The Intricacies of Women’s Health Coding for Maternal Care and Childbirth
Poor coding quality is costly, leading to denied claims, care delays, and inaccurate or slow reimbursement. Recent research finds that more than 15% of claims submitted to private payers are denied, although more than half are eventually overturned. This means providers spend excessive time appealing claims that should have been paid in the first place. […]
How to Develop a Successful Utilization Management Program
Utilization management (UM) helps lower costs and improve outcomes by ensuring members receive the most appropriate care in a timely, cost-effective manner. Initially, UM was primarily focused on reducing excessive use that leads to waste without any measurable gains in quality or outcomes. The focus has now expanded to encompass improving quality and regulatory compliance […]
International Nurse Recruiting: A Formula to Measure Success
“Workforce challenges” is the number one hurdle faced by healthcare organizations today, and those challenges revolve around nursing. Respondents to a recent survey stated overwhelmingly that managing repercussions from staff shortages, recruiting nurses from outside the organization, and retaining them are their most pressing concerns. Nurses are leaving the field in catastrophic numbers. Over 610,000, […]
Shortcomings in the U.S. Nursing Education System
Nursing education is designed to professionally prepare nurses for clinical practice. To ensure a smooth transition into patient care, nursing schools are increasingly collaborating with clinical partners to provide students with a hands-on educational experience. However, the U.S. nursing education system limits the enrollment of qualified nurse applicants due to faculty vacancies, limited infrastructure, and […]
Bridging the Nursing Shortage: Shearwater Health’s Impact and Solutions
The global nursing shortage crisis is a formidable challenge. Discover innovative approaches to bridging the nursing shortage.
The Differences between Utilization Management and Case Management
Effective Care Management involves many people with differing roles and responsibilities, collaborating for the benefit and wellbeing of patients/members. Care Management itself is a wide umbrella, which Utilization Management (UM) and Case Management (CM) are both under. Depending on the structure of an organization, UM may be a stand-alone service in partnership with CM, or […]
How Shearwater Health Navigates Visa Retrogression
Any business is tasked with problem-solving within its field. The healthcare space is no different, and at Shearwater Health, we pride ourselves on developing creative strategies to drive optimized clinical performance. However, some problems we face, like Visa Retrogression, are beyond our control to solve. How Visa Retrogression Impacts the Immigration Process The immigration process is […]
Navigating Complex Coding Requirements to Minimize Denials
Revenue streams are in a state of flux in today’s changing healthcare landscape. However, at least one constant remains: quality medical coding is a critical factor in maintaining a healthy revenue stream. Around 42% of claims are denied because of coding issues, emphasizing the importance of precise coding practices. It is important to ensure your […]
Realizing the American Dream
As the Marketing Coordinator for Shearwater Health, my day-to-day is typically geared towards the client facing side of the business. While I hear about nurse arrivals and work indirectly with the CPO side of Shearwater, I’ve never had the one-on-one time with the nurses whose time and commitment to their profession make up a big […]
Risk Adjustment Coding: Addressing Accuracy, Quality and Productivity
About the Client Organization A world-class academic healthcare system with three highly regarded hospitals, physician practices, home hospice care, and various other support services located in the Eastern U.S. Challenge The health system had previously used a single revenue cycle vendor for risk adjustment coding. With the arrival of COVID, the organization decided it needed […]
