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RCM Performance, AI-Enabled Controls, and Predictable Revenue
Articles and insights on RCM performance, AI-enabled controls, and building predictable revenue outcomes.
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March 23, 2026
4 Proven Methods to Optimize Risk Adjustment
Risk adjustment adjusts payments based on how sick and complex a provider's patients are, using models such as CMS-HCC. Four proven ways to optimize it are stronger payer–provider collaboration, better understanding of H…
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March 23, 2026
Transformations in Evaluation & Management (E&M)
The 2025 CPT update changed Evaluation and Management coding and added new telemedicine codes, alongside revisions in the surgery and medicine sections and new Category III codes. Revenue cycle teams need updated coding …
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March 19, 2026
Eliminating CO-119 Denials with AI-Driven Revenue Cycle Management
A multispecialty medical group eliminated recurring CO-119 denials on Medicare screening colonoscopy claims with QWay Healthcare. AI-based checks validated each patient's screening history against Medicare frequency limi…
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March 19, 2026
Improving Claim Accuracy by 25% Across a Multi-Specialty Healthcare Network
A multi-specialty healthcare organization improved claim accuracy by 25%, billing turnaround by 20%, and coder capacity by 30% with QWay Healthcare. Coders were aligned to specialties, providers received documentation fe…
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March 9, 2026
Reducing Claim Denials by 65% in 6 Months
A mid-sized healthcare facility reduced its denial inventory by 65% in six months with QWay Healthcare, recovered $1 million in net collections from a $2 million balance, and cut costs by 40% by outsourcing coding denial…
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March 9, 2026
Accelerating Clinical Readiness in 90 Days
QWay Healthcare fully credentialed a relocating family medicine physician within 90 days of hire. Parallel payer enrollments, a corrected CAQH profile, early hospital privileging, and weekly follow-up got Medicare approv…
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February 24, 2026
Top 10 Benefits of Prior Authorization (With Tested Ways to Maximize Approvals)
Prior authorization confirms medical necessity and coverage before high-cost services, which helps control costs, protect patients, and reduce claim denials. To improve approval rates, submit complete clinical documentat…
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February 24, 2026
CMS HCC Coding: Top Mistakes and How to Prevent Them
The most common CMS HCC coding mistakes are missing or unsupported chronic conditions, unspecific diagnosis codes, and documentation that doesn't meet MEAT criteria. These errors lower RAF scores, reduce reimbursement, a…
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February 24, 2026
Healthcare has come a long way from what it used to be.
The CMS-HCC model adjusts Medicare Advantage payments based on each patient's documented chronic conditions, which produce a risk adjustment factor (RAF) score. Sicker patients mean higher expected costs and higher payme…
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February 24, 2026
The Turning Point in Global Healthcare
ICD-11, the World Health Organization's latest disease classification, replaces ICD-10 with a digital, more detailed code set. It improves how conditions are captured and analyzed, but U.S. providers still bill with ICD-…
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