Waystar Holding Corp. · NASDAQ:WAY

Waystar — Mastering the 2025 Healthcare Payment Landscape webinar

47 slides from Waystar's conference presentation, Jan 22, 2025

Slide 2: Before we begin
Before we begin Minimize control panel by clicking orange arrow • Use your questions box to submit questions or report any technical issues. • We will be polling, please participate! • Please fill out the survey at the end of webinar. Submit questions here using your chat box at any time throughout
Slide 3: Today's speakers
Dr. Elizabeth Woodcock Revenue Cycle Management Expert Today’s •DrPH, Bloomberg School of Public Health, Johns Hopkins University •MBA, Wharton School of Business, University of Pennsylvania •BA, Duke University speakers •Fellow, American College of Medical Practice Executives © 2024 Waystar. All ri
Slide 4: Telemedicine, Medicare Reimbursement, Medicare Services, CPT 2025, Future
1. Telemedicine 2. Medicare Reimbursement 3. Medicare Services ▪ Advanced Primary Care Management ▪ Quality Payment Program 4. CPT® 2025 5. What the Future Holds Resources © 2025
Slide 5: COVID-era waiver for telemedicine services through December 31, 2024
COVID-era waiver for telemedicine services through December 31, 2024… https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2025-medicare- physician-fee-schedule-final-rule © 2025 5 5
Slide 6: American Relief Act extends telemedicine flexibilities
December 21, 2024 President Biden signed the American Relief Act (HR 10545) Extends the Telemedicine Flexibilities until March 31, 2025 (but does nothing else… more on that in a few minutes!) © 2025 6 6
Slide 7: Telemedicine flexibilities allowed and continued
Allow Recognize Permit Continue Allow teaching Recognize Permit Continue physicians payment for clinicians to use payment for supervising audio-only their enrolled telemedicine residents and services if the practice RHCs and direct patient is not locations FQHCs via supervision of capable or does in
Slide 8: Telemedicine
Telemedicine Telemedicine or In-person • Caregiver training 97550: initial 30 minutes 97551: Each additional 15 minutes 97552: Group training • Caregiver behavior management and modification training https://www.cms.gov/files/document/health-related-social-needs- © 2025 faq.pdf (caregiver training)
Slide 9: Virtual Check-In G2012 / 98016
Virtual Check-In G2012 98016 Brief communication technology-based service (e.g., virtual check-in) by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related evaluation and managemen
Slide 10: American Medical Association CPT Manual
New Patients Established American Medical Association CPT® Manual Patients CPT® Code Minutes CPT® Code Minutes 98000 15 98004 10 98001 30 98005 20 98002 45 98006 30 98003 60 98007 40 Synchronous audio-video visit for the evaluation and management of a new or established patient, which requires a med
Slide 11: CPT Codes Future
• Research the protocols for the CPT® Codes payers in your market • Research your state laws • Determine what services may Future revert back to pre-COVID rules • Analyze the value proposition of maintaining telemedicine given the uncertainty via the federal government © 2025 11
Slide 12: Medicare Conversion Factor decline by 2.83%
$33.29 to $32.35 Medicare Conversion Factor decline by 2.83% Used in the payment formula for Medicare reimbursement © 2025 12
Slide 13: Hospital and community health center payment updates
+2.9% +3.4% COMMUNITY HEALTH HOSPITAL CENTER FY 2025 Hospital Inpatient Prospective Payment System (IPPS) CY 2025 Medicare Physician Fee Schedule Final Rule 2001 to Present © 2025 https://www.ama-assn.org/system/files/2024-medicare-updates-inflation-chart.pdf 13
Slide 14: Medicare Patient Access and Practice Stabilization Act
Medicare Patient • Addresses fifth year of payment Access and cut in a row Practice • H.R.10073 • Bipartisan bill Stabilization Act • House Energy and Commerce & House Ways and Means • Provide a 4.73% payment boost © 2025 https://murphy.house.gov/sites/evo-subsites/murphy.house.gov/files/evo-media-
