P R O B L E M S T A T E M E N T
The client, a mid-sized healthcare facility, was grappling with a high denial rate for their
insurance
claims. Despite their best efforts, a substantial percentage of claims were being rejected or
denied by
insurance payers. This situation not only hampered the facility’s revenue stream but also put a
strain on
their administrative resources.
FINDINGS
QWay Healthcare conducted a thorough assessment of the client’s RCM processes and identified key
findings:
Data Analysis: A significant portion of denials were attributed to incorrect patient information,
coding errors, and missing documentation.
Lack of Automation: Manual data entry and claim submission processes were prone to errors and
inefficiencies.
Limited Denial Insights: The client lacked a robust system to track and analyze denial patterns,
hindering the ability to make informed decisions.
OUTCOMES
QWay Healthcare achieved a 65% decrease in the denial inventory within 6 months and achieved net
collections of $1 million on a balance of $2 million. Additionally, the health system achieved a 40%
cost savings from outsourcing coding denial management to QWay Healthcare
A T A G L A N C E
CH A L L E NGES
Lack of visibility
Manual Processes
Complex payer guidelines
Inadequate follow-ups
B E N E F I T S
Process Automation
QWay implemented automated systems for data entry, claim submission, and verification, reducing
human errors and expediting the entire claims process.
Payer Guidelines Integration
QWay integrated the diverse payer guidelines into the facility’s workflow, ensuring accurate claim
submissions.
Denial Analysis Tool
QWay introduced a powerful denial analytics tool that identified recurring denial reasons, allowing
the facility to address root causes systematically.
Follow-up Protocols
QWay established a streamlined follow-up protocol to address denied claims promptly, correcting
errors and resubmitting claims within stipulated timelines.
65%
Denial Rate Reduction within 6 months with frequent reviews of the usage of the appropriate usage of
coding and payer guidelines.
40%
Cost reduction by hiring mobile workforce provided by QWay Healthcare for denial management
services.