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 […]
Workflow Innovation for Remote Patient Monitoring
The growth of wearable devices has brought great potential for improved, more proactive healthcare, especially in the area of sensor-enabled remote patient monitoring (RPM). According to research, remote patient management services and tools are expected to reach over 70 million U.S. patients by 2025. The challenge is that activating the data needed for effective RPM […]
Revenue Cycle Management and Coding Services
About the Client Organization A leader in homecare, palliative, and hospice services committed to enhancing the quality and consistency of healthcare delivered at home. With locations in Florida, Illinois, Michigan, and Pennsylvania, the organization serves patients and their families across seven states. Challenge The Home Health Patient-Driven Groupings Model (PDGM), which was released on January […]
Utilization Management at Shearwater Health
https://www.youtube.com/watch?v=5-GBbsqKzZQ&t=10s Utilization Management is an invaluable resource in handling time and reducing management costs in the healthcare space. When a nurse has proper training in Utilization Management, they are equipped to evaluate the appropriateness of care, and ensure decisions are made properly. Shearwater Health is committed to ensuring our nurses have proper training in Utilization […]
Improving Patient Care with Coding
The healthcare industry has been no stranger to shortages of qualified workers over the few years, and the coding workforce is no exception to this trend. There is a need for more medical coders across the U.S., making it increasingly more challenging to find skilled and credentialed coders who can execute the specific type of […]
Health Insurance Claims Analysis
A current trend in the Healthcare industry is the increasing volume of inpatient claims denied by payers based on lack of medical necessity. While Medicare offers detailed payer categories compared to other providers, they also reject the highest number of shares. However, from 2021 to 2022, the inpatient claim denial saw a rise of 18.5% […]
2023 Healthcare Trends Forecast
The healthcare industry is constantly evolving, especially in the wake of COVID-19 and constant technological advancements. At Shearwater Health, we strive to revolutionize healthcare systems that align with our mission to “improve healthcare outcomes globally.” With the start of a new year, trends are emerging that could potentially impact the healthcare industry in 2023. From […]
Improving Healthcare with Virtual Case Management
With the nursing shortage and the overcrowding in hospitals, Virtual Case Management (VCM) is a valuable option for minimizing challenges that the healthcare industry faces. Hospitals today are understaffed, which leads to inefficiency in patient flow. Often this results in extended patient stays, compromise to the quality of care, and higher readmission rates. These factors […]
Shearwater Health Leverages Expertise to Aid Premier Retail Clinic in Improving Documentation, Coding, and Reducing Denials
As the U.S. entered life amid a pandemic there was a great concern amongst healthcare leaders as to how we could appropriately and effectively see and treat patients without increasing risk of exposure to the prevalent COVID-19 virus. Fortunately for U.S. healthcare consumers, telehealth had been a growing practice prior to the onset of the […]
Creating a Cost-Effective, Scalable Physician Prep Program
For a Large Managed Care Organization Providing Medical Review Services
