Revenue Capture

TRANSFORMING REVENUE CYCLE MANAGEMENT

Ensure reimbursement reflects patient care delivered.

Reinforce revenue capture

Ensure accurate reimbursement for the care delivered and remain compliant with ever-changing regulations.

Attention to detail matters.

The attention you put into patient care should be matched by the attention put into claim accuracy.

Utilization Management + PHYSICIAN ADVISORY

Prevent denials with appropriate level of care and authorizations

Experienced physicians and utilization review nurses with clinical expertise combined with real-time analytics to track conversion rate, two midnight rate, peer-to-peer win rate, initial denial rate and total denial write-offs.

Intelligent workflow to optimize the review of level of care appropriateness

UR nurse review of observation patients within 24 hours of order

Analytics-driven workflow to assist physicians in patient statusing,  concurrent follow-up on pre-bill medical necessity denials, and peer-to-peer reviews

Nearly 60% of observations successfully converted to inpatients

Centralized, streamlined process for verification, notice of admission, inpatient/observation authorizations, status changes and discharge notification to payers

Medical necessity/statusing verified within 24 hours of order

Operator Insights: Utilization management

“As a physician, I intuit so much but I don’t document it. What the payers are asking us to do now is document our thought process,” said Dr. Robert Wagner on the role of utilization management in the revenue cycle.

Health Information Management

Prevent lost revenue with accurate and efficient coding and documentation

Leverage advanced technology to detect missing charges and coding errors prior to billing and provide real-time targeted education to prevent future errors. 

Acute care, inpatient, outpatient, DRG assignment and ED coding combined with internal coding quality audits

7-day-per-week coverage with 98% quality scores

“Human + machine” approach to review 100% of inpatient accounts in real time to identify coding errors and query opportunities

5%–10% average error rate identified on inpatient charges

Operational assessment and development of HIM policies, procedures, KPIs, and staffing structure to increase productivity, ensure chart completion compliance and reduce capital expenses 

99.8% quality average

Advanced query optimization, clinical validation and denial prevention

$85M impact identified from query intervention for 27-hospital system

Operator Insights: Clinical documentation improvement

“It’s not just about clinical documentation. It’s not just about coding, but how those relationships work together for the greater good of our patients that we ultimately serve.” – Alison Bowlick, AVP Clinical Documentation Improvement

Revenue Integrity

Ensure accurate revenue capture with compliant, consistent charging

Prevent errors that lead to revenue loss and avoid compliance risks with robust auditing, process improvement and education.

Ongoing analysis and management of hard-coded items, charge errors, revenue codes, CPT, WQs, services and supplies

100k+ payer updates tracked annually

Proprietary algorithms to automatically detect absent or incorrect charges

1% average net revenue lift from charge capture improvement

Targeted charge capture education for revenue cycle and clinical staff including monitoring and regular testing of ongoing charge capture efforts 

Ongoing analysis to identify trends and update algorithms to reduce manual intervention

The inpatient-only list is back

One critical change in CMS’ 2022 Medicare OPPS/ASC proposed rule is the reversal of last year’s initiative to eliminate the inpatient-only (IPO) list. Make sure your organization is prepared for the impact.

chevron-1-1.png

“Whenever there is a project, [Ensemble] will rise to the occasion and speak to our doctors to produce helpful data for me. Today I was beaming with joy because this was the first time that our charges on hold where #1 (lowest) in our hospital system. And this is in large part because of working so closely with [Ensemble’s team].”

– Dr. Tucker Woods, CMO | CarePoint Health