Excelin Health Case Study

How Excelin Health Cut Clinical Review Staffing by 50% Without Sacrificing Quality

Excelin was growing quickly, but OASIS review, clinical QA, 485 completion, and physician order workflows were creating operational pressure. 21 Solutions built custom automation around the way Excelin actually worked, helping the team reduce staffing pressure, speed up billing readiness, and maintain the quality metrics leadership cared about.

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Built with Excelin Health, a home health and hospice organization focused on bringing medical excellence home.

50%

Fewer FTEs required for coding and OASIS review

~$475K

Estimated annual savings

~39%

Reduction in 485 completion time

Quality

Star-rating measures tracked and preserved

A growing home health network facing real operational pressure

Excelin Health was scaling quickly, but the workflows behind coding, OASIS review, 485 completion, and physician orders were becoming harder to keep up with. Completion times were rising, staff capacity was constrained, and the team was being forced to prioritize throughput just to stay ahead of volume.

Excelin Health is a home health and hospice organization focused on bringing medical excellence home. As the organization grew, the operational workflows behind clinical documentation, coding, orders, and billing readiness became harder to scale manually.

The problem was not a missing EHR module. It was the operational gap between clinical documentation, review queues, billing readiness, and the people responsible for keeping the process moving.

The challenge: scale without adding headcount or compromising review quality

OASIS and 485 completion timelines were increasing.

Rapid growth created more work than the existing team could absorb.

Hiring more staff was not a realistic or scalable answer.

The work was too nuanced for generic automation.

Delays affected revenue-cycle timing and cash flow.

Leadership needed to reduce cost without creating compliance, payment, or star-rating risk.

“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

Excelin did not need a plug-and-play product. They needed a partner willing to build around the workflow.

Excelin looked at other options, but most vendors offered pre-built products that would have forced the team to spend months adapting the software to their operation. 21 Solutions took the opposite approach: understand the workflow first, then build the automation around how the work actually gets done.

“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 solution: custom automation for coding, OASIS, 485s, QA, and orders

21 Solutions built practical AI and workflow software around Excelin’s existing operations, not instead of them. Walter, in particular, became a clinical QA layer that could review documentation at scale, not just move OASIS work through a queue.

Walter

OASIS, clinical QA, coding, and 485 automation

Walter was originally built for OASIS, but Excelin also uses it to perform QA on evals and general nursing visits. It reviews clinical documentation against predefined criteria, then either automatically corrects qualifying issues on OASIS or suggests corrections for clinicians to review.

Performs QA on OASIS, evals, and general nursing visits.
Compares clinical documentation against predefined review criteria.
Automatically corrects qualifying issues on OASIS where appropriate.
Suggests corrections for clinician review on evals and nursing visits.
Supports coding and helps prioritize the right codes in available OASIS coding spots.
Speeds 485 completion and documentation needed for billing readiness.
Provides a scalable QA and review layer that does not take PTO or create staffing bottlenecks.

Wilma

Physician order workflow automation

Helps manage order status visibility.
Supports follow-up and triage workflows.
Reduces ambiguity around whether orders are ready for review, pending signature, or returned.
Gives teams clearer operational visibility across order workflows.

Why the QA layer mattered

For Excelin, one of Walter’s strongest capabilities was not just faster OASIS completion. It was structured clinical QA: reviewing documentation against defined criteria, correcting what could be corrected automatically, and routing the rest back to clinicians with clear suggested fixes. That let the team reduce manual review pressure without giving up oversight on evals, nursing visits, or the quality measures leadership tracked.

The systems were not treated as one-time software handoffs. 21 Solutions continued to support, adjust, and improve the workflows after go-live based on Excelin’s real operational feedback.

The measurable impact

50%

Reduction in coding and OASIS review FTEs

Excelin reduced the staffing required for coding and OASIS review by half while continuing to track compliance, quality, payment, and star-rating measures.

~$475K

Estimated annual savings

The staffing reduction translated into approximately $475,000 in annual savings.