Slide 15: Specialty payment impacts
Interventional Radiology -2% No Physicians Vascular Surgery [Psychologists +3% + -2% Social Workers +4%] Ophthalmology -2% © 2025 15
Slide 16: Source: https://public- inspection.federalreg
Source: https://public- inspection.federalreg ister.gov/2024- 25382.pdf
Slide 17: Source: https://public- inspection.federalreg
Source: https://public- inspection.federalreg ister.gov/2024- 25382.pdf
Slide 18: CARC CO253
© 2025 2030 CARC CO253 Sequestration - reduction in federal payment. CARC=Claim adjustment reason code 18
Slide 19: Free tool for 2025 rate for any CPT code
This free, easy-to-use tool will give you the 2025 rate for any CPT code for Medicare for your location. © 2025 https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PFSlookup 19
Slide 20: Reality and Future
• Analyze the Impact Reality • Medicare • RBRVS-based payments • Advocate for payment cut reversal Future • Watch for Congressional action © 2025 RBRVS = resource-based relative value scale 20
Slide 21: Safety Planning Interventions Post-ED
Safety Planning Interventions Post-ED FDA-Cleared Discharge (Crisis Digital Treatment Encounter) Devices Payment for Psychologists, Social Workers, etc © 2025 Source: https://public-inspection.federalregister.gov/2024-25382.pdf 21
Slide 22: G0444
G0444 all MCR patients https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/medicare- preventive-services/MPS-QuickReferenceChart-1.html (for G0444): https://www.cms.gov/medicare-coverage- database/view/ncd.aspx?NCDId=346 © 2025 22
Slide 23: G0537 ASCVD risk assessment service
G0537 Atherosclerotic Cardiovascular Disease (ASCVD) risk assessment service and accompanying risk management services https://tools.acc.org/ascvd-risk-estimator-plus/#!/calculate/estimate/ Source: https://public-inspection.federalregister.gov/2024-25382.pdf © 2025 23
Slide 24: Colorectal cancer screening and Hepatitis B vaccination changes
• Colorectal cancer screening – removed coverage of barium enema and added computed tomography colonography (CTC) and blood-based biomarker screening test • No order required for Hepatitis B vaccinations; no cost-share for Medicare beneficiaries. © 2025 Source: https://public-inspection.federalregis
Slide 25: G2211 visit complexity add-on code
G2211 “Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient’s single, serious condition or a compl
Slide 26: G0545 for infectious disease care
+ G0545 for infectious disease care © 2025 https://public-inspection.federalregister.gov/2024-25382.pdf https://www.idsociety.org/globalassets/idsa/clinical-affairs/g0545-fact- sheet.pdf 26
Slide 27: Advanced Primary Care Management
Advanced Primary Care Management “…consent, initiating visit, 24/7 access and continuity of care, comprehensive care management, patient-centered comprehensive care plan, management of care transitions, care coordination, enhanced communication, population - level management, and performance measure
Slide 28: Advanced Primary Care Management considerations
Advanced Primary Care Management Do we have the infrastructure in place? (if not, what will it cost us to do so?) Let’s identify and stratify our Medicare patients; estimate patient enrollment. (what is our revenue projection?) Determine us v. third party (will we do this – or hire a company?) How w
Slide 30: Exceptional performance bonus ended
2022 was the final year for the “exceptional performance” bonus, so 2024 was the last year for any payment boost https://qpp.cms.gov/ Download “MIPS Performance Feedback is Available” © 2025 30
Slide 32: PY2025 MIPS changes
PY2025 • Performance threshold = 75 points • Same weighting of categories… …but there are changes Quality Measures • Changes to 66 current measures • Addition of 7 new measures, including COVID vaccine • Removal of 10 measures, including colonoscopy + 6 new Merit-based Incentive Payment System (MIPS
Slide 33: New CPT codes, deletions, and revisions
