Waystar True North Conference

Over three days, attendees discussed important issues such as leveraging AI, safeguarding data, and managing rising transaction volume. They uncovered key software advancements that are simplifying healthcare payments through dozens of sessions, workshops, and events.  

Additionally, attendees gained insight from other leaders in the industry while making critical connections (and having a little bit of fun).  

Here are just a few takeaways from our Waystar True North Conference 2024. 

TIP #1 FOR HEALTHCARE REVENUE CYCLE LEADERS 

Invest in AI + generative AI strategically to see high ROI 

Many industries are excited about the possibilities of artificial intelligence (AI) and generative AI (gen AI), and healthcare payments are no exception.  

At Waystar True North, Waystar’s Chief Technology Officer, Chris Schremser, unveiled new research from Waystar and Modern Healthcare showing the ROI of AI in healthcare payments. In this study of 60-plus senior executives and finance leaders, a fact became clear: AI is a major driver for financial growth — now and in the future. 

The research reveals: 

• 75% of respondents report that AI has already delivered a positive ROI 

• 90% plan to invest in AI in the near future, most within the next year 

• 66% foresee investing in generative AI over the next 12-18 months 

As he delved into the details, Schremser put the numbers in context. 

“Data doesn’t mean anything if you can’t surface the right information at the right time,” he said. “And if you train a model on bad data, you get bad results. That’s why not all AI is equal. 

“When we talk about use cases, we have to focus on deploying the right AI and machine learning to solve the problem at hand in a cost-effective way. Using AI or gen AI to solve small problems doesn’t make sense. But using it to generate claim rules, track payer behavior, or evaluate medical necessity? That shows ROI.”  

TIP #2 FOR HEALTHCARE REVENUE CYCLE LEADERS 

An end-to-end software platform yields positive results — for providers and patients 

Another common theme at Waystar True North 2024 was the value of adopting an end-to-end platform strategy to maximize performance. 

Healthcare payments are complex enough without having to manage multiple vendors or train staff on disparate systems. Plus, consolidating vendors provides a better experience for staff and patients.  

A recent study by Waystar and The Health Management Academy shows:  

• 70% year-over-year increase in the adoption of end-to-end RCM platforms versus singular, specific products; and 

• 100% of the health systems that have adopted an end-to-end platform approach are experiencing a positive ROI or expect to within 1-2 years. 

The focus on operational efficiency was a top consideration for leading health systems surveyed. Many find that fewer partners can eliminate redundancies and foster improved care delivery for patients, providers, and staff. 

Read report

TIP #3 FOR HEALTHCARE REVENUE CYCLE LEADERS 

Partnership is essential to overcoming RCM challenges 

Revenue cycle management is complex. To solve complicated problems, organizations must leverage the right RCM software.  

This year, however, many leaders pointed out it’s just as important to invest in a trusted partner as it is in software, especially when the unexpected happens.  

At the conference, Waystar’s Chief Executive Officer, Matt Hawkins, shared thoughts on the importance of building smart software alongside a strong community — especially amid challenges such as the February 2024 cyberattack. 

“We’ve done some remarkable things to our software. We’ve added direct connectivity to dozens of new payers, bolstered our network, and helped well over 30,000 providers join us at Waystar,” says Hawkins. “So, we’re adding to our community, and we believe that’s very important.”  

“We’re grateful that Waystar is in a position to be helpful. That work is ongoing, it continues now. And, if you happen to be a provider or represent an organization that joined us through that effort, we thank you for trusting us in a very vulnerable period of time that was very challenging,” shares Hawkins. 

Earlier this year, Waystar had the opportunity to host a panel of healthcare experts who echoed this sentiment. 

“It’s usually not so much the event, but it’s how you react to the event,” says Steve Burr, Senior Vice President of Revenue Cycle at CHRISTUS Health. “It’s the people who are there for you, advancing the mission, even through those challenges.”

Watch panel

But how, exactly, do you find those trusted people?  

In-person events like Waystar True North are a great place to start. You can also find key checkpoints in this eBook: Empowering your team to get RCM results with the right partner. 

Interested in joining the next Waystar True North experience? 

Registration for Waystar True North Conference 2025 is now open.  

Join us September 15-17, 2025, in Nashville, TN, at the Gaylord Opryland Resort & Convention Center. We’ll discuss top revenue cycle challenges, unlock the latest breakthroughs in healthcare payments, and strengthen industry connections.  

Find your True North

The post Waystar True North™ 2024: 3 tips for healthcare revenue cycle leaders appeared first on Waystar.

And the possibilities only grow when you layer on generative AI. (See how Waystar and Google Cloud have automated the extraction of prior authorization requirements from complex payer data sets, reducing the time to generate a procedural preauthorization report by 99.93% while increasing accuracy by 13%.) 

But whether you’ve been using automated prior authorization software for years or you’re still in the research stages, there are steps you can take to ensure: 

1. Your workflows are operating as seamlessly as possible, and 
2. Your staff is set up for long-term success. 

1. Establish the facts: automated prior authorization works

Once you select the automated prior authorization software your organization will use, show staff its potential. That means features and functionality, of course, but also the results that teams are seeing using this solution.   

If you’re leveraging Waystar’s prior authorizations solutions, for example, you could highlight the fact that users see a: 

• 50% reduction in authorization process time 
• 8-day increase in authorization lead days 
• 2,172 hours saved leveraging automation in one year 

No matter your solution, sharing success stories with staff is a good way to foster trust and excitement. You’ve chosen a solution because it can address a critical problem or opportunity. Sharing key information with your team sets the stage for success. 

2. Activate exception-based workflows

Working accounts by exception is one of the most crucial aspects of automated prior authorization.

By automating repetitive, time-consuming tasks, staff can work only the records that truly need intervention. That allows them to:

• Save time
• Focus on high priority tasks
• Improve turnaround times and lead days
• Boost patient and provider satisfaction
• Improve outcomes

If you’re still transitioning to exception-based workflows, increase efficiency by taking four steps:

1. Prioritize worklists in your EHR
   Set up worklists within your EHR to foster an efficient workflow. Make sure staff can easily identify the records that require attention and sort lists so priority items populate at the top.

