Case Study

Dr. Angela Ramirez had seen it all. As a family medicine physician in a busy, multi-specialty healthcare organization, her days moved fast—patients, charts, follow-ups, more patients. Like many of her colleagues, she relied on her clinical instincts and focused on providing excellent care. 

But behind the scenes, something wasn’t working. 

Despite an advanced healthcare IT ecosystem, including top-tier EHRs, billing tools, and patient engagement systems, claims were being denied more than ever. Coders struggled to interpret the provider’s notes. Payments were delayed. Tension grew between clinical and billing teams. 

And it wasn’t just Angela. Across the organization: from orthopedics to OB-GYN to urgent care, coders were wrestling with unclear documentation and complex, specialty-specific coding rules. Everyone was doing their best, but it wasn’t enough to bridge the gap. 

Provider Snapshot: A Multi-Specialty Care Leader 

Our client is a mid-sized healthcare organization operating across both outpatient clinics and hospital settings. The network provides comprehensive care to a wide demographic, covering a diverse range of specialties: 

• Evaluation & Management (E/M): Family Practice, Paediatrics, Internal Medicine, OB-GYN, Psychiatry, and more. 

• Surgical Specialties: Orthopaedics, Cardiovascular Surgery, Podiatry, Gastrointestinal Surgery, and others. 

While the diversity of services is a strength, it also brought layers of complexity, especially in coding. 

The Hidden Problem 

Serving a wide variety of specialties, this healthcare organization faced the challenge of aligning coding processes across different areas. Each specialty came with its own unique set of coding requirements. For instance, neurology had little in common with gastrointestinal surgery, and documentation for Federally Qualified Health Centres (FQHCs) was particularly nuanced. 

Common problems included: 

• Incomplete or unclear documentation, leading to coding delays and denials. 

• Coders lacked specialty-specific training and tools, relying too much on guesswork. 

• Weak feedback loops allowed documentation gaps to persist. 

• Initial clinical notes missed key coding details, creating more work downstream. 

Despite having advanced tools, the system was misaligned—technology alone couldn’t solve the people and process challenges. 

A Strategic Turnaround — Powered by QWay Healthcare 

Facing growing challenges and an unsustainable approach, the leadership team realized that a new strategy was essential—not just for short-term fixes but for a lasting transformation. That’s when they turned to QWay Healthcare to guide them through a strategic overhaul, focusing on three core pillars: people, process, and platform. 

Specialty-Focused Coding Support 
Coders were aligned with specialties they were experienced in or had a strong interest in. Instead of bouncing between unrelated areas, coders became specialists in their respective fields—improving accuracy and confidence. 

Real-Time Collaboration 
New feedback mechanisms bridged the gap between coders and providers. Dr. Ramirez, for example, began receiving brief, targeted documentation insights embedded directly into her EHR workflow—no more retroactive corrections. 

Continuous Training 
Coders received ongoing, specialty-specific training to stay current with payer changes and regulatory shifts. Providers also got tailored, scenario-based education to improve documentation in their practice areas. 

Quality Embedded in the Workflow 
Audits and peer reviews were no longer reactive; they became proactive. Errors were caught upstream, increasing the rate of first-pass claim approvals and reducing unnecessary back-and-forth. 

Smart Technology Activation 
Beyond the EHR, intelligent coding tools were integrated to validate codes, flag discrepancies, and automate repetitive tasks—giving coders more time to focus on complex cases. 

The Outcome: Scalable Excellence 

The changes went beyond just improving operations; they reshaped how the entire team worked together. Coders and providers became more aligned, with documentation now being a collaborative process. And the results were immediate: 

• Claim Accuracy Jumped by 25% 
  First-pass approvals soared, dramatically reducing denials and rework. 

• Billing Turnaround Improved by 20% 
  Faster processing meant quicker reimbursements and better financial stability. 

• Coder Capacity Increased by 30% 
  New tools and training empowered teams to handle more work—without burnout. 

You’re in Great Company—Our Client Network Grew by 21% 
As more practices choose us for the same reasons you did, it’s clear that these results speak for themselves. The improvements in claim accuracy, billing turnaround, and coder capacity are just the beginning. With proven results and a commitment to smoother workflows, we’re here to help your practice continue to thrive and succeed. 

Conclusion: More Than Just Numbers 

This wasn’t just a win for finance teams, it was a win for patients and providers alike. Dr. Ramirez now spends less time clarifying notes and more time focusing on care. Coders feel like trusted partners, not behind-the-scenes troubleshooters. And the organization now runs with clarity, speed, and a shared purpose. Because when documentation is clear, coding becomes seamless—and care, ultimately, becomes better. 

The success of our clients is a testament to the strength of our partnerships, and that’s the value QWay Healthcare brings.