Shannon White, Chief Operating Officer, Author at Ensemble Health Partners https://www.ensemblehp.com/blog/author/shannon-white/ Your modern revenue cycle solution Thu, 14 Aug 2025 19:37:59 +0000 en-US hourly 1 https://www.ensemblehp.com/wp-content/uploads/2023/10/Logo-Chevron-80x80.png Shannon White, Chief Operating Officer, Author at Ensemble Health Partners https://www.ensemblehp.com/blog/author/shannon-white/ 32 32 Ensemble’s Always-On Management of Uninsured + Underinsured Populations https://www.ensemblehp.com/blog/ensembles-always-on-management-of-uninsured-underinsured-populations/ Thu, 14 Aug 2025 19:36:09 +0000 https://www.ensemblehp.com/?p=19320 Ensemble treats underinsurance as a perpetual, complex challenge, not a one-off crisis. Our end-to-end model easily scales to the OBBA era. … Read More

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Congress’ newly enacted One Big Beautiful Bill Act (OBBA) introduces work requirements, caps on state-directed payments and other measures that will slash roughly $1 trillion from Medicaid over ten years, leaving millions more patients potentially uninsured or under-insured according to the American Hospital Association.

While this has generated headlines, coverage churn is not new. State “Medicaid unwinding” began in April 2023 when unenrollments and reverification that had been suspended due to the Covid pandemic were lifted, and people fell off the rolls more quickly than they would have historically. This has already led to approximately 25 million disenrollments.

Ensemble has long treated under-insurance as a perpetual and complex challenge, not a one-off crisis. The same end-to-end operating model we deployed for the Medicaid unwinding easily scales to the OBBA era — protecting hospital revenue, safeguarding patient coverage and continuing to deliver a consumer-grade experience.

Why the industry is buzzing about OBBA

OBBA will bring significant impacts in the near future, including:

  • Medicaid cuts + work requirements: OBBA introduces nationwide work verification and tightens eligibility redeterminations. States that exceed the 3% limit on eligibility errors face fiscal penalties such as a reduction in matching federal funds.
  • Provider payment constraints: New caps on supplemental payments and limits on provider taxes intensify margin pressure for safety-net hospitals.
  • Timeline shock: Major provisions phase in beginning January 1, 2026, giving hospitals less than 18 months to prepare before these provisions are effective.

OBBA magnifies an already-underway shift from insured to self-pay. Success hinges on proactively qualifying patients for coverage and crafting frictionless payment pathways.

Coverage + conversations at every step

At Ensemble, we provide always-on management of uninsured and underinsured populations , another benefit of our end-to-end approach. Our interactions with patients at every stage enable us to have a greater impact and to keep sight of coverage issues throughout the entire process. By engaging with patients from scheduling all the way to post-service billing and payment, we also have the ability to handle challenges that arise at many different stages, rather than just one based on a single point solution deployment.

Our approach is:

  • Comprehensive, not episodic: Our model addresses every coverage disruption (e.g., policy change, life event or data error) through continuous analytics and advocacy.
  • Patient equity- and advocacy-first: Financial conversations emphasize benefits eligibility before payment collection, preserving community trust.
  • Digital by default, human by design: Tailored agentic AI automation handles routine eligibility and coverage checks as well as estimate creation. Trained financial advocates intervene where human judgment and care for the patients matter most.

Ensemble’s end-to-end patient-financial flow is already ready for OBBA, continually screening for coverage and centering the patient’s experience at every step.

Pre-service auto-screening

At scheduling, every patient record runs through Ensemble’s rules engine and 200+ data feeds to check Medicaid/Marketplace eligibility, commercial coordination of benefits, local charity and a propensity-to-pay score after an estimate is generated.

