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21 Solutions

Excelin Health · Healthcare Operations

Excelin cut coding and OASIS review staff in half. Quality scores stayed the same.

Excelin Health was growing fast. Review work could not keep up. Hiring more people no longer made financial sense. We learned their clinical and money limits. We decided what software could handle safely and what should stay with clinicians. We built the systems. We still support them today.

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Built with Excelin Health, a home health and hospice company that brings medical care to patients at home.

50%

Half the coding and OASIS review staff

~$475K

About $475K saved per year

28 → 17 days

Average time to finish: 28 → 17 days

Maintained

Quality and star ratings stayed on track

Numbers reported by Excelin leaders and tracked through the project.

Growth outpaced how the business could keep up

Excelin was taking on more work fast. OASIS review, coding, clinical QA, 485 completion, and physician orders all went through people. Deadlines kept slipping. The easy fix — hire more reviewers — was not possible at this scale. There was no budget to keep hiring. Every sick day or vacation pushed the backlog further behind.

By the time leaders looked for another answer, they faced a bad choice: keep up with volume, or review every chart as carefully as their own standards required.

Work was growing faster than reviewers could handle.
No budget to keep hiring reviewers as volume grew.
OASIS and 485 deadlines kept getting longer.
Sick days and vacation turned straight into backlog.
Speed pressure fought against doing thorough reviews.
Slower completion meant slower billing and more DSO (days to get paid) pressure.

“Before automation, survival meant prioritizing quantity over a detailed comprehensive quality review. But to truly scale, we needed a solution that would preserve Excelin’s uncompromising standards for quality and compliance.”

Sheena Meeker, Excelin Health

This was not a normal software problem. Growth had broken the math of doing the work by hand.

The vendors had products. Excelin had a problem.

Excelin looked at other vendors first. Most sold ready-made software built for how someone else runs a home health agency. Making one of those systems fit Excelin’s workflow would have taken months of Sheena’s time — time they did not have while the backlog grew.

Ready-made software is fine when the workflow is standard. Excelin’s review workflow was not standard. It tied directly to payment, compliance, and quality scores.

A product looking for a fit

“Here is what we have. Can you work with what we have?”

The business has to reshape itself around the software. A senior leader spends months doing that. Parts that do not fit become permanent manual workarounds.

21 Solutions

“Show us how the operation actually runs and what is breaking. We will figure out what needs to exist.”

We do the learning. We learn the workflow, the money side, and the limits first. Then we decide what to build — including what should stay with people.

“Other companies were saying, ‘Here’s what we have. Can you work with what we have?’ 21 Solutions was willing to say, ‘This is what you want to do. Let us figure out how to scope it out for you.’”

Sheena Meeker, Excelin Health

The real question was not whether automation could work. It was whether Excelin could trust it.

Sheena did not trust automation at first. She has spent her career in home health coding and OASIS review. She knows even skilled people make mistakes. She agreed to try it while, in her words, hoping for the best and expecting the worst.

That caution made sense. The risk was not a bad report. Excelin would cut staff at the same time software took over the work. If automation failed, payments could drop, star ratings could slip, and compliance risk could rise — with fewer people left to catch problems.

Payments could drop before anyone noticed.
Star ratings could slip. They are hard to get back.
Compliance risk could rise on every reviewed record.
Staff cuts were happening at the same time. There was no easy way back.

“My fear was the star ratings and the erosion on payment were going to be a problem. At the same time I was cutting staff, so if this did not work, I created a bigger problem for myself.”

Sheena Meeker, Excelin Health

That shaped what we built. The goal was never to automate as much as possible. It was to take work off the team without adding risk to the agency.

The technical decision and what we built

We built two systems. Both fit how Excelin already worked. Excelin did not have to rebuild itself around software. The rule is simple: software handles repeat analysis and keeps work moving. Clinicians keep judgment calls and exceptions.

Walter

The review and coding layer

Walter reviews clinical charts against Excelin’s rules. It fixes what can be fixed automatically. It sends everything else to a clinician with the problem already flagged. It covers OASIS review, coding, clinical QA, the 485 workflow, and QA on evaluations and nursing visits.

  • Reviews charts against clinical rules at high volume
  • Fixes qualifying issues automatically; sends the rest to clinicians
  • Supports coding and how OASIS coding slots get used
  • Gets charts ready for billing faster

Wilma

The physician order layer

Physician orders were the other bottleneck between finished clinical work and getting paid. Wilma tracks status, follow-up, and sorting so the team knows what is ready for the next step.

  • See order status across the whole operation
  • Follow-up and sorting on pending items
  • Clear view of pending signatures and returned items
  • A clear answer to “is this ready to move?”

How the work moves

Clinical documentation

  1. Clinician completes the documentation
  2. Automated review and coding using Excelin’s rules
  3. Hard cases sent to a clinician
  4. Completed and ready to bill

Physician orders

  1. Order goes out to the physician
  2. Status tracked and triaged
  3. Follow-up on pending signatures and returns
  4. Signed, closed, and ready for billing

Both paths end the same way: work is truly ready for the next step, without someone checking by hand.