2. Create custom worklist columns
   If your EHR allows, add columns to help drive the workflow for staff. For example, add a custom worklist column to indicate if a payer is Waystar-enabled, or add columns to denote authorization status or insurance verification.

3. Eliminate duplicate or unnecessary tasks
   Every extra step you can delete from your workflow will increase efficiency and productivity. That will have a direct impact on other important metrics, such as turnaround times and authorization lead days.

4. Streamline notations
   In healthcare, staff often must notate the same information in multiple areas. Leverage smart phrases, automatic filing, or templates to save time and standardize processes. 

3. Get staff excited about adopting new technology

When it comes to implementing new technology, organizations that prioritize change management have a drastically better experience than those who assume staff will adopt the technology because they’ll inherently see the benefit.   

Communicate clear plans with staff, offer frequent training, and be consistent with expectations and issue resolution. 

1. Update staff success measures
   If you switch to a new, automated system but the measures for staff success stay in a manual workflow, employees will continue to follow the manual process because that’s where they’re being tracked. Make sure your metrics and tracking transition with you. 

2. Get buy-in from auxiliary departments + partners
   Partner with other departments, physicians, leaders, and teams when selecting and deploying automated prior authorization. The earlier you can bring them into the discussion, the more likely they are to be active, productive participants. 

3. Leverage training partners: superuser + new user
   Once a few team members are proficient with your new automated prior authorization software, leverage peer-to-peer training. Pairing a “super user” with a novice is a proven tactic to make new users feel more supported and comfortable as they onboard.

4. Schedule continuing education
   Schedule periodic group trainings to ensure processes are continuing and expectations are being met. 

5. Close communication loops
   Establish a communication feedback loop. When team members surface an issue and never hear about resolution or next steps, they may stop reporting issues altogether. That silence makes it difficult to maintain a high level of product performance. Leverage team meetings to close the communication feedback loop so that anytime something is resolved, staff hear about it. 

Prior authorization software in action: Atlantic Health System  

For Atlantic Health System, industry-wide labor shortages and disparate workflows led to delays in securing authorizations — to the point that many patients were postponing or canceling care.  

With Waystar as their guide, Atlantic leveraged cutting-edge automation to ensure patients can receive care as quickly and seamlessly as possible. That’s led to powerful results including: 

• 50%+ reduction in average auth submission 
• 8-day increase in average lead time for starting auths 
• 97% DAR clearance rate 

Read their story

The post Automated prior authorization 101: How to activate staff + exception-based workflows appeared first on Waystar.

A recent study, Examining AI adoption + ROI in healthcare payments, evaluated the role of artificial intelligence in improving RCM processes. Modern Healthcare and Waystar joined forces to survey 68 healthcare leaders and professionals about:

• The role of AI
• Where it’s making an impact today, and
• How healthcare organizations hope to use it in the future.

Here are just three highlights from the study that leaders need to know now.

1. FACT: AI in RCM yields positive ROI

AI implementation can improve claim accuracy from the start, helping teams bring in faster, fuller payments.

It’s easy to see the positives associated with applying AI to the revenue cycle. Every health executive surveyed agreed that AI can bring value to healthcare revenue cycle management. But while leaders understand the benefits of using AI, there are barriers to entry. The top is cost, according to 75% of those surveyed, followed by security concerns (65%), and the ability to integrate within their existing EHRs and PMs (65%).

And then there’s the overarching question every leader must answer: Will the organization see returns?

According to the study, early adopters say “yes.” Most survey respondents (75%) who use AI already see a return on their investment.

More about security + AI in RCM

2. FACT: AI in RCM increases efficiency

Using AI to cut manual RCM tasks gives healthcare professionals more time to focus on patients.

It’s no secret that many RCM tasks are repetitive, transactional, and time-consuming. AI can help alleviate all those problems.

Automating tasks related to claim management, eligibility verification, and even authorizations allows teams to work by exception only. In other words, the software takes on the bulk of the repetitive tasks so your team only needs to spend time on tasks outside the norm. With this change, teams can shift their focus to:

1. Only work on high-level initiatives, and
2. Spend more time focusing on the patient.

With efficiencies implemented throughout the revenue cycle, real change can be tracked and measured. Study respondents agree, with 75% saying that AI enhances staff productivity.

Looking at specific examples of this in action, automated technology can help shave:

• 17 minutes off each claim status inquiry, and
• 16 minutes off each eligibility check.

With the high volume of claims coming through each day, time saved quickly adds up.

More about generative AI in RCM

3. FACT: AI in RCM has extensive capabilities in healthcare

Generative AI can improve efficiency and accuracy in specific areas across the revenue cycle — and healthcare leaders are ready to use the new technology.

AI is poised to change the landscape of healthcare payments, inspiring leaders to explore ways the software can make a positive difference. They’re also taking that to the next level with generative AI, technology that learns and creates new content based on prompts and inputs from users

Waystar is working with Google Cloud to use generative AI to address some of the U.S. healthcare system’s most complex and critical challenges.

In one use case, Waystar and Google Cloud automated the extraction of prior authorization requirements from complex payer data sets. In a proof-of-concept study by Waystar, the application:

• Reduced the time to generate an authoritative report of procedural preauthorization by 99.93% while
• Increasing accuracy by 13%.

This is just one example of the powerful results AI can deliver.

Dive deep into gen AI in RCM

Learn more about the possibilities of AI in healthcare RCM

Download the full report from Waystar and Modern Healthcare, plus explore real-world examples of successful implementation.

The post 3 benefits of AI in RCM — starting with ROI: Findings from Waystar + Modern Healthcare appeared first on Waystar.

Individual data breach notifications raise concerns for patients of affected health organizations. In addition, there’s the ever-present worry that, when hackers begin using the stolen data for fraudulent activity, patients could end up with exhausted benefits or surprise bills for care they never received.