Digital estimate + financial clearance information

The patient receives a consolidated packet via preferred channel (text, email, portal) containing:

  • Accurate cost estimate
  • Real time coverage status and gaps
  • Simple task list (e-sign forms, document uploads, prompt-pay discount window)

Arrival + Point-of-Service advocacy

Fast-track check-in exists for financially cleared patients. If coverage or payment is pending, financial advocates engage pre-service. Emergency department or unscheduled inpatients get bedside assistance (where allowed by policy) to secure coverage and set up liability arrangements before discharge.

Continuous eligibility search + auto-populated applications

The platform keeps scanning for new coverage and can auto-qualify for charity. Our comprehensive database and connections not only look at Medicaid options but also COBRA, exchange plan options, local funding and special programs such as crime victim funds, searching all avenues for coverage so patients aren’t left to bear the financial burden on their own. If additional data is needed, it triggers pre-filled forms sent to the patient. They simply review and e-sign or snap photos of proofs of income/ID.

Customized payment solutions

Ensemble’s post-care outreach begins with the patient’s chosen channel (including email, text, agent or human call), then expands based on engagement analytics. Plans include:

  • Prompt-pay discounts for settlement within 15 days
  • Interest-free installments over a number of months, depending on the balance
  • Sliding-scale terms that mirror third-party financing without the 8%-15% merchant fees that siphon revenue from our providers

Auto-reverification + compliance reminders

For benefits subject to work-verification or annual proof-of-income, Ensemble triggers reminders 30/15/5 days before lapse. Patients respond by uploading documents (camera capture in app or web), keeping coverage — and revenue — intact.

Post-cycle analytics + bad debt reclass

If coverage still isn’t found, analytics rerun eligibility logic; newly identified payers prompt rebilling, or accounts convert to presumptive charity, as appropriate, to avoid bad debt write-off.

The bottom line

OBBA may feel like the latest earthquake in health-policy land, but for Ensemble and our clients it is simply another tremor our end-to-end model was built to absorb. Our model:

  • Mitigates coverage volatility: Automated screens and reverification reminders cut avoidable self-pay conversions triggered by OBBA’s new rules.
  • Protects hospital margin: Direct payment plans retain every dollar, avoiding fintech “skim” and preserving goodwill.
  • Elevates patient experience: One digital journey, from estimate to zero balance, reduces anxiety and boosts loyalty in an era of heightened financial sensitivity.

Continuous eligibility analytics, advocacy-centered workflows and fee-free payment flexibility keep patients covered and hospitals financially whole, no matter how the ground shifts next.

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]]> Cyber or System Downtime — Strategies for Staying Operational https://www.ensemblehp.com/blog/staying-operational-system-downtime/ Mon, 30 Jun 2025 14:23:25 +0000 https://www.ensemblehp.com/?p=19003 Epic Business Continuity Access + an Incident Recovery Application strategy help maintain operations during an incident + recover afterward. … Read More

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Why you need Epic Business Continuity Access and an Incident Recovery Application

Downtime is inevitable. Disruption doesn't have to be.

Whether caused by planned maintenance, unexpected outages, or cyber security incidents, system downtime is a reality every healthcare organization must face. But patient care can’t wait. That’s why having both Epic Business Continuity Access (BCA) and an Incident Recovery Application (IRA) strategy is essential. Together, they ensure your organization can maintain
operations and patient care during an incident and effectively recover afterward.

What is Epic Business Continuity Access (BCA)?

Epic BCA is a suite of tools that ensures users can access critical patient information even when the main Epic system is offline. It includes:

  • BCA PC: Standalone computers deployed across ambulatory clinics and throughout hospitals to print physical copies of patient info for use in conjunction with downtime procedures — even without network or power. This is a minimum requirement to maintain patient care.
  • BCA Web and Web Data Entry: A web-based portal for viewing reports, printing patient labels and entering essential data like ADT events during downtime so an up-to-date census is available. It also allows events and notes to file back into Epic, reducing manual work during recovery.
  • Isolated Recovery Environment: A pre-configured environment with a limited version of Epic that is accessed via a web browser to allow basic ADT and clinical note access along with secure chat, In Basket and basic appointment scheduling. This requires the use of Epic software called Harbor, which is available with the Epic November 2024 release and can be made available back to the February 2024 version with Special Updates.

