SUCCESS STORIES
Prevent denials from diminishing revenue.
Identify + resolve root cause issues causing costly denials.
We help providers stay ahead of denials.
Successful denial management requires an end-to-end view of the revenue cycle. We identify and resolve upstream issues to prevent downstream impact.
first-pass denial rate
<
0
%
final denial write-offs as % of NPR
<
%
better DRG + coding accuracy
0
%
Ensemble Innovation
EIQ for clinical denial prevention
Clinical denials routinely put millions of dollars at risk for large health systems. EIQ® helps ease the burden by reading the medical record in seconds, identifying denial risk with clear rationale and actionable recommendations — right in existing processes.
“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
84% denial reduction doubles hospital wound care capacity.
A large faith-based health system faced high denial rates for specialized outpatient services. Ensemble pinpointed root cause issues, optimized authorization workflows, strengthened clinical documentation and educated staff. The results — an 84% reduction in first-pass denials and a 4.2% denial reduction systemwide. The additional revenue from accurate insurance payments funded two new specialty medical devices, doubling patient treatment capacity at a wound care center.
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
10-hospital system recovers $5M missed by existing vendors.
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 detected anomalies missed by others and applied best practices to recover $5 million and prevent $1.5 million in underpayments annually.
CLIENT SNAPSHOT
Ensemble’s secondary zero-balance review yields $13M in recoveries.
A Midwest health system needed a secondary partner to focus on an opportunity untouched by its primary vendor: zero-balance accounts.
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
Resources
- VIDEO
Clinical denials routinely put millions of dollars at risk annually for large health systems. EIQ® helps ease the burden by reading the medical record in seconds, identifying denial risk with clear rationale and actionable recommendations — right in existing workflows.
- EBOOK
See why future-focused healthcare leaders view the revenue cycle as a value driver, not a cost center.
- BLOG
The right RCM outsourcing partner can impact your bottom line, optimize revenue streams and streamline operations for your organization.
- BLOG
Hospitals will leave money on the table if they don’t think holistically about identifying, recovering and resolving underpayments.
- BLOG
Providers must leverage what's in their payer contract, comparative data and price transparency rules to level the playing field with payers.
- BLOG
With financial pressures increasing, providers can’t afford not to implement effective denial management and prevention strategies.
- WEBINAR
Experts share common issues that lead to costly underpayments as well as effective resolution strategies leveraged across 200+ hospitals nationwide.