Discover how a large, multi-department hospital recovered more than $40M in revenue in a single year by changing its approach to denials management.

With over $1B in net patient revenue and 34,000+ annual discharges, the organization struggled to keep up with rising denials and appeals volume. Limited internal capacity forced the team to make tradeoffs, including choosing not to appeal certain DRGs and downgrading others at the time of denial, leaving reimbursement at risk.

To improve outcomes without adding burden to staff, the hospital piloted R1 Denials Recovery. R1 reviewed 25 cases that would have otherwise been closed without appeal and recovered $293,000, demonstrating the value of pursuing cases previously considered not worth appealing.

After the pilot, the hospital selected R1 as its sole denials management vendor. The partnership supported ongoing operational improvement through stronger denial identification, collaboration with payers, and consistent feedback loops. These efforts improved appeal turnaround times, increased payer accountability, and highlighted opportunities for denials prevention and clinical documentation feedback.

In the first year, the hospital referred 9,234 cases and recovered more than $40M. Today, the organization appeals 100% of denials and has a more scalable, insight-driven process to protect revenue and strengthen performance.