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 1, 2020, is one of the largest regulatory and reimbursement changes in the home health segment over the past two decades. The new regulation has brought with it numerous challenges for the home health industry—including significant cost cuts and growing
revenue pressures. And because PDGM’s goal is to better align payments with quality patient care and outcomes, providers now have exponentially more plan-of-care review responsibilities. This means that already overworked nurse managers face additional review tasks, most of which are highly manual, taking precious time away from patient engagement and clinician education. The Shearwater client needed a way to optimize revenue while enabling nurses to perform at peak of license and coaching clinicians on how to improve outcomes. In other words, they wanted their nurses to focus on people, not charts.
Solution
The home health organization chose to partner with Shearwater Health to help improve revenue cycle operations, especially coding quality, while also ensuring PDGM compliance.
Shearwater Health leverages offsite credentialed clinical coders who are expertly trained in coding and PDGM compliance. These clinicians are the foundation of Shearwater’s coding services. These services include home health coders, risk-adjustment/HCC coding, inpatient/outpatient coding, CDI and provider education, and coding audits. Shearwater also
provides vital feedback to facilitate more accurate, complete OASIS (Outcome and Assessment Information Set) documentation.
Results
The home health organization is pleased with the significant improvements Shearwater Health has delivered. The Senior Vice President of Clinical Integration and Performance Management was especially impressed with Shearwater’s project management expertise, saying, “Shearwater did such a wonderful job collaborating.” She was also impressed with the consistency among Shearwater’s clinicians and its approach. “With Shearwater, we have
a dedicated workforce that is available around the clock—something other vendors don’t provide.”
Shearwater Health achieved significant results, including:
Shearwater Health Revenue Cycle Management Coding Solutions
Charts Coded Annually
Accuracy by 3rd Party Quality Audits
Client Satisfaction
AHIMA, AAPC, or Decision Health Coders including HCS-D Certified Home Health Coders
identified reimbursement opportunity from accurate coding in 2022
Quality Compliance
improvement in turnaround times
Reduced case completion from 7 days
Because of the vast improvements, the home health organization has expanded Shearwater’s services from two branches to nine.