Why BCA matters

BCA ensures that the hospital can continue to function at a basic level and access important information while IT and security teams work on recovery measures.

  • Continuity of Care: Clinicians can still access vital patient data to make informed decisions.
  • Operational Resilience: Keeps workflows moving during outages or cyber events.
  • Regulatory Compliance: Supports paper-based documentation to ensure nothing is missed.

What is Incident Recovery Application (IRA)?

IRA refers to the post-downtime recovery process that ensures all data captured during the
outage is safely and accurately integrated back into the Epic system.

Key IRA functions

  • Data Reconciliation: Transfers downtime records into the live system without data loss.
  • System Restoration: Verifies data integrity and supports safe reactivation of Epic.
  • Audit Readiness: Ensures complete and accurate records for compliance and reporting.

Why you need both: A dual strategy for resilience

During the Incident

BCA keeps patient care going with access to critical data.

Prevents chaos and delays in care.

Supports clinicians with tools like SRO, BCA PC, and Web Entry.

After the Incident

IRA ensures all downtime data is reconciled and restored accurately.

Protects data integrity and supports regulatory compliance.

Helps IT teams safely bring systems back online.

Best practices for implementation

  • Deploy BCA PCs across all care sites.
  • Set up BCA Web servers and ensure users have specific security added to their Epic template to allow them to access the web portal and enter data.
  • Configure CSN and MRN assignments to avoid duplicates in the Epic system.
  • Establish clear downtime protocols by site/department for data reconciliation and system restoration.
  • Conduct regular drills to ensure readiness across clinical and IT teams.
  • Create a workflow to send special downtime reports daily.
  • Create a separate cloud server environment with a secure connection to the primary data center. Epic Hosting offers this service.

RELATED CONTENT

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]]> How to Avoid the Top 4 RCM Issues Impacting Your Bottom Line​ https://www.ensemblehp.com/blog/how-to-avoid-the-top-4-revenue-cycle-issues-impacting-most-hospitals-bottom-line/ Fri, 12 May 2023 12:00:22 +0000 https://www.ensemblehp.com/?p=7405 1 in 3 hospitals are expected to continue operating with a negative margin and lose billions due to revenue cycle issues, but there's hope. … Read More

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With 1 in 3 hospitals expected to continue operating with a negative margin, leaving money on the table isn’t an option. But it’s a billion-dollar issue.

We’ve found more than $1.1B left on the table across 36 healthcare organizations through in-depth assessments of revenue cycle operations in the past four years alone.

Here’s where we typically find the biggest financial impact and revenue cycle issues within the healthcare industry, regardless of an organization’s size:

 01  Denial Recovery 

Every organization is faced with denials, but not many have mastered the art of identification, recovery and prevention. The result? Avoidable lost revenue. 

Problem: Lack of visibility, expertise + specificity 

Some organizations lack the ability to map denials and separate them from contractual adjustments, preventing them from being tracked and trended. We see organizations where the biller is responsible for denial follow-up, where clinical teams aren’t engaged to support appeals, where appeal letters are written globally instead of specifically addressing a denial reason — the list goes on.  

Without fundamental visibility into denial volume and specificity in the appeal process, avoidable write-offs keep piling up and potential revenue keeps getting missed. 

WHAT IT WAS COSTING OUR CLIENTS: >$400M EACH YEAR 

Solution: Dig into the details 

The first thing to do is make sure you are accurately mapping and tracking denials instead of masking them as contractual write-offs. Does the 835 match up to the contractual adjustment?  

Once you’re confident you know where your denials are coming from, ensure you have dedicated resources in place to properly monitor and appeal them. Engage the right clinical and medical billing experts to increase your overturn rate and provide upstream teams with training on denial trends and ways to reduce claim denials to prevent future issues.  

02  Unbilled Management  

Decentralized unbilled management leads to costly delays in revenue and is a problem that starts the minute the patient walks in the door. 