What does this mean for providers?

As organizations recover from the fallout, it’s more important than ever for providers to offer compassionate patient financial care and select a healthcare payments partner who shares their values. It’s also critical for organizations that chose stopgap vendors back in February to decide if their current vendor is meeting the mark — or if another partner could better deliver on security, trust, and long-term ROI. 

To help healthcare organizations with this process, we’ve collected some of our most-accessed resources on six topics:

1. Enhancing security + trust
2. Providing patient financial care
3. Tracking metrics that matter
4. Selecting superior support
5. Picking a partner (not just a vendor)
6. Leading with the future in mind

1. Scrutinize + strengthen security

Get step-by-step instructions directly from top Waystar security experts for the following processes:

• Assessing vendor ability
• Checking certifications
• Key security questions to ask
• Strengthening existing controls
• Training employees on compliance

EXPERT PANEL: Generative AI + data security in healthcare payments

Tune in to see a panel of healthcare providers and industry experts discuss how organizations are using generative AI to solve payment challenges while keeping data security front and center.

Watch the full panel on demand

SECURITY SPOTLIGHT: A software platform designed for trust

At Waystar, we are steadfast in our commitment to compliance and take strategic steps to ensure the safety and security of our clients’ data. Hear directly from our Chief Technology Officer Chris Schremser about the proactive measures we take to safeguard our software.

2. Commit to compassionate financial care

As far as patients are concerned, healthcare organizations need to simplify the patient financial experience (PFX). As a provider, you need a revenue cycle vendor who’s going to make that easier.

That means finding an RCM partner who’s committed to helping you provide the financial care patients not only deserve but seek from healthcare providers. Look for a vendor who invests in PFX research, technology, and software, and make sure they’re leading the way — not following.

REPORT: What role does PFX play in improving revenue?

Today, 93% of consumers say a bad billing experience impacts whether they’ll return to a provider. This report from The Health Management Academy + Waystar uncovers how leading health systems view PFX and how automation can drive financial sustainability and patient loyalty.

Read now

BLOG: Proven tactics to overcome patient payment challenges

For your healthcare organization, helping patients understand their financial responsibility up front — and the options to pay for it — should be a top priority. Here are five proven ways to do it while also improving cost management, labor productivity, and the well-being of your workforce.

Read now

3. Ask for evidence

The time to ask for proof that a solution works is before you switch vendors. Request client success stories and customized projections for your organization. Check in on company metrics once you’ve been using the solution for a while to make sure you’re seeing positive ROI.

VALUE CALCULATOR: Is the status quo costing you?

With billions lost each year to administrative waste, organizations can save money and time by using the right platform. At Waystar, we offer a Value Calculator to show how much each client can potentially save.

Calculate savings

PERFORMANCE BENCHMARKS

Another key tactic? Poll fellow leaders on the top KPIs they track. That way, you’re armed with information as you ask vendors how their clients perform in those areas.

A few of Waystar’s most requested metrics include:

• First-pass clean claim rate
• Time-savings opportunities
• Remit-to-claim match rate
• Rules + edits updates
• Payments remitted to clients

4. Vet implementation + support

Ask vendors for contacts (or even better: case studies) so you can learn about their implementation process and support experiences for yourself. Look for mentions of things that are important to your team that you’ve had difficulty finding in the past — such as transparency, partnership, or directness.

SCA Health: Seamless solution adoption

Waystar’s implementation experts are laser-focused on making transitions smooth and seamless so our clients get powerful revenue cycle solutions, reach peak financial performance, and improve the patient experience.

SUPPORT METRICS

Some revealing data points to request from a vendor include:

• Customer satisfaction rate
• Average time to reach support
• Percent of clients who trust an organization
• Net Promoter Score

Below are Waystar’s customer experience numbers.

5. Evaluate the partnership

EBOOK: Finding a partner to guide you to peak performance

Choosing the right RCM partner is critical. This eBook outlines exactly:

1. How to alleviate disruption while maximizing payments
2. What you should expect from a new RCM partner
3. How to empower your team to get results across the complete revenue cycle

Read now

EXPERT PANEL: Thriving through crisis + embracing change

From cyberattacks to COVID, today’s revenue cycle leaders have lived through extraordinary challenges — and learned invaluable lessons — in recent years. Watch this panel to hear directly from leaders how they navigate crises, leverage automation, and partner strategically.

Watch now

ON DEMAND: How to (re)evaluate your RCM partner + get results

If you’d rather watch or listen to learn the must-have attributes of an RCM partner, or the functionality you need to maximize workflow efficiency, watch this webinar on demand.

Watch now

6. Ensure a plan for the future

When you look at a vendor’s website or social channels, do you see a plan for innovation, automation or AI? Unique opportunities for clients to grow? A listen-and-learn culture driving their roadmap?

Look for clear, confident direction that aligns with your organization to ensure you’re selecting a partner that is not only right for you today, but one that can grow with you tomorrow.

At Waystar, you might find us:

• Deploying generative AI to simplify healthcare payments in collaboration with Google Cloud
• Taking top honors as a healthcare payment software platform from Black Book or KLAS
• Partnering with MEDITECH or integrating with Epic
• Planning for our next annual True North user conference

Ready to see what Waystar can do for you? 

Make the switch

The post Data security, providing patient financial care + more: Navigating cyberattack ripple effects appeared first on Waystar.

When hospitals don’t receive payment from insurers or patients for the services they provide, it can cause everything from bad debt and negative operating margins to closure.

At the same time, the more patients are asked to pay, the more likely they are to delay or skip care, especially during times of inflation. That leads to worsening health conditions and higher future healthcare costs.  

Inflation also has a dramatic, negative effect on hospitals. According to the American Hospital Association (AHA), inflation grew at more than double the rate of reimbursement under IPPS (inpatient prospective payment system).

And when all these challenges converge, it creates a cycle that’s not good for anyone. 

