Meet the Client

A multi-site pain management group in the Midwest operates clinics across several cities, serving thousands of patients each year with interventional and non-surgical treatments. With growing patient demand and a wide mix of commercial and government payers, leadership recognized the need to tighten revenue operations and prevent leakage across its high-volume claims environment.

The Challenge: Complex Claims, Rising Denials

Pain management billing is uniquely complex with frequent prior authorization requirements, high-cost procedures, and payer-specific documentation rules. For this group, challenges included:

• Denial-prone claims, often tied to medical necessity and prior authorization.
  
  
• Manual reporting processes that made it difficult to track payer trends.
  
  
• Reactive issue resolution, where teams addressed denials only after revenue was at risk.
  
  

As volumes grew, these challenges slowed cash flow and placed added strain on staff.

The Solution: Ember for Smarter RCM

The group adopted Ember to shift from reactive to proactive revenue management. By unifying visibility across claims and surfacing risks before submission, Ember enabled the team to safeguard revenue and standardize processes across locations.

With Ember, the practice gained:

• Early alerts on denial risks, especially tied to payer rule changes.
  
  
• Cleaner, first-pass claims that reduced delays and rework.
  
  
• Actionable insights that helped leadership allocate staff time to the highest-impact issues.
  
  

The Impact: Financial Strength at Scale

In the first year, the pain management group achieved measurable improvements:

• 21% reduction in denials, preserving more than $400K in revenue.
  
  
• Nearly 3-week improvement in days to cash, accelerating reimbursement cycles.
  
  
• 4.5x ROI, driven by stronger collections and reduced rework.
  
  
• Improved payer confidence, with fewer requests for additional documentation.
  
  

Looking Ahead

As the group expands to new sites, Ember has become foundational to its financial operations. With proactive insights and scalable workflows, the RCM team can focus on driving revenue performance rather than reacting to problems.

“We used to spend too much time chasing denials after the fact. Now, we’re preventing them upfront and seeing the financial results right away.” – VP of Revenue Cycle