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Make the PDGM transition smart + simple

The Patient-Driven Groupings Model (PDGM) is set to deliver the biggest impact to home healthcare in 20 years. Starting on January 1, 2020, the adjusted payment model will rely more heavily on clinical characterizations and patient information—and is projected to double claim volumes.

Waystar is here to help. We’ve built a resource library to help home health agencies like yours get ready for PDGM, as well as technology solutions to help you succeed in the new regulatory landscape.

Get in touch

NAVIGATE THE TRANSITION TO TELEHEALTH

The shift to telehealth has accelerated since the onset of COVID-19. In just a month’s time, we’ve seen the volume of telemedicine claims on our platform grow by 40 times, indicating our clients are rapidly converting their care from office-based to remote.

For many providers, this means big changes to their infrastructure to meet patient needs and demand while maintaining financial stability. That’s why we’ve compiled a list of considerations and resources to help you navigate the new telemedicine landscape.

 
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STAY UP TO DATE ON FEDERAL TELEHEALTH REGULATIONS

Federal guidelines have changed due to the COVID-19 pandemic. Below are a few key things to note:

  • HHS is enacting enforcement discretion for HIPPA—in other words, not penalizing providers for noncompliance with HIPAA rules while using telehealth in order to encourage telehealth visits. It is important, however, to ensure you’re using secure technology when conducting telehealth visits.
  • This page gives more detail on what non-public facing platforms are best to use.
  • Get more information at the master CMS resources page.

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Discover the Waystar difference

We’ve aligned our most effective claims and denials solutions to help make your organization as productive as possible. Drawing on the latest tech and predictive analytics, your team will benefit from:

KNOW YOUR STATE'S GUIDELINES

In addition to federal regulations, you will also need to be aware of and in compliance with guidelines in your state.

  • Visit the Federation of State Medical Boards resource page to see which states have altered licensing requirements related to physicians licensed in another state and retired or clinically inactive physicians. This opens the door to telehealth services that cross state lines and ultimately increases access to health providers.
  • Get the facts on reimbursement policies: 36 states have payer parity laws, which require private insurance companies to cover telehealth the same as they would an in-person visit. Many states, however, still restrict telehealth coverage based on the type of visit and who is providing care, underscoring the importance of closely monitoring state guidelines.
  • In addition to the federal mandate requiring payers waive cost-sharing for COVID related testing, there are some states mandating that payers waive cost-sharing for even more services. Check with your state to find out what applies to your organization.
  • Automated pre-claim eligibility detection
  • Automated secondary claims processing
  • Aging claim worklists
  • Industry-leading denial and appeal management
  • Automated Medicare Part A claim status checks
  • Extensive user productivity reporting
  • Analytics packages with end to end transparency
  • Industry-best client service and support
  • Custom edits built free of charge

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COMMUNICATE WITH PAYERS AND ADAPT TO NEW CODES

Government and private insurers are evolving their guidelines and processes. Make sure you’re informed about payer requirements and preferences.

  • CMS expanded Medicare and Medicaid coverage for telehealth, allowing patients to receive a wider range of health care services from their physicians without having to visit a health care facility. This is temporary, though no end date has been specified yet. Check out the CMS fact sheet and Medicaid overview, and find covered services + codes here.
  • Check with your payers for their preferred POS codes and modifiers on the claim. Here is a great resource from CMS about their telemedicine coding preferences.
  • Many private insurers are following suit, some even waiving cost-sharing for patients for COVID-19 treatment/testing. Ultimately, every payer sets its own rules about whether to cover telehealth and complying with the payer’s individual telehealth billing policies can impact if a provider is paid promptly or at all. Read more here.

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A FEW MORE TELEHEATH TIPS

Once you’re clear on federal and state regulations, as well as payer requirements, check out the miscellaneous tips and resources below.

  • Approved communication methods: Currently, CMS allows for use of telecommunications technology that has audio and video capabilities for two-way, real-time interactive communication. This is only required for telehealth visits, not e-visits or virtual visits. Read FAQs here.
  • Online security: Work with your technology team and third-party vendors to ensure the security of any communication platforms used during telehealth appointments and the secure transmission of any electronic medical records between provider and patient.
  • Personnel training: For many physicians, this could be the first time they are regularly seeing patients through a screen rather than in-person. Consider how you can set your team up for success with the proper training and adequate resources on how to administer patient care remotely.
  • Waystar’s response: For more information about how Waystar is supporting clients through this time, visit our COVID-19 resource center.

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telehealth-Gif(full-rez).gif

NAVIGATE THE TRANSITION TO TELEHEALTH

The shift to telehealth has accelerated since the onset of COVID-19. In just a couple month’s time, we’ve seen the volume of telemedicine claims on our platform grow by more than 100 times, indicating our clients are rapidly converting their care from office-based to remote.

For many providers, this means big changes to their infrastructure to meet patient needs and demand while maintaining financial stability. That’s why we’ve compiled a list of considerations and resources to help you navigate the new telemedicine landscape.

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JOIN US FOR A WEBINAR

Top 5 proven strategies to optimize the patient financial journey

Join us on , at

During this webinar, you will:


RSVP today

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SPEAKER:

Nicole Nye, VP, Product Management, Waystar

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What Our Clients Say:

100%

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Everything you need to know for a smooth PDGM transition

Check out the resources below for background info and tips for success.

Contact us

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Get the full rundown on PDGM with our webinar
> Watch webinar

Learn more about PDGM basics
> View fact sheet

Make sure your team is ready with our PDGM checklist
> Get checklist

Three tips for transitioning to the new home healthcare landscape
> Read blog

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Results that matter. Experience that counts.