What is the rise in uncompensated care doing to hospitals?

Uncompensated care, the sum of charity care and bad debt, typically comprises a small percentage of a hospital’s expenses.

In 2020, for example, half of hospitals reported charity care costs made up 1.4% or less of their total operating expenses. Naturally, this varies widely depending on size, location, mission, and population served.   

Some hospitals serve larger populations of uninsured or underinsured patients, such as: 

• Hospitals in urban areas 
• Facilities designated as safety-net hospitals 
• Rural hospitals in non-expansion states 

However, in recent years, nearly all hospitals have seen uncompensated care swell as Medicaid eligibility has narrowed.  

• In the first half of 2023 alone, the median rate of uncompensated care for hospitals surged from 6.4% to 8.7% — an increase of one-third in just six months.  
• According to the AHA, hospitals lost almost $745 billion in uncompensated care from 2000-2020.

Between these increases, continuing changes to Medicaid, and the ongoing struggles with inflation, hospitals can’t afford to wait for a charity care solution to present itself.   

Here are four steps hospitals must take now to ensure they’re on the right track.  

4 ways to minimize uncompensated care + bad debt

1. Don’t rely on patients to provide accurate insurance information.

One of the first lines of defense against uncompensated care is to find active insurance patients don’t know they have. That means using a solution that automatically: 

• Confirms active coverage regardless of patient’s point of entry 
• Provides a high degree of control validating patient coverage 
• Accesses a substantial amount of payer connections and patient data

How much can this stop your bad debt from ballooning? Here’s just one example: Using Waystar’s Coverage Detection solution, Aultman Health found coverage for 34% of patients presenting as self-pay. Over 16 months, they gained $414,000 in revenue. 

2. Do maintain non-profit status.

If you operate as a non-profit health system or hospital, you must comply with the requirements for 501(c)(3) hospitals under the Affordable Care Act (ACA). Failure to do this could result in penalties or the loss of non-profit status, and three of these requirements relate directly to revenue cycle operations. Make sure to: 

1. Establish a written Financial Assistance Policy (FAP) 
2. Set charge limits for FAP-eligible patients 
3. Make a reasonable effort to determine FAP eligibility 

Financial barriers for patients who were covered by the ACA are becoming more pronounced, and many are unable to manage unexpected medical expenses. This increased financial insecurity is driving more individuals to seek charity care, and that means non-profit hospitals that provide that care must be even more diligent in doing so (and documenting it properly).   

3. Don’t use credit to screen for uncompensated care.

Before you assign a patient to bad debt, it’s essential to screen patients electronically for financial assistance. However, the traditional method of screening — by credit score — is not the most effective. People living in poverty aren’t likely to be heavy credit users. Only 59% of people in low-income neighborhoods even have credit cards, which means many won’t show up on the radar of credit companies at all.  

If your screening tool only uses credit score to evaluate a patient’s financial reality, your hospital will miss an enormous piece of the puzzle. Worse, when a credit-based tool comes up short because it can’t find a match in the database, it may simply return a default score, which gives you something worse than no information — it gives you incorrect information.  

4. Do use socioeconomic data to screen for uncompensated care.

The most successful screening tools focus on socioeconomic data to evaluate patients. They leverage thousands of sources of data like education, income, and access to health services to determine a patient’s likelihood of qualifying for financial assistance. And they use artificial intelligence to make determinations based on your organization’s specific FAP, which means verdicts are tailored to your hospital, not someone else’s.   

This yields positive results for patients and providers: 

• It saves time and hassle.
  Predictive modelling can prevent patients from applying for financial assistance that they won’t ultimately qualify for. 
• It instantly removes financial barriers for patients who need care.
  This includes those who are unaware of charity care, as well as those who are unable or unwilling to apply. 
• It decreases hospitals’ bad debt.
  By eliminating 25-40% of uncollectible accounts from bad-debt portfolios, hospitals can increase productivity and performance substantially.*  

With the right solution, healthcare providers can find additional charity dollars for patients, better manage financial pressures, and improve the patient experience.  

Waystar data, 2024

Slash uncompensated care with Waystar Charity Screening

When hospitals automate eligibility determination and charity care applications, patients receive the support they need promptly and efficiently.   

Waystar uses PARO, a socioeconomic predictive model that considers the barriers that prevent 25-40% of patient-pay patients from applying for financial assistance. As a presumptive charity model — a last-resort approach for those who are unresponsive — it can be applied:  

1. Prior to bad-debt assignment to ensure all patients are assessed  
2. As a one-time reclassification for accounts currently sitting in bad debt  
3. At the point of service to identify accounts that will likely qualify for assistance and should be triaged to exhaust other funding sources before going to charity care

Once activated, Waystar’s Charity Screening solution can instantly help: 

• Streamline financial processes 
• Reduce administrative burdens  
• Improve access to care for vulnerable populations

See how

The post 4 do’s and don’ts of uncompensated care: Improving charity care for providers + patients appeared first on Waystar.

Providers are losing money they’re rightfully owed because of coding errors, missing charges, underpayments, and other mistakes. So, how do we prevent this?

First, we identify two elements that have a profound impact on revenue but aren’t always prioritized:

1. The integrity of charge capture (securing revenue for services provided), and
2. The precision of Diagnostic Related Group (DRG) assignments.

Why charge capture + DRG accuracy are critical

The proof is in the numbers. According to HFMA data, hospitals in the U.S. lose roughly 1% of their net revenue to charge capture mistakes. That means, for example, that a hospital with an annual net revenue of $750 million could lose $7.5 million to charge capture errors alone. On top of that, DRG inaccuracy can decrease reimbursements, and may even trigger audits and penalties.

Taken together, it’s easy to see why revenue capture is a challenge — but also an opportunity.

When organizations optimize charge capture and DRG assignments, they boost financial performance, protect their bottom line, and establish a cycle of continuous improvement that will keep delivering in the future.

