Pagosa Springs Medical Center (PSMC)’s biggest pain point in the revenue cycle? Denied claims. Their incumbent clearinghouse was unable to deploy custom rules, which resulted in labor intensive, inefficient processes and a first-pass clean claim rate of just 70-75%. For all denied claims, the PSMC team had to extract claim adjustment reason codes and then manually match them to the associated denial before reworking and appealing. Every rejection or denial had to be rebilled, and even after extensive denial mapping, their results only improved marginally.
PSMC’s Director of Revenue Cycle, Debbie Campbell, began looking for a better solution. First, she implemented eSolutions (now part of Waystar) to replace the vendor they were using for government billing. eSolutions’ direct connection to Medicare FISS was a big reason for the switch. “With our old clearinghouse, it wasn’t easy to work RTPs– it’s so much easier with eSolutions,” said Campbell.
PSMC hopes to catch 90% of would-be denials using Waystar’s pre-submission eligibility checks
Debbie Campbell, Director of Revenue Cycle, Pagosa Springs Medical Center
Waystar simplifies and unifies healthcare payments with innovative, cloud-based technology. Together, our technology, data and client support streamline workflows and improve financials for our clients, so they can focus on their patients.
