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PRICE TRANSPARENCY RESOURCE CENTER

Empower your patients + ensure CMS compliance

Price transparency is a perennial issue in healthcare. When patients don’t know in advance what they will owe, it could lead to financial stress and inability to pay after point-of-service. This results in patient dissatisfaction and makes it more difficult for providers to collect payment. As an added challenge, CMS has mandated that hospitals publish meaningful price information for patients— effective January 1, 2021.

Waystar has you covered. We hope you find the resources collected here useful as you prepare to fulfill the CMS mandate.

Make the PDGM transition smart + simple

The Patient-Driven Groupings Model (PDGM) represents one of the biggest adjustments to home healthcare in 20 years. The new payment model, which went into effect on January 1, 2020, relies 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 transition to PDGM, as well as technology solutions to help you succeed in the new regulatory landscape.

Contact us to learn more

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What you need to know for Jan 1, 2021

Automate Medicare Part A status checks

Your claim volume has likely doubled in this new PDGM era. Waystar is now proud to offer an add-on to our Claim Monitoring solution specifically for Medicare Part A. This technology automates one of your team’s most burdensome tasks—navigating the Medicare FISS system to check on the status of Part A claims. Reponses are then converted into simple, easy-to-understand messages, so your team knows exactly what to do next. As claim volume increases under PDGM, it’s more important than ever to streamline workflows and increase staff productivity.

Request demo

There are two primary requirements for hospitals to publish standard charges. See below for a summary, and reach out to Waystar to find out more about how we can help your organization meet the CMS mandate and improve your patient experience.

  • Applies to all hospitals
  • Update at least annually
  • Must be prominently displayed + easily accessible
  • Daily $300 penalty for noncompliance

Read more

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The CMS transparency timeline

On November 15, 2019, CMS finalized policies requiring hospitals to disclose standard charges for items and services in the hopes that patient-driven shopping will create market competition and ultimately make healthcare affordable. See a snapshot of how the timeline is unfolding and what it means for 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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* Recent litigation has ruled in favor with HHS, however plaintiffs plan for an expedited appeal which could impact Final Rule effective date and/or requirements.

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Solve your price transparency
challenges with Waystar

Empower your patients to make informed healthcare decisions with Waystar’s Price Transparency solution. This market-tested, self service tool generates accurate estimates in consumer-friendly terms.

The Price Transparency tool can be deployed on your patient portal or website, giving patients a web and mobile-friendly price shopping experience.

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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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Upcoming + recent webinars

We’ll be hosting webinars to keep you informed about price transparency updates, readiness preparation and the solutions that can help you succeed.
June 18
Price Transparency Mandate - 
Making Sense
of the CMS
Final Rule


Watch recording

July 9
Complying with CMS Price Transparency Requirements - 
Strategies for Organizational Readiness

Register

August 6
How Waystar Supports Price Transparency 




Registration
coming soon

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What Our Clients Say:

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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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Solve your price transparency 
challenges with Waystar

Empower your patients to make informed healthcare decisions with Waystar’s Price Transparency solution. This market-tested, self-service tool generates accurate estimates in consumer-friendly terms.

The Price Transparency tool can be deployed on your patient portal or website, giving patients a web and mobile-friendly price shopping experience.


Key benefits include: 
  • Real-time patient-generated estimates for most shoppable procedures
  • Consumer-friendly terms allow for easy search and selection
  • Requires minimal patient input to retrieve complete out-of-pocket details
  • Intuitive scheduling and financial assistance tools
  • Auto-attaches known complementing charges to increase accuracy rates
Work with Waystar to give your patients the information and level of service they deserve. Learn more by clicking through the resources below.

Waystar Price Transparency fact sheet > Download

Waystar Price Transparency white paper > Download

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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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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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At vero eos et accusamus

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At vero eos et accusamus

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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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At vero eos et accusamus

Sed ut perspiciatis unde omnis iste natus error sit voluptatem accusantium doloremque laudantium, totam rem aperiam, eaque ipsa quae ab illo inventore veritatis et quasi architecto beatae vitae dicta sunt explicabo.

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At vero eos et accusamus

Sed ut perspiciatis unde omnis iste natus error sit voluptatem accusantium doloremque laudantium, totam rem aperiam, eaque ipsa quae ab illo inventore veritatis et quasi architecto beatae vitae dicta sunt explicabo.

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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.

At vero eos et accusamus

Sed ut perspiciatis unde omnis iste natus error sit voluptatem accusantium doloremque laudantium, totam rem aperiam, eaque ipsa quae ab illo inventore veritatis et quasi architecto beatae vitae dicta sunt explicabo.

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At vero eos et accusamus

Sed ut perspiciatis unde omnis iste natus error sit voluptatem accusantium doloremque laudantium, totam rem aperiam, eaque ipsa quae ab illo inventore veritatis et quasi architecto beatae vitae dicta sunt explicabo.

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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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