The right revenue capture strategies, paired with artificial intelligence (AI) and predictive analytics, can help organizations:

• Enhance revenue
• Proactively address problems
• Deliver better patient care

How do you maximize revenue capture? Use predictive analytics + AI

Today, predictive analytics and AI are game changers in healthcare revenue integrity. By leveraging historical data, these systems can anticipate potential revenue leakage points and suggest preventive measures.

For example, in the realm of denial prevention, predictive models can analyze data and identify patterns that lead to denials. Then, when that pattern occurs again, software can flag these issues so corrections can be made before submission.

The same principles can be applied to charge capture and DRG assignments.

Charge capture and DRG accuracy are more than just steps in the revenue cycle; they are its pillars.

Fostering a culture that prioritizes both using technology — especially AI-driven solutions and predictive analytics — is not only prudent but essential.

TAKING CHARGE OF CHARGE CAPTURE + DRG ACCURACY 

9 checkpoints for an effective revenue capture platform

As healthcare finance evolves, organizations that embrace technological advancements will succeed in the era of value-based care.

When evaluating revenue capture solutions, make sure they check the following boxes to ensure you’re getting a comprehensive, effective platform.

1. Charge capture capabilities

• Integration with various EHR systems
• Analysis of EHR data to identify missed charges
• Automated alerts for staff to rectify errors promptly
• Customizable rules and workflows to match facility-specific requirements

Explore Charge Integrity

2. DRG analysis

• AI-powered analysis of clinical documentation
• Integration with contract management engine to identify additional revenue opportunity
• Coding standards that ensure compliance
• Machine-learning algorithms that continuously improve accuracy based on expert feedback

Explore DRG Anomaly Detection

3. Data security + privacy

• Robust data security measures to:
  • Protect sensitive patient information
  • Ensure compliance with HIPAA regulations
• Regular security audits and penetration testing to identify and address vulnerabilities

4. Predictive analytics for revenue integrity

• Analysis of historical data to identify patterns and trends impacting revenue
• Ability to predict revenue leakage points driving actionable insights for:
  • Proactive revenue optimization
  • Prioritization of high-risk claims

Explore Revenue Integrity

5. Pre-bill leakage detection

• AI-powered identification of errors and inconsistencies in claims before submission

6. Reporting + analytics

• Comprehensive reporting and analytics capabilities for tracking
• Customizable dashboards and reports for monitoring progress
• Actionable insights for optimizing performance

Explore Analytics + Reporting

7. Integration + implementation

• EHR-agnostic integration with existing facility systems and workflows
• Minimal disruption during implementation
• Cloud-based platform for scalability
• Regular updates, comprehensive training, and support for successful adoption

Explore implementation

8. Auditing + support staff

• Dedicated auditing team to:
  • Confirm findings and provide expert level feedback
  • Ensure accuracy
  • Provide guidance and support
• Collaborative approach to resolving auditing discrepancies
• Proactive monitoring and alerts for potential risks or issues

9. Contract modeling

• Integration of the facility’s unique payer contract details to:
  • Support accurate net patient revenue calculations
  • Ensure fair and accurate reimbursement

By considering these key areas, organizations can select a revenue capture solution that will leverage their data and contract details to build custom models and optimize financial performance. That will lead to more accurate predictions, improved net patient revenue calculations, and, ultimately, better financial outcomes.

Want to learn more about charge capture + DRG accuracy?

See how Waystar’s Revenue Capture suite delivers an average 4:1 ROI.

Unlock Revenue Capture

The post Need to improve revenue capture? Start with charge capture + DRG accuracy appeared first on Waystar.

But through Waystar’s Accelerated Implementation Program (AIP), tens-of-thousands of providers were able to resume operations and restore cashflow in record time, even submitting claims within 72 business hours of contract execution.

By choosing Waystar as their new partner, these organizations have set themselves up for success now — and for the future.  

See the solution

48-hour SUCCESS STORY

Health system submits $42.5M in claims in 2 days with Waystar

When systems went down and cashflow stopped, this leading Texas-based health system had to act — quickly. With more than 60 hospitals, their $6 billion in annual net patient revenue was at risk.

They chose Waystar, and in just 48 hours, they saw powerful results.

Waystar data, 2024

Why did this health system choose Waystar?

Hear directly from revenue cycle leaders in this on-demand webinar. From weighing the pros and cons of working directly with payers to logistical questions about enrollment, they: 

• Outline every step of their decision-making process, and  
• Answer questions from audience members who are evaluating their options. 

Watch now

powerFUL partnershipS

What the industry is saying 

“Within 24 hours of reaching out to the Waystar team, we fully completed system design and build efforts,” says Experity CEO David Stern. “In less than 72 hours, we were able to get up and running, submitting claims again. The responsiveness and high-quality work of the Waystar team cannot be overstated, and we are eternally grateful to them for their efficient, effective, and timely service.” 

Waystar is a software company that serves people — and we always remember that. Our goal is to guide and empower providers with a better experience and long-term solutions. That way, organizations can reach peak performance and deliver patient financial care, today and in the future. 

“Throughout the crisis, we were amazed by the tireless efforts of healthcare organizations to ensure continuity of patient care at all costs,” says Waystar CEO Matt Hawkins. “Waystar is honored to work alongside these organizations.”  

Book a product tour

IMPLEMENTATION INSIGHTS

What clients are saying about Waystar’s implementation + support 

Speeding time-to-value

“The fact that claims were stood up and out the door in less than 4 days — and cash back in and auto-posted into Epic in 12 days — is pretty impressive. Thanks for your partnership.”

— Senior Vice President of Revenue Cycle, Leading Health System

Expediting implementation

“The team was literally cheering, ‘We’re in production!’ I cannot thank you all enough for all the long days, late nights and insanely fast responses to all our requests. The quality of work your teams are doing cannot be overstated.”

— Executive Vice President, DME/HME Company

Offering superior support

“Thank you for the efficient, effective and timely client service. Wow! [It was] very impressive that you were able to get us up so quickly and help us so thoroughly. Talk about phenomenal client service! It truly is a blessing, and we are eternally grateful.”