Walter and Wilma fit Excelin’s operation. A different agency with different bottlenecks would need something different. The repeatable part is the method: understand the operation first, make the tech choice, then build what should exist.

What changed

Excelin measured results by what leaders are judged on — staff cost, completion time, cash flow, quality, and payment — not by how much work the software did.

50%

Half the staff doing coding and OASIS review

Excelin cut staff for those jobs in half. Volume kept climbing while review staff did not.

~$475K

Estimated annual savings

About $475,000 a year saved by fixing the workflow instead of hiring more people.

28 → 17 days

Average completion time

Completion time fell from about 28 days to about 17. Work got ready for billing sooner. That reduced DSO pressure and improved cash flow.

Maintained

Quality and star-rating measures

Excelin tracked quality, payment, function, compliance, and star ratings throughout. Automation stayed in acceptable ranges. Some measures beat the human baseline.

Capacity that absorbs growth

Excelin can now grow without adding review staff at the same rate as volume. That is leverage — not a promise they will never hire again.

“When we shaved down the time from 28 days and started averaging around 17 days, that decreased our DSO and increased our cash flow. That made our revenue cycle team much happier.”

Sheena Meeker, Excelin Health

Wondering how much of your review work software should handle?

The free assessment shows where systems, manual steps, and staff are doing work software could handle.

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About 5 minutes. No sales call required.

The hard part was not making software do more. It was knowing where it should stop.

Home health coding is not data entry. Excelin has about 25 OASIS coding slots. How they are picked and grouped affects whether legitimate comorbidity adjustments get captured. Sheena put numbers on it: about $250 extra payment for a low adjustment, about $500 for a high one.

The obvious but wrong goal: push every case to the highest number possible. An agency far outside the normal range invites Medicare scrutiny. The target was never the highest number software could produce. It was better payment inside safe clinical and compliance limits.

Optimizing the metric

Push every case to the highest adjustment, watch revenue rise, and quietly become an outlier that draws review.

Optimizing the business

Capture what the chart truly supports. Keep the agency’s profile normal. Count compliance risk as part of the return.

We also found places where Walter scored function items too strictly compared to clinical reality. We adjusted it. You do not find that in a demo. You find it by watching the system run in a real operation and comparing it to what the business expected.

“I do not think there has been anything you told me you were not able to do. And if there was, it was truly in protection of our compliance and our agency.”

Sheena Meeker, Excelin Health

Go-live was not the finish line

Nearly a year into Walter, Excelin and 21 Solutions still talked regularly — not about support tickets, but about how the system should keep changing as the operation changed. Senior US-based people stayed on the account during and after implementation.

One example: Excelin users hit a gap in order status visibility. Before the call ended, our team walked through the workflow with Sheena, found a simple fix, and scheduled the change. That is what the ongoing relationship looks like.

“Some companies get you to go live and get you paying monthly and then they are like, ‘Peace out.’ I feel like 21 Solutions has done a really nice job of asking how we can make the product better and improving it as we go.”

Sheena Meeker, Excelin Health

“You are almost a year into Walter and I still communicate with you super regularly. You have a lot of support during implementation and thereafter.”

Sheena Meeker, Excelin Health

A project ends. Production does not. Real users find problems the design never saw. The operation changes. The system has to change with it. That is why the senior team stays involved after launch.

How Excelin describes 21 Solutions

In the client’s words

“A group of exceptionally intelligent people that thoughtfully take what you want to do and make it happen.”

Excelin Health
Sheena MeekerExcelin Health

“I share my pain points and what we need, and they carefully scope out exactly how they can do it.”

Sheena Meeker, Excelin Health

Sheena has offered to take reference calls from other agencies looking at 21 Solutions. People inside Excelin have named the team in conference talks. That is hard to fake in a case study.

Excelin needed a senior tech team that understood the operating problem.

The details are home health, but the pattern is broader. A growing operation hits a point where the manual model stops making financial sense. The work needs too much judgment for generic software. Careless automation is more dangerous than doing nothing. The right team must understand the business, make careful tech choices, execute, measure results, and stay involved.

Learn before automating

Understand the workflow and the money side first. The tech choice comes after knowing what the business problem actually costs.

Build around how the business works

Where a workflow is standard, buy the software. Where it is part of how the business competes, forcing it into a generic tool costs more than it saves.

Measure business results

Staffing, completion time, payment speed, quality, and risk are what matter. The number of features shipped does not.

Stay after launch

Real users find new problems. The business changes. The system has to change with it.

Is your workflow too important for another generic tool?

If growth is forcing you to hire more people, work around software, or take more risk than you should, we will help you figure out whether the problem is process, systems, automation, or all three — and what is worth building.

Book a Fit Call Explore Healthcare Operations

Is review work growing faster than your patient count?

The 20-minute fit call is a straight talk about your problem, what it costs, and whether we are a good match.

If we are a good fit, we will suggest a clear next step based on the workflow and the work required.

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