Quick answer: 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, analytics-ranked recovery work, and root-cause corrections ran in parallel, and appeal turnaround became 25% faster.
Eight Percentage Points in Six Months, With $4.2M of a $12M Denied-Claim Backlog Cleared Alongside It
Working the backlog would have recovered the $4.2M. Working the inflow at the same time is what moved 22% to 14%.
Overview
A Michigan cardiology and cardiovascular group was denying 22% of its claims, roughly double what a practice its size should expect. More than $12M sat in unresolved denied claims and the 90+ day AR bucket grew every month. The group ran two workstreams at once: clearing the denials it already had, and stopping the ones still coming. In six months, the denial rate fell to 14% and $4.2M of the backlog came back.
Impact & Key Metrics
| Measure | Start | Six months later |
|---|---|---|
| Denial rate | 22% | 14%, an 8-point improvement |
| Denied-claim backlog | $12M+ unresolved | $4.2M recovered, clearing 35% |
| Appeal turnaround | baseline | 25% faster |
| Denial trends, payer patterns, and service-line performance | no view | visible through business intelligence reporting |
Challenge
A 22% denial rate has several causes running at once. This group could not see which ones.
The claims data showed denials. It did not show why. Nobody could say which payer drove the most write-offs, which service line generated the most rework, or which denial reasons repeated month after month. Without that, the billing team worked the queue in front of them: newest first, loudest first, largest first. Reasonable triage with no information behind it.
So the backlog compounded. Denials that needed an appeal sat past the window. Denials that needed a corrected claim went back with the same error. The 90+ day bucket grew every month, and each month the team worked hard and the number got worse.
Cardiology makes this harder than most specialties. Prior authorization on imaging, medical necessity on procedures, and cath lab coding each deny for different reasons and each needs a different response. An undifferentiated denial pile hides all of it.
No outside event forced the decision. Three numbers did. A 22% denial rate, a $12M+ denied-claim backlog, and a 90+ day AR bucket climbing every month told leadership that the problem was structural. They went looking for a more structured approach to denial management rather than more effort applied to the same process.
Solution
Two problems were running at the same time: the denials already sitting in the queue, and the denials still arriving. The group addressed both in parallel rather than clearing the backlog first.
On the prevention side, newly submitted claims got reviewed for denial risk before they went out. Every claim caught at that stage is one that never enters the queue, never needs an appeal, and never ages. That is what an 8-point drop in the denial rate looks like from the inside.
On the recovery side, the denial management team worked the existing denied claims, identifying which held real recovery potential and pursuing those. QWay Healthcare's analytics ranked the pile by payer and by service line, which turned $12M of undifferentiated denials into a list with an order to it.
The analysis connected the two. Detailed denial review surfaced the root causes that kept repeating, and each recurring cause became a targeted correction applied at the source. The same finding that explained why a claim denied last quarter stopped the next one from denying at all. One diagnosis served both sides of the work.
Results, Before and After
Before QWay Healthcare:
- Denial rate at 22%
- More than $12M in unresolved denied claims
- 90+ day AR climbing month over month
- No view of denial root causes or payer trends
After QWay Healthcare, at six months:
- Denial rate at 14%, an 8-point improvement
- $4.2M recovered, clearing 35% of the denial backlog
- Appeal turnaround 25% faster
- Denial trends, payer patterns, and service-line performance reported and reviewable
The 25% appeal turnaround gain is worth more than it looks. Appeals run against payer deadlines, so every day cut off the turnaround moves claims inside a window they would otherwise have missed. An appeal that misses its window stops being a receivable and becomes a write-off.
Frequently Asked Questions
What was driving the group's 22% denial rate?
Several causes were running at once, and the group could not see which ones. The claims data showed denials but not why, so no one could say which payer drove the most write-offs, which service line generated the most rework, or which denial reasons repeated. In cardiology, prior authorization on imaging, medical necessity on procedures, and cath lab coding each deny for different reasons.
What results did QWay Healthcare deliver?
In six months, the denial rate fell from 22% to 14%, $4.2M was recovered from previously denied claims (35% of a $12M+ backlog), and appeal turnaround became 25% faster.
Why work the backlog and new claims at the same time?
Working the backlog alone would have recovered the $4.2M. Reviewing newly submitted claims for denial risk before they went out, at the same time, is what moved the denial rate from 22% to 14%.
What does the group keep after the engagement?
Business intelligence reporting now gives the group a standing view of denial trends, payer patterns, service-line performance, and open recovery opportunities, along with documented methods for preventing the same denials from recurring.
The Bottom Line
The recovered dollars are the headline. What the group kept is the reporting underneath them.
Business intelligence reporting now gives this group a standing view of denial trends, payer patterns, service-line performance, and open recovery opportunities. Revenue cycle decisions get made against that view instead of against last month's aging report. The root causes that drove the original 22% turned into documented methods for preventing the same denials from recurring, which is the part that survives after a recovery push ends.
A recovery push pays once. This group finished the six months with the $4.2M and with the reporting that shows them where the next 22% would come from.
Start With the Denial Rate
Most revenue leaders can quote their denial rate. Far fewer can name their top three denial reasons by payer, and that second number is the one that determines whether the first one moves.
If you cannot name yours, start with a denial baseline. QWay Healthcare will rank your denials by payer and service line, quantify what is recoverable against what is aging out of appeal, and put a dollar figure on both before either of us discusses scope.
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