— Revenue Cycle Director, Leading Health System

Make the switch

The post Waystar’s Accelerated Implementation Program: Success stories, metrics + more appeared first on Waystar.

Recent research by The Health Management Academy and Waystar says they do.

The study offers a snapshot of the healthcare RCM industry:

• 73% of leading health systems use 4+ RCM vendors
• Half don’t yet use a platform strategy but plan to within 2 years
• 100% of organizations using end-to-end RCM solutions report positive ROI or expect to within 1-2 years.

In addition, there’s been a 70% increase in adoption of end-to-end RCM platforms year-over-year.

To learn more, download the full report — Accelerate healthcare financial performance with an RCM platform strategy — or keep reading for three top takeaways. 

3 facts from the RCM platform strategy report

HEALTHCARE RCM VENDOR REVIEW FACT:

1. 100% of systems using an end-to-end solution experience positive ROI or expect to within 1-2 years

Today, healthcare leaders are investing heavily in the revenue cycle to support their RCM needs. But a change in strategy that reduces vendors in favor of a single platform requires buy-in from the primary decision makers, including the: 

• Chief Financial Officer 
• Chief Revenue Cycle Officer 
• Director/VP of Revenue Cycle 

According to The Academy’s survey, these leaders prioritize four factors — in this order— when considering a single-platform strategy: 

1. Financial return 
2. Operational efficiency 
3. Cost reductions 
4. Ability to replace/reduce multiple vendors 

In light of recent security breaches, you may wonder why data security and privacy don’t top the list of considerations. This report was released just before a major healthcare security breach changed everything for healthcare organizations across the country in 2024. At the time this survey was completed, about a third of health system leaders said security was of some importance when considering vendors. 

The bottom line, however, is the same pre- and post-breach: Organizations who have reduced their number of RCM vendors have seen financial gains — and the others are receptive to adopting a consolidated platform strategy within one to two years. 

“Everything is going to be clear return-on-investment decision making — whether that’s financial return or some other outcome … in support of what we’re trying to accomplish.” 

– Chief Revenue Officer 

HEALTHCARE RCM VENDOR REVIEW FACT: 

2. To build trust + secure data, the “relationship factor” is critical

In order to successfully implement RCM solutions and protect data, healthcare organizations spend money — but they also spend time. Leaders invest hours, energy, and social capital in collaborating with their revenue cycle partner. One major benefit of paring down vendors in favor of a single platform? The relationship factor.  

It becomes more manageable to establish long-term relationships that prioritize trust and mission alignment when you have fewer partners. 

“We try to pick a partner that aligns very well with us from a values perspective and competence perspective. Then, we invest a lot of effort in those relationships to make sure that it’s a true partnership and it’s going to be a long-term relationship.” 

– Chief Revenue Cycle Officer 

Taking time to collaborate is key to a successful revenue cycle partnership, influencing hard metrics (time and cost savings) and soft metrics (staff and patient satisfaction). 

A true RCM partner will walk through effective change management with the healthcare organization, from start to finish of implementation, and long into the future. 

HEALTHCARE RCM VENDOR REVIEW FACT: 

3. Leaders now prefer enterprise-wide implementation over pilot then expand

According to The Academy’s survey, half of leading health organizations currently use multiple vendors, but all are receptive to paring down partners and software in the next one to five years. 

So what’s the hesitation? Concerns include:  

• Cost 
• Workforce implications 
• The process of switching vendors 
• Workflow disruptions 

On top of that, implementation fatigue is real: Some leaders spend 18 months rolling out new software. That’s spurred many to forgo pilot testing in favor of enterprise-wide adoption, which is more efficient and cost effective. This approach, however, requires additional upfront planning and change management — both of which point back to the pivotal role of relationships in today’s RCM partnerships.  

Partnership in action

But a true RCM partner works hand-in-hand with the healthcare organization, offering white-glove client support and a smooth, on-time implementation. 

For example, after a 2024 cyberattack, a 60+ hospital system made the switch to a new RCM partner via an accelerated implementation program that was offered for a limited time. The system worked closely with the new partner to launch fast, alleviating cashflow issues almost immediately

It was a quick, collaborative win that helped the system build trust with its new RCM partner.

In the long run, healthcare RCM partners can prove their value by helping monitor success and track progress through metrics like net AR days, cost-to-collect, and avoidable denial write-off rate. And, by being available every time they’re needed.  

Platform consolidation provides a unique opportunity for health systems to lean on their RCM partners and collaborate to drive greater value for their organization — and their patients.  

Think your vendor volume might be causing rvenue leaks?

If you’re wondering how much you could save with a platform approach to managing all healthcare payments (commercial, government, and patient), we’ve got you covered. Use this step-by-step calculator to find out. 

Calculate now

The post Can you have too many healthcare RCM vendors? Findings from The Health Management Academy report appeared first on Waystar.

But how do you know if the goals of revenue cycle management you’ve set will make a real impact within healthcare today?

From protecting your foundation with key security checks to expanding denial prevention, here is your expert-vetted roadmap.

6 data-driven goals of revenue cycle management for 2024

1. Security best practices
2. Hospital price transparency
3. Patient experience initiatives
4. Denial prevention
5. Medicare Advantage growth
6. Technology checkup: AI/ML

GOAL 1: REVENUE CYCLE MANAGEMENT IN HEALTHCARE

Shore up security with 3 best practices

The case for shoring up security is simple: More than 132 million Americans were affected by health-record data breaches in 2023 alone. That’s roughly 40% of the U.S. population — and more than double the number of people who experienced breaches in 2022. 

