Case Study: Leading Private Not-for-Profit Hospital achieves $1M recovery in 45 days and ~$8M annual revenue with Optum (2% net revenue improvement)

Leading Private Not-for-Profit Hospital - Customer Case Study

Leading Private Not-for-Profit Hospital, a Southeastern nonprofit health system with more than 1,000 beds and over $1 billion in annual net revenue, partnered with Optum to ensure full reimbursement capture. The hospital had an internal contract modeling system and believed revenue leakage was minimal, but suspected opportunities to optimize reimbursement; Optum was engaged to audit prior claims, validate contract modeling, and provide denial-management expertise.

Optum deployed its proprietary contract modeling, Audit and Recovery services, and Denials Management program to review two years of paid and denied claims, identify clinical documentation and coding conflicts, and appeal underpayments with payers. Within 45 days Optum generated more than $1 million in cash remittances, recovered additional denials (about 40% of underpayments), and ultimately delivered roughly $8 million annually thereafter—improving overall net revenue by about 2%—while reducing aged A/R, bad debt, and denial write-offs through ongoing analytics and process improvements.