Revenue Cycle Management (RCM) affects all aspects of client health care delivery. When RCM is not optimized, there can be issues that impact financial outcomes, clinical outcomes, patient satisfaction, and/or provider experience.

When outsourcing Revenue Cycle Management, it is imperative to find a premium solution that focuses on the highest quality to optimize your business.


Reasons to Outsource:

The ongoing resignation crisis, especially in healthcare, often makes it challenging to find capable replacements to fill the gaps. Hospitals and physician groups are struggling to keep up with both clinical and administrative duties while maintaining a quality revenue cycle. Augmenting the existing staff with skilled RCM resources would help alleviate some of that burden.

In addition to enhancing the staff, keeping a close eye on key RCM metrics and benchmarks will ensure success and effectiveness such as:

Coding Accuracy –

  • One of the top 10 most common RCM claim denials is related to coding accuracy. When coding accuracy is not monitored, it can impact reimbursement and become an added burden to administration. In healthcare, it is imperative to have high coding accuracy matched with high quality.

Filing claims timely –

  • Discharged, not final billed, or DNFB, is the ratio of accounts being held for billing for various reasons. DNFB is a key metric that could be indicative of potentially serious systemic problems.
  • Failure to submit claims timely leads to inflated DNFB and AR Days (accounts receivable days), which can result in revenue delays or loss.

Denial Management –

  • Claims denials are a common cause for many healthcare practice revenue leaks which include coding errors, missed filing deadlines, missing or invalid information, etc.
  • Monitoring the claims denial data will provide insight and pertinent data points and trends to enable a proactive approach to denial prevention.
  • Standardizing and implementing a denials management process will enable a higher clean claim rate and will result in getting paid faster. Shearwater supports internal client informational processes as well as provides a high quality of coding thus reducing the amount of coding denials.


Key Differentiators:

Shearwater Health has the flexibility to work with an established RCM workflow or aid in the development of optimized improvements. Shearwater is tech-agnostic, which means we work within the client’s IT healthcare platform

Shearwater Health continually holds a high standard of quality and 95% accuracy or better, surpassing the industry standard. With Shearwater’s upscale coding academy to ensure the highest accuracy and quality.