Shearwater Health Once Again Earns URAC Accreditation in Workers’ Compensation and Health Utilization Management
Shearwater Health, a global leader in clinical solutions for the healthcare industry, today announced that it has earned full URAC accreditation for Workers’ Compensation Utilization Management and full URAC Health Utilization Management certification in Pre-Review Screening + Initial Clinical Review. URAC is the independent leader in promoting healthcare quality and patient safety by setting evidence-based […]
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 […]
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 […]
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 Services Improve Case Handling Time and Reduce Management Cost
Fortune 500 National Health and Wellness Organization
Utilization Review Solution Scales Clinical Teams and Reduces Medical Management Cost
Nations Leading Third Party Administrator
The Key to Effective Utilization Management Better Patient Care Reduced Cost
Utilization management is commonly assumed to be a strategy payers implement to reduce healthcare cost. Although successful UM programs do result in reduced cost of claims, the focus of an effective utilization management program is improved quality of care. When utilization management programs focus on denials – prioritizing cost savings over patient care – they […]
3 Best Practices of a Successful Utilization Management Program
Effective utilization management programs are based on providing the right patient care at the right time. Outlined below are the 3 best practices employed by the most successful UM programs. 1. Clearly Define Processes, Responsibilities, And Policies A well-defined utilization review process – that clearly maps out each step in the process and the roles […]
