CASE STUDY
Community health system lowers first-pass denials by 43%.
Partnership modernizes revenue cycle to address growing needs of community.
SNAPSHOT
A 7-hospital system engaged Ensemble for end-to-end revenue cycle managed services after poor financial performance threatened its ability to meet the needs of its community.
Ensemble transitioned and upskilled the system’s staff, filled talent gaps, streamlined processes and applied AI-infused technology to catch errors before they resulted in denials. The system saw a 43% reduction in first-pass denials, a 3x increase in point-of-service collections and a 44% decrease in AR aged over 90 days, enabling investment in new equipment and expanded community care.
PROFILE
- Nonprofit health system
- < $1B NPR
- Midwest
- End-to-end RCM partner since February 2018
Challenges
The strategic and operational review of the system’s revenue cycle identified the root causes of suboptimal cash performance, low point-of-service collections, high volumes of unbilled claims inventory and a considerable amount of accounts receivable over 90 days. Contributing factors included insufficient education and training, fragmented operations and an outdated Epic system configuration.
Solutions
The partnership with Ensemble enabled the health system to use a mix of AI-infused technology, process refinement and industry expertise to streamline operations, identify root causes and improve financial performance on a large scale.
- Used proven methods and scripts to enhance POS collections while maintaining the patient experience
- Established denial reporting and prevention, using AI to identify potential denials with operational leaders working with front-end staff to optimize processes
- Provided comprehensive ongoing training and education on revenue cycle management best practices
- Optimized Epic to fully utilize its features and capabilities
Results
denial rate
POS collections
AR > 90 days