Problem: Decentralized ownership

We often find providers don’t have centralized management of their unbilled accounts. The billing team thinks it’s a coding responsibility, the coding team thinks it’s a registration issue, and so on.

No centralized ownership of unbilled management means no centralized visibility into unbilled edits needing resolution and no shared accountability to get them resolved, further contributing to revenue cycle issues. 

WHAT IT WAS COSTING OUR CLIENTS: >$290M  

Solution: Collaborative unbilled management  

Ensuring claims go out accurately and on time is the responsibility of the entire revenue cycle team and requires collaborative management of the whole process. 

A registration error can lead to a coding edit, which can lead to system edits, all of which have the potential to delay the bill. Establishing a multidisciplinary team to monitor all unbilled accounts, assign ownership and accountability for resolution, and track action items drastically accelerates revenue. 

03  Pre-Service Collections  

Research shows healthcare professionals only have a 30% chance of collecting on a patient balance after the patient walks out the door. So why is it so difficult for providers to collect upfront? Many hospitals struggle with the myth that discussing patient financial responsibility prior to service diminishes the patient experience. But, in fact, it has the opposite effect.  

Problem: Unequipped patient access staff 

We work with clients who believe pre-service collections aren’t possible because of the type of facility or service they provide, like long-term care or pediatric oncology, or because it doesn’t align with their culture. Combined with the misconception that asking for money is a bad thing, many hospitals fail to equip their front-office staff with the tools and training needed to effectively talk with patients about financial responsibility and offer ways to collect a balance. 

WHAT IT WAS COSTING OUR CLIENTS: >$250M 

Solution: Tools + training to collect with empathy

The reality is 80% of patients want their doctors to help them manage financial responsibilities by clearly communicating what insurance covers versus what they owe. Equip your patient access staff with scripts, job aids and software to adequately support these conversations without diminishing the patient experience.

Discussing financial liability upfront helps patients feel more informed about their financial responsibility in advance rather than being contacted after the fact and left wondering how they can go about settling outstanding balances. It also creates opportunities to connect to financial aid, determine eligibility for discounts, research applicable insurance coverage and set up payment plans, if needed. It can add certainty and peace of mind in an otherwise uncertain circumstance, which can be a huge relief to patients regardless of the facility they’re in or the type of care they’re receiving. 

04  Coding Validation 

A recent study showed one-third of healthcare reimbursement experts report coding errors as the major concern for denials. One wrong code could lead to significant delays in revenue, missed opportunities for reimbursement or risk for overpayment recoupment.  

Problem: Manual coding review 

Either no internal audit team is in place (yikes!) or a small group of coders and CDI specialists are tasked with selecting a certain sample of accounts, reviewing the coding and documentation, flagging any errors and extrapolating results.  

So why is manual review an issue? Because nearly 40,000 individual codes would need to be reviewed each month for a hospital seeing 900 inpatients and 4,250 outpatients. That volume alone would require six skilled auditors performing nothing but reviews every month to validate the accuracy of 100% of accounts. Even if a hospital could staff a team of experienced auditors solely focused on account review (which most can’t), human error would still be an issue.

 

WHAT IT WAS COSTING OUR CLIENTS: $132M EACH YEAR 

Solution: Automate your audit  

Leveraging technology to audit 100% of accounts and validate all codes eliminates human error and prevents the risk of undercoding or overcoding. This ensures the associated revenue is accurate and the claim has a higher likelihood of being paid on time. 

Think your metrics are stable? Suspect you may have a performance gap? Or maybe your root cause issues are unknown? An operational assessment every few years can help pinpoint areas of strengths and weaknesses across your revenue cycle management processes to prevent costly mistakes and alleviate margin pressure. 

Remember, just because your KPIs are green doesn’t mean there aren’t any underlying revenue cycle issues costing you money you probably can’t afford to lose.  

If you’re ready for a thorough assessment and detailed action plan for resolution, contact our team today.

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