offering consists of end-to-end RCM, where R1 takes responsibility for achieving improved performance as measured by agreed upon metrics and scores. The end-to-end service solution is provided as a co-managed relationship, or in a partnership model where the client’s staff become R1 employees. Once implemented, R1’s technology solutions, processes and services are deeply embedded in the customers’ day-to-day operations.

Modular Services
R1 also offers modular services to solve specific RCM problems. And while most of the market players are focused on

selling software licenses, R1 provides
technology-enabled services to address challenges related to medical denials, appeals, coding revenue capture and more.

For example, for medical denials, R1 assists hospitals in complying with payer requirements regarding whether to classify a hospital visit as an in-patient or an out-patient observation case for billing purposes, while the company's revenue capture offering includes charge capture, charge description master (CDM) maintenance and pricing services that help providers ensure they are capturing the maximum net compliant revenue for services delivered.

R1 is also helping hospitals as they build their brand. Attracting and retaining patients is key to brand success and in today’s world where negative consumer experiences are plastered on social media, ensuring patient satisfaction becomes everyone’s responsibility, including those in revenue cycle management.

With tools that improve the scheduling, registration and bill paying consumers face, R1 is showing hospitals how RCM can improve the patient experience. From preestimates to financial counselling to self-service registration technologies, R1 is helping hospital give patients what they want.

The headwinds providers are facing are not letting up, resulting in pressure to think differently about their business. Given the deep domain expertise and years of experience across revenue cycle management, R1 has gathered the know - how to bring a thoughtful and flexible approach to meet their customers’ needs.

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