Reduce Denials + Underpayments
SUCCESS STORIES
Prevent denials from diminishing revenue.
We help providers stay ahead of denials.
denial rate
as % of NPR
overturn rate
“Ensemble’s team has a degree of focus and commitment to overturning every stone with a diligence and thoroughness you simply don’t see with a lot of other partners across the revenue cycle.”
SVP, Revenue Management, Southeastern Health System
CLIENT SNAPSHOT
Community health system lowers first-pass denials by 43%.
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 proprietary AI to catch errors before they resulted in denials. The system saw a 43% reduction in first-pass denials and 44% decrease in AR aged over 90 days.
CLIENT SNAPSHOT
Physician practice group reduces denials by 48% with end-to-end partnership.
Facing increasing financial pressure, a 10-clinic system engaged Ensemble for end-to-end revenue cycle management based on a referral from its community connect partner. Here’s how we helped:
Clinical denial appeals
Clinically trained denials specialists exhausted all appeal and recovery efforts
Cash acceleration
Strengthened charge capture and denial follow-up for $550K increase in monthly collections
Ongoing training
Established regular reporting, communication and training for practice alignment
CLIENT SNAPSHOT
Despite working with multiple underpayment vendors, a southeastern health system felt it was missing out on revenue opportunities and wanted a more tactical, hands-on approach. It engaged Ensemble to perform a deep dive into its accounts to recover revenue and prevent future underpayments.
Ensemble deployed AI to eliminate false variances and detect anomalies other vendors missed, recovering $5 million and preventing $1.5 million in underpayments annually.
CLIENT SNAPSHOT
Ensemble’s secondary zero-balance review yields $13M in recoveries.
A midwestern health system needed a secondary partner to focus on opportunity untouched by its primary vendor: zero-balance accounts. How we helped:
Resolved rev code errors
Billing edits resolved revenue code errors that were causing millions in underpayments
Prevented underpayments
Predictive AI and anomaly detection identified and prevented $20M+ in underpayments
Led contractual disputes
Identified and disputed > $6M in underpayments based on contract language for implants