Waystar helps home health agencies significantly streamline operations while securing reliable revenue streams. Learn more by reading a couple of our success stories.

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Results that matter. 
Experience
that counts.

Waystar helps home health agencies significantly streamline operations while securing reliable revenue streams. Learn more by reading a couple of our success stories.

How BAYADA decreased denial rates by 72%
> Read case study

How Preferred Home Health rebilled $4.1M in claims
> Read case study

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Feature

Waystar

Other

Details

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Waytstar
Category
Average

Overall Score

95.7

87.3

% Clients Satisfied

73

N/A

Best Vendor Relationship

95.2

84.3

Product

94.2

86

Value

96.9

86.6

Operations

95.5

88.9

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Patient
Financial
Clearance

Revenue
Integrity

Claim
Management

Denial
Management

Contract
Management

Patient
Financial
Experience

Agency
Management

Patient
Insights

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90%

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90%

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CLAIM MANAGEMENT

   

Starter

Simplify Denials Management

Core

Reach Workflow Excellence

Performance

Get visibility into the claim lifecycle

Premium

Achieve Revenue Cycle Automation

Expanded claim lifecycle visibility through date tracking and proof of timely filing reports

Automated front-end claim editing and scrubbing

View and edit claims in customizable workgroups for prioritization and staff assignment

Payer response clarified and simplified with Simple Response™ technology

Hundreds of crowdsourced rules and edits

Claim process lifecycle visibility with date tracking and proof of timely filing reporting

Dashboards and reports for key rev cycle performance and user productivity metrics

Real-time claim status inquiries with approximately 5-7 second payer responses

Make eligibility and benefit coverage inquiries

Leverage 1,200 payer connections

Verify eligibility and co-payments

Quickly and easily enter patient info

Expedite check-in by accessing real-time plan information in seconds

Automated provider enrollment

Denial prevention with automated pre-claim eligibility verification

Streamline denial management

Flexible workgroups and automation to close non-workable denials

Eligibility integration to check patient coverage within denial workflow

Root cause reporting to reduce preventable denials

Robust outcome reporting and dashboards for user-friendly resubmissions and payer follow-up

Simplify appeal processes

Appeals wizard that allows you to create three-step, 100% paperless appeals packages

More than 600 payer appeal templates available and pre-populated with remit and provider data, including proof of timely filling

Custom and dynamic attachments and saved responses streamline submission

Ability to batch 100 similar appeals to same payer

Automate claim status checks

 

Custom schedules to accommodate follow-up workflow

 

Proactive claim status checks based on predictive analytics that determine optimal timing

 

Automatic claim status checks without the need for batch files

 

Early notification of pended claims

 

Payer response clarified and simplified with Simple Response™ technology

 

Ability to work by exception with focused workgroups

 

Visualize your performance and deliver actionable insights

   

Custom dashboards and reports

   

Alerts to drive corrective action when KPIs deviate from target range

   

All-in-one, standardized rev cycle analytics for financial performance clarity

   

Intuitive drill-down capabilities to identify key details in the health of the rev cycle

   

Automate bank reconciliation processes

     

Automated identification of missing or inaccurate deposits and ERAs

     

Streamlined payment posting workflows to avoid posting delays that increase AR days

     

Aggregated reporting for payment information —even if you use more than one bank

     

Convert paper EOBs to electronic files

     

Indexing of checks and documents for historical tracking

     

Automated payment posting and reconciliation

     

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FEATURES

 

ANALYTICS PRO

ANALYTICS PEAK

Expanded claim lifecycle visibility through date tracking and proof of timely filing reports

PRO

+

PEAK

+

+

+

Dynamic, interactive, easy-to-use data visualization tools that allow for a deeper understanding of your rev cycle

PRO

+

PEAK

+

+

+

Your data unified on an end-to-end RCM platform

PRO

+

PEAK

+

+

+

Unlimited custom dashboards + reports with simple, yet robust BI tools to see and explore the data your way

PRO

 

PEAK

+

 

+

Tailored insights with custom defined calculations, definitions and KPIs unique to your organization

PRO

 

PEAK

+

 

+

Ad-hoc data analysis tools for deeper insights into every facet of your revenue cycle

PRO

 

PEAK

+

 

+

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Number of claims you follow up on monthly

<  >

Number of FTEs dedicated to payer follow-up

<  >

Fully loaded annual salary of medical biller

<  >

Total savings per year

$204,327

These numbers are for demonstration only and account for some assumptions. Contact us for a more comprehensive and customized savings estimate.

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Monthly claim volume

<  >

Current denial rate

<  >

Average claim value

<  >

Average number of appeal packages submitted per month

<  >

Total additional revenue recovered per year

$204,327

Total staff hours saved

These numbers are for demonstration only and account for some assumptions. Contact us for a more comprehensive and customized savings estimate.

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Gross patient revenue

Net patient revenue

Patient mix (% Inpatient)

<  >

Payer Mix (% Commercial)

<  >

Payer mix (% Government)

<  >

Payer mix (% Other/self pay)

<  >

Note: The above values need add up to 100%

100%
$1.8M
$2.2M
$3.3M
$7.9M

OUTER RANGE: Likely cash impact range for a system of your size

INNER RANGE: Most probable range given your specific information

Benefit range accounts for benefit to be attained through missing charges, CPT coding errors and DRG assignment errors. This calculator is designed to be educational in nature based upon limited information. It is therefore not a guarantee of performance. 1 HFMA blog, 2016

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Join our clients in reducing rejections
and denials by payers

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CONTACT US

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