Meet this smart goal:

Secure three critical checkpoints:

1. Review vendor access annually.
   Companies are often attacked through vendors who have access to more data than they should. Limit vendors to minimum required access to reduce the likelihood of a breach.
2. Conduct a cross-functional ransomware tabletop exercise.
   Many companies perform technical tests routinely and consider their system secure if they pass. But that excludes other teams — executives, legal, public relations — who must weigh in if a breach actually occurs. Conduct a cross-functional exercise to ensure you answer the necessary questions in advance.
3. Create a drawbridge protocol for B2B connections.
   When a third party is infected, you need a fast way to break that connection — or “pull up your drawbridge” — until the threat is resolved. Just as with ransomware, build drawbridge plans now so you’re not making critical decisions in moments you could be taking action.

GOAL 2: REVENUE CYCLE MANAGEMENT IN HEALTHCARE

Comply with new hospital price transparency requirements

Since 2021, hospitals have been required to publicly post certain price and payer data in machine-readable files.

Now (as of January 1, 2024) CMS is taking that one step further by ensuring this data is displayed the same way across facilities so consumers can access and read it easily.

Meet this smart goal:

1. Adopt the new CMS template
2. Include an affirmation statement on your website
3. Make this information easy to find
4. Ensure your self-service tools are accurate

If you’re looking for an automated price transparency solution, pick one that’s market-tested to deliver answers in real-time. Simple, accurate tools will not only help you cultivate stronger patient loyalty but also increase cash flow.

Explore Price Transparency

GOAL 3: REVENUE CYCLE MANAGEMENT IN HEALTHCARE

Prioritize (the right) patient experience initiatives

Patient-facing financial processes have never been more critical.

So why are less than 7% of executives “very satisfied” with their technology in that department? Nearly half say insufficient automation is a top barrier to change in recent surveys.

With patient responsibility rising, it’s difficult to identify which actions will increase patient satisfaction and reimbursements.

Meet this smart goal:

1. Educate your team.
   Set standards for how to properly financially clear a patient. Provide detailed training and offer specific tips to help them collect with compassion at the point-of-service and after a visit.
2. Use technology to automate manual processes.
   Implement solutions that are high-accuracy and low-touch first.
   • Run coverage discovery for eligibility transactions, or to solve denials when patients present as self-pay.
   • Launch or optimize personalized, omni-channel communications.
   • Send patient estimates prior to service via their preferred channel.
   • Offer text-to-pay in addition to email and paper statements.

Implementing even one of these solutions will have an exponential impact on productivity and patient satisfaction.

Explore Patient Payments

GOAL 4: REVENUE CYCLE MANAGEMENT IN HEALTHCARE

Stop denials at these 4 key points

Research shows that 60% of denials come from the front end, and nearly 40% are caused by authorizations alone.

But if you put the right solutions in place at four key points, you can prevent denials before they happen.

Meet this smart goal:

1. Use software to find more active insurance.
   When 34% of patients who present as self-pay actually have active coverage, you can’t afford to let that revenue go.
2. Work by exception.
   Use robust alerts and claim monitoring technology to work claims with a high probability of payment. That puts human efforts where they’ll matter most.
3. Arm managers with data and directives. 
   Build real-time dashboards to help managers identify root causes of denials. When managers can show other teams exactly what’s happening, it’s easier to shift from denial management to denial prevention.
4. Hold payers accountable.
   Use payer scorecards to track where they’re impacting your cashflow. If a trend isn’t consistent with what you’re seeing from other payers, call that out.

Explore Denial Prevention

GOAL 5: REVENUE CYCLE MANAGEMENT IN HEALTHCARE

Prepare for Medicare Advantage growth — and related denials

More than 33 million older Americans are enrolled in Medicare Advantage (MA) plans, wooed by lower premiums and more benefits than traditional Medicare. As that enrollment grows, providers should expect related denials to grow, too.

Why are those denials happening with Medicare Advantage?

1. Insurers are denying claims due to lack of medical necessity.
   While traditional Medicare is a straightforward payer category, MA plans have adopted more restrictive criteria commonly used among commercial payers. That’s led them to deny more inpatient hospital claims than all other payer types.
2. AI algorithms are wrongfully denying claims.
   Some insurers are prioritizing faulty, profit-driven AI tools over doctor recommendations to decide how long patients need services, resulting in early coverage cutoffs. While 90% of these denials have been overturned, less than 0.2% of patients are actually choosing to appeal. And that leaves patients paying out of pocket or discontinuing post-acute care early.
3. Operational requirements are different from traditional Medicare. 
   Reports found that MA plans have, at times, delayed or denied beneficiaries’ access to medical care — even though the requests met Medicare coverage rules. They also denied payments for services that met both Medicare coverage rules and their own billing rules, such as MRIs and stays in post-acute facilities.

Meet this smart goal:

Make sure your team understands the potential denials impact for MA plans and implement solutions to mitigate those effects.

Automate:

1. Prior authorization
   Find a solution that automatically verifies, initiates, statuses, and retrieves comprehensive auth details — and ideally automates patient referral status to cut manual work.
2. Medical necessity checks
   Look for a solution that auto-generates Advance Beneficiary Notices or Notice of Non-Coverage forms.

Explore Authorizations

GOAL 6: REVENUE CYCLE MANAGEMENT IN HEALTHCARE

Quality-check your tech

Artificial intelligence (AI) and machine learning (ML) are key to optimizing end-to-end transactions, from processing more volume to improving patient outcomes. But as you implement them, ensure your partner or internal teams are delivering what they promised.

Meet this smart goal:

Perform a quality check. Ask:

1. Is this technology scalable and secure?
   It’s great to have a model that derives insight, but if it can’t handle your data load and output your information appropriately, you’re not going to get full value.
2. How large are the data sets we can access for this project?
   Data-model performance is directly related to the size of the data set used to train that model. Make sure your data covers as many bases as possible.
3. What’s the use case for this model?
   Models can’t be trained on data alone. Identify decision makers and people who can act as subject matter experts to help structure your model properly, reduce risk, and increase the likelihood of success.
4. How are we implementing automation within workflows? 
   The best models accurately predict outcomes, and real value comes from combining that information with strategies to change that outcome. That must happen inside workflows.

