CASE STUDY
Large physician group achieves 98%+ denial appeal success rate.
Roper St. Francis Physician Partners receives Clarivate Healthcare Business Insights™ award for top-decile performance in denial appeal success rate + cash collections
SNAPSHOT
Roper St. Francis Physician Partners, the employed physician group of 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 top recognition in revenue cycle performance from Clarivate HBI in the $250M and under net revenue category. Comprehensive training, improved relationships between coders and physicians, implementation of best practices and the use of artificial intelligence and automation resulted in a 98.7% success rate in appealing denials and a 108% cash collections rate.
PROFILE
- Large physician group
- $160M NPR
- South Carolina
- End-to-end RCM partner since 2021
Challenges
Roper St. Francis Physician Partners aimed to enhance data utilization, increase physician engagement and improve collaboration for better financial health. It recognized that effective data use was essential for identifying root causes, making informed decisions and understanding costs and revenue opportunities. Engaging physicians required clear communication and robust training to foster collaboration, elevate patient engagement and prevent denials — outcomes critical for improving financial stability and supporting its mission.
Solutions
By leveraging Ensemble’s expertise, best practices and innovative technology, Roper St. Francis Physician Partners reduced administrative burdens, improved cash collections and addressed the root causes of denials through a more streamlined appeals process. This collaboration enhanced operational efficiency and financial health, ensuring the physician group can provide care regardless of a patient’s financial situation.
It is never an us-versus-them or a Roper St. Francis Physician Partners-versus-Ensemble conversation; it is discussing how we can be successful in meeting the needs of the community and moving the organization forward together.
Here’s how we partnered to drive their award-winning performance:
- Collaborated with physicians through our “practice optimization partners” team to provide training materials, including scripts and tip sheets, helping front-desk staff improve payment communications and identify patients needing financial assistance, ensuring they receive support without affecting care.
- Built strong relationships between coders and physicians, establishing searchable operations guides and consistent communication and collaboration to reduce denials due to insufficient or unclear documentation.
- Used real-time reporting and business intelligence to derive data-driven insights, including physician billing scorecards for identifying trends in rejections and unbilled claims, detailed aged trial balance reports to highlight accounts requiring reviews and real-time monitoring of cash flow, accounts receivable aging and denials.
- Conducted monthly operational review and denial reporting meetings with site CFOs and VPs, fostering transparency, collaboration and effective communication to address concerns.