~39%

Reduction in 485 completion time

Average 485 completion time was reduced by approximately 39%, helping improve billing readiness and reduce DSO pressure.

10 to ~7 days

OASIS completion improved

OASIS completion improved from a 10-day baseline to roughly 7 days on average during the measured period.

Quality maintained

Star-rating measures preserved

Excelin tracked quality and star-rating measures throughout the implementation and was able to objectively support that automation was not creating a new quality or rating risk.

Scalable capacity

Growth without proportional headcount

Excelin gained a workflow layer that could scale with volume without requiring the same staffing increases, PTO coverage, or manual coordination burden.

Faster completion meant faster billing readiness

For Excelin, speed was not just an operational convenience. When OASIS and 485 workflows took longer to complete, billing readiness slowed, DSO pressure increased, and cash flow was affected. By reducing completion times, Walter helped the revenue-cycle team move faster without forcing clinical operations to compromise review standards.

“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

The win was not just doing the work faster. It was doing it without creating new risk.

The biggest fear was not whether automation could move work through a queue. The fear was whether it could handle the nuance of home health coding and OASIS review without damaging payment performance, compliance confidence, or star-rating measures.

“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 is why Excelin tracked the metrics that mattered: completion time, comorbidity adjustment mix, functional scores, revenue per period, and star-rating measures. Walter’s QA layer gave leadership a way to review documentation systematically before those metrics moved in the wrong direction. The result was not a blind automation rollout. It was a measured, operationally accountable system that gave leadership confidence.

Built for the nuance generic automation misses

Home health coding is not a simple rote task. Excelin needed automation that could help use available OASIS coding spots strategically, capture appropriate comorbidity adjustments, and avoid becoming an outlier that would create review risk.

Walter helped Excelin capture available comorbidity adjustments more effectively while keeping the overall payment and risk profile within an acceptable range. The goal was not to maximize every metric blindly. The goal was to improve the workflow while protecting the agency.

A partner that stayed involved after go-live

A major part of the value was not just the initial build. Excelin emphasized that 21 Solutions continued to support, improve, and refine the system after launch. That mattered because healthcare operations change, edge cases appear, and teams need a partner who owns production outcomes.

“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

How Excelin describes 21 Solutions

“21 Solutions is a group of exceptionally intelligent people that thoughtfully take what you want to do and make it happen. I share my pain points and what we need, and they carefully scope out exactly how they can do it.”

Sheena Meeker, Excelin Health

Excelin described 21 Solutions as a custom development partner with excellent customer service, US-based support, and a willingness to solve operational problems that off-the-shelf vendors were not willing to take on.

“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

Before and after 21 Solutions

Before

Completion timelines increasing
Staff capacity stretched
Growth outpacing manual workflows
Quantity-over-quality pressure
Billing readiness delays
Fear that automation could harm quality or payment
Plug-and-play vendors unable to fit the workflow

After

Clinical QA on OASIS, evals, and nursing visits with auto-correction or clinician review
Coding and OASIS review staffing reduced by 50%
About $475K annual savings
485 completion time reduced by approximately 39%
OASIS completion improved from 10 to roughly 7 days
Revenue-cycle process improved
Star-rating measures maintained
Custom automation continuously improved after launch
Ability to scale without proportional headcount growth

If your workflow is too nuanced for generic AI, that is exactly where 21 Solutions fits.

Excelin’s challenge is common across multi-site healthcare operations: high-volume work sits between clinical documentation, EHR-adjacent systems, billing requirements, compliance expectations, and staff capacity. Generic tools rarely solve that entire workflow. 21 Solutions embeds into the operation, builds around the real process, and stays accountable after launch.

For home health and post-acute organizations
For revenue-critical documentation workflows
For QA, coding, OASIS, 485, physician order, referral, and billing-adjacent bottlenecks
For teams that need custom workflow ownership, not another disconnected SaaS tool
For operators who need measurable results without outsourcing the operational risk

Have a healthcare workflow that cannot stay manual?

If your team is scaling faster than your manual processes can support, 21 Solutions can help identify where custom automation will have the highest operational and financial return.

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