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 to diversify vendors to offset dependency and expand to include additional clinics such as primary care and specialty outpatient. They needed a vendor adept at managing documentation and with significant experience coding for value-based care, which is complex. They engaged with Shearwater Health to launch the risk adjustment coding platform, as Shearwater has exceeded results since partnering with the academic healthcare system to provide
outsourced revenue cycle services in 2019.
Solution
The health system chose to partner with Shearwater Health for risk adjustment coding for clinics and specialty outpatient based on its industry reputation for delivering high-quality outsourced coding services as well as the results Shearwater delivers for the existing partnership, including inpatient coding, pre-service verification, and authorization denials services. For this client’s risk adjustment coding, Shearwater Health leverages offsite registered clinicians who are expertly trained and licensed in coding to review and adjust documentation for compliance. An internal educator takes Shearwater’s findings back to their providers and educates them for improvements.
Results
The health system is very pleased with its Shearwater Health partnership and the positive results they’ve seen, especially the low employee turnover, productivity, and high-quality coding accuracy.
Because of Shearwater’s impressive results, work has expanded from in-patient coding, pre-service verification (inpatient), authorization denials, and risk adjustment coding to medical
necessity denials, and revenue integrity audit and appeals management
According to the manager of coding operations, “A huge benefit to Shearwater is that they are nurse coders—their clinical background helps with this type of work.” The manager was also impressed that all of Shearwater’s coders are certified through AHIMA or AAPC
Accuracy
Quality as measured by the client’s quality parameters
consistently above expectations
About Shearwater Coding Solutions
Accuracy as measured by independent 3rd Party Quality Audits
Certified Coders including dual certified Philippines Licensed Nurses.