Get the AI guide

Ready to see a specific Waystar solution in action?

Discover the way forward.

Schedule a demo

The post 6 smart goals of revenue cycle management in healthcare appeared first on Waystar.

This was called into sharp focus recently, when a cyberattack breached the network of a health IT giant, disrupting operations for healthcare organizations across the U.S.

While that situation is complex and ongoing, there are proven strategies proactive organizations can implement now to reduce future cybersecurity threats.

TIP 1: REDUCING FUTURE CYBERSECURITY THREATS IN HEALTHCARE

Assess your vendor’s ability to serve + support you

When the unthinkable happens, you need to know you’re working with a trustworthy partner who has the same values you do. You also need to be confident in their ability to support an organization of your size, scope, and with your specific data-protection needs.

Ideally, you’ll explore all of this before a crisis happens. But if you find yourself shopping for a new vendor after — or even during — a crisis, ask potential vendors:

• What is your average implementation satisfaction score?
• How often do you meet or exceed implementation timelines?
• What is your average client support satisfaction score?
• How long does it take to reach a live support representative?
• What is your average turnaround time on support case resolution?

If your vendor can’t or won’t offer those metrics, find an RCM partner who provides a better experience.

TIP 2: REDUCING FUTURE CYBERSECURITY THREATS IN HEALTHCARE

Check vendor certifications + assessments 

Vendors who value security will leverage leading security performance-evaluation firms to maintain up-to-date, secure practices.

Ask about these common certifications and standards:

1. SOC 2 Type II

SOC 2 is a security framework that specifies how organizations will protect client data from security incidents and unauthorized access. It ensures a SaaS provider is managing the environment to the ‘trust service principle’ — prioritizing security, privacy, availability, confidentiality, and processing integrity.

Make sure your vendor:

• Adheres to SOC 2 Type II because that provides evidence of long-term, ongoing processes that protect customer data
• Keeps this certification current since some vendors will achieve it and then allow it to lapse

2. HITRUST r2

The HITRUST Common Security Framework (CSF) helps healthcare organizations prove they are operating securely and compliantly while keeping personal health information (PHI) secure. Make sure your vendors adhere to the HITRUST r2 Validated Assessment as that is the gold standard for information protection assurances.

3. PCI DSS

The Payment Card Industry Data Security Standard (PCI DSS) validates that any organization processing credit card payments is authorized to do so.

HIPAA compliance

The Health Insurance Portability and Accountability Act (HIPAA) sets the security and privacy regulations required to protect sensitive patient health information. It’s enforced by the Office of Civil Rights and is legally required for any healthcare or IT service provider that accesses PHI.

4. Security information and event Management (SIEM) system

SIEM systems collect and analyze data from sources across the organization’s network — firewalls, intrusion-detection systems, endpoint security solutions — to help identify unusual activity that may indicate a threat.

TIP 3: REDUCING FUTURE CYBERSECURITY THREATS IN HEALTHCARE

Ask partners + vendors key security questions 

When you partner with a vendor who can impact your cash flow, you must be confident they can keep your data secure and act swiftly when threats occur. 

Setting expectations — on both sides, in advance — will help everyone maintain order so you can act fast to keep data as secure as possible in the event of a cybersecurity attack.

TIP 4: REDUCING FUTURE CYBERSECURITY THREATS IN HEALTHCARE

Strengthen existing security + access controls 

Security and access control are essential measures that determine who can access your data, resources, and apps. Make sure your organization is leveraging all available options to safeguard data and prevent unauthorized access.

Ask your IT department to:

1. Require frequent password rotations.

Schedule regular password changes across your organization and systems. Consider increasing the minimum password length and special-character requirements.

2. Implement two-factor authentication.

Consider asking for two separate, distinct forms of identification to access your systems, phones, and even buildings.

3. Review IP whitelisting settings.

IP whitelisting lets organizations grant access to trustworthy IP addresses, but it’s not something you should “set and forget.” Review IP whitelisting periodically so you can restrict unauthorized access to systems and networks and ensure every IP address with access should, in fact, have it.

4. Monitor user activity.

Monitor user activity on the network to detect suspicious behavior, such as unauthorized access attempts or data exfiltration.

TIP 5: REDUCING FUTURE CYBERSECURITY THREATS IN HEALTHCARE

Train employees regularly on data security + compliance

While most RCM employees understand the magnitude of cybersecurity threats in healthcare, regular training is still critical. Not only will it show staff the risks and threats your organization faces, but it will also give them the knowledge to identify potential threats and the tools to report them.

Make sure every employee completes regular training on the most common methods of cyberattack, including:

1. Email

According to the HIPAA Journal, phishing is a leading cause of healthcare data breaches — and attacks are increasing. Malicious links, attachments, and downloads are common ways attackers gain access to systems. Give your team tips for spotting malicious content to prevent network infiltration.

2. QR codes

Today’s attackers have also expanded their phishing efforts to include QR phishing. An attacker will send the target a code and convince them to scan it for a seemingly valid reason. That can lead to compromised credentials, data breaches, or ransomware infections.

3. Mobile

Employees often unknowingly use personal or work mobile devices in ways that make them susceptible to mobile-based attacks.

• If you allow employees to access work information via personal devices, make sure you activate the necessary controls (company portal applications for remote management, password-strength requirements, etc.).
• Teach employees about smishing (fake SMS/text messages) and vishing (fraudulent phone calls), which can easily trick victims into providing sensitive information via text or phone call.

4. Working remotely

With remote work now a permanent part of revenue cycle management, employees must (1) know the risks of working outside a secure office environment, and (2) follow best practices when doing so. Consider who needs to be using a virtual private network (VPN), who should come into the office to perform specific tasks, etc.

Remember to include compliance and regulatory training in your schedule as well. Accidental HIPAA violations are much easier to avoid when training outlines what each staff member needs to do to stay compliant while performing their specific duties.

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The post 5 strategies to reduce future cybersecurity threats in the healthcare revenue cycle appeared first on Waystar.