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RCM Performance, AI-Enabled Controls, and Predictable Revenue

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A Michigan Cardiology Group Took Its Denial Rate From 22% to 14% and Recovered $4.2M September 25, 2026

A Michigan Cardiology Group Took Its Denial Rate From 22% to 14% and Recovered $4.2M

A Michigan cardiology and cardiovascular group cut its denial rate from 22% to 14% in six months with QWay Healthcare and recovered $4.2M, clearing 35% of a $12M+ denied-claim backlog. Pre-submission denial-risk review, …

Read Article A New York Hospital Collected $2.1M of Its Own Aged AR in Six Months September 25, 2026

A New York Hospital Collected $2.1M of Its Own Aged AR in Six Months

A New York multi-specialty hospital recovered $2.1M in aged AR in six months with QWay Healthcare, cut its 90+ day AR by 39%, brought AR days from 58 to 43, and made collection turnaround 28% faster. A dedicated, special…

Read Article CGM Billing Errors: How Documentation Gaps Lead to Denials and Lost Revenue September 25, 2026

CGM Billing Errors: How Documentation Gaps Lead to Denials and Lost Revenue

Continuous glucose monitor (CGM) claims are denied most often because of documentation gaps, not coding mistakes. Missing or outdated records, supplier changes mid-therapy, and poor handoffs between prescribers and suppl…

Read Article Chemotherapy Infusion Coding: How Treatment Plan Mismatches Cause Claim Denials September 25, 2026

Chemotherapy Infusion Coding: How Treatment Plan Mismatches Cause Claim Denials

Chemotherapy infusion claims are often denied when the drugs, doses, or administration codes billed don't match the approved treatment plan or authorization. Payers' automated systems catch these mismatches first. Reconc…

Read Article Critical Care Time vs. Shift Duration: How Documentation Errors Cause Systematic Undercoding September 25, 2026

Critical Care Time vs. Shift Duration: How Documentation Errors Cause Systematic Undercoding

Shift duration is how long a physician was on the clock. Critical care time is the specific number of minutes spent directly managing a critically ill patient on a given date, and it's the only number CPT codes 99291 and…

Read Article Dialysis Capitation Billing Errors: How Incorrect Claim Segregation Can Delay Reimbursement September 24, 2026

Dialysis Capitation Billing Errors: How Incorrect Claim Segregation Can Delay Reimbursement

Dialysis patients generate several claims every week, so errors in separating capitated services from separately billable ones repeat quickly and delay reimbursement. Most of these errors come from payer arrangement chan…

Read Article How Incorrect EMS Call Type Classification Leads to Claim Denials and Lost Revenue September 23, 2026

How Incorrect EMS Call Type Classification Leads to Claim Denials and Lost Revenue

EMS call type classification determines the level of service billed, so a misclassified call can lead to medical necessity denials or downcoding even when the transport was appropriate. Most errors start in dispatch and …

Read Article ENT Diagnostic Testing Bundling: How Incorrectly Unbundled Hearing Tests Trigger Claim Denials September 22, 2026

ENT Diagnostic Testing Bundling: How Incorrectly Unbundled Hearing Tests Trigger Claim Denials

Many audiology tests are designed to bundle, meaning some components are included in a more comprehensive test code and can't be billed separately. Billing those components individually triggers bundling denials. Knowing…

Read Article Infectious Disease Consultation vs. Established Patient Visits: How Coding Errors Cause Denials September 21, 2026

Infectious Disease Consultation vs. Established Patient Visits: How Coding Errors Cause Denials

A consultation requires a documented request from another provider, an opinion rendered, and a report sent back, while an established patient visit simply means the patient was seen by the same specialty group within the…

Read Article Modifier 57 vs. Global Surgical Period Rules: How General Surgery Claims Get Denied September 20, 2026

Modifier 57 vs. Global Surgical Period Rules: How General Surgery Claims Get Denied

Modifier 57 marks an E/M visit on the day before or day of a major surgery (90-day global period) as the visit where the decision to operate was made, so it can be paid separately. Modifier 25 applies to minor procedures…

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