CASE STUDY
Roper St. Francis excels in revenue cycle performance.
Physician group achieves 98%+ success rate in denial appeals while acute services earns top-decile performance for reducing initial denials and AR days
SNAPSHOT
Roper St. Francis Healthcare, in partnership with Ensemble, strives to alleviate administrative burdens, enhance patient care and improve financial health, aligning with its mission of compassionate, faith-driven excellence. It earned two Clarivate Revenue Cycle Awards for revenue cycle performance. The system employed AI and automation technology, payer scorecards and staff training throughout its acute services to optimize revenue cycle operations — successfully reducing initial denials due to patient access errors to below 20%, significantly lower than the 28.5% hospital average, and decreasing net accounts receivable (AR) days. Roper St. Francis Physician Partners, the employed physician group of Roper St. Francis Healthcare, achieved a 98.7% denial appeal success rate and 108% cash collections through the implementation of best practices, coder-physician collaboration and intelligent automation.
PROFILE
- Nonprofit health system
- $1.1B NPR
- South Carolina
- End-to-end RCM partner since 2021
Challenges
Roper St. Francis faced revenue and operational challenges in both acute care and its physician group. Recurring issues such as workflow inefficiencies in patient access, coding inaccuracies and manual processes in areas like appeals and cash reconciliation led to high initial denials and administrative burden. The physician group sought better data utilization for decision-making and root cause identification, as well as increased physician involvement and improved collaboration through clear communication and robust training for enhanced financial health. The system needed streamlined processes, automation, and targeted training to reduce errors, improve financial performance, and support the objective of delivering high-quality, accessible care.
Solutions
Ensemble applied its expertise, best practices and technology to enhance Roper St. Francis’ revenue cycle operations, enabling a greater focus on patient care. This support alleviated administrative burdens while improving collections and reducing initial denials, ensuring the system’s financial stability and the continued provision of care regardless of a patient’s financial circumstances.
Here’s how we partnered to drive their award-winning performance:
- Strengthened revenue cycle operations by implementing weekly workqueue reviews, internal audits and AI-driven automation to improve coding accuracy, reduce denial response times and accelerate cash flow across the healthcare system.
- Enhanced financial oversight and accountability with weekly AR calls, payer scorecards and cash waterfall analyses, which enabled proactive cash flow management and supported more effective contract negotiations.
- Empowered frontline staff through targeted training, scripts, and tip sheets, helping front-desk teams improve patient payment communications and identify those needing financial assistance — ensuring access to care without compromising revenue.
- Improved documentation and denial prevention, fostering strong collaboration between coders and physicians that was supported by searchable operations guides and regular education, to reduce denials caused by unclear documentation.
- Enabled data-driven decision-making using real-time reporting, physician billing scorecards and monthly operational reviews with leadership to provide transparency and actionable insights, driving continuous improvement across both hospital and physician operations.
“It truly is about the relationship. If we recognize that there is a gap, all I have to do is tell the other leaders that we need somebody here to work with us. Very quickly, there are people on site, sitting face-to-face across the table, across the registration desk, to ensure we have that support and that we are moving forward together.
Results
of net revenue, achieving
top-decile performance
(physician group)
achieving top-decile performance
physician group)
access errors, achieving
top-decile performance
(acute services)
achieving top-decile performance
(acute services)