270 new codes, 112 deletions, and 38 revisions • Remote therapeutic monitoring (RTM) • Skin grafts for wound care and recovery • Genetic testing (cytogenomic analyses) • MR safety implant codes (76014-76019) • AI augmentative data analysis • New telemedicine codes (98000-98016) © 2025 CPT® codes are
Slide 34: Opportunity
• Are there services that we are Opportunity performing but not coding/billing? • Is the “Advanced Primary Care Management” program for our practice? In 2025 – or next year? • If we must participate in the QPP, what changes do we need to make? • Are there changes to our coding? © 2025 34
Slide 35: Retailers in healthcare: A catalyst for provider evolution
Retailers in healthcare: A catalyst f or pr ovider evolution A Definitive Healthcare Report May 2025 Source (for image): Adapted from Key Re ply https: //k eyreply. com/b log/digital -fro nt-doo r-strategy / © 2025 35 35
Slide 36: 281.01 uso eee
te 281.01 uso eee +68.49 (32.23%) past 5 years C I Jan 13, 2:37 PM EST = Disclaimer nda 1D 5D 1M 6M YTD 1Y Mkt cap PIE ratio Ws Low Div yield woopcocKk 36
Slide 37: Experian state of claims report
https://www.experian.com/healthcare/resources-insights/thought-leadership/white-papers-insights/state- claims-report © 2025 https://premierinc.com/newsroom/blog/trend-alert-private-payers-retain-profits-by-refusing-or-delaying- legitimate-medical-claims 37 37
Slide 38: Kaufman Hall M&A quarterly activity report
© 2025 https://www.kaufmanhall.com/insights/research-report/ma-quarterly-activity-report-q3-2024 38 38
Slide 39: Physician Shortage
According to new projections published by the Association of American Medical Colleges, the US will face a physician shortage of up to 86,000 physicians by 2036. [we only have 1.1 million!!?] Physician Shortage © 2025 https://www.aamc.org/media/75236/download?attachment 39 39
Slide 40: Trump announces RFK Jr. for HHS, Dr. Oz as leader of CMS
TRUMP ANNOUNCES RFK JR. FOR HHS, DR. OZ AS LEADER OF CMS © 2025 https://www.kff.org/potential-health-policy-administrative-actions-in-the-second- trump-administration/ 40 40
Slide 41: Telemedicine, Medicare Reimbursement, Medicare Services, CPT 2025, Future
1. Telemedicine 2. Medicare Reimbursement 3. Medicare Services  Advanced Primary Care Management  Quality Payment Program 4. CPT® 2025 5. What the Future Holds © 2025
Slide 43: Industry Data about Medicare Patients
Industry Data about Medicare Patients (may be helpful for APCM analysis) NOT E: Estimates incl ude benefi ciar ies living in the conti nental U.S. (48 states and D.C.). Full-benefit Medicare- Medi caid enrollees r eceive full Medi caid benefits and Medic aid payment of Medicar e premiums and, in man
Slide 44: Sample APCM revenue analysis
4,000 MCR Patients CPT® Category Payment Calculation Total Code (Monthly) Revenue G0556 1 chronic $15 25%*$15*12*1,000 $45,000 condition G0557 2+ chronic $50 50%*$50*12*1,000 $300,000 condition G0558 2+ chronic $110 25%*$110*12*1,000 $330,000 condition + QMB $675,000 Proportion of active MCR patient
Slide 45: Polling Question #1
Polling Question #1 Q. Which area of your revenue cycle has the most room for improvement? (select one) A Automating claim management workflows B Efficiently statusing claims C Prioritizing denial work + managing appeals D Understanding your revenue cycle performance, as a whole E Something else? Pl
Slide 46: Polling Question #2
Polling Question #2 Would you like to learn more about Q. overcoming those challenges with one of our experts? (select one) A Yes B No

Waystar Holding — Mastering the 2025 Healthcare Payment Landscape webinar on 6ix

Waystar — Mastering the 2025 Healthcare Payment Landscape webinar

Slide 1: Mastering the 2025 Healthcare Payment Landscape

Slide 2: Before we begin

Slide 3: Today's speakers

Slide 4: Telemedicine, Medicare Reimbursement, Medicare Services, CPT 2025, Future

Slide 5: COVID-era waiver for telemedicine services through December 31, 2024

Slide 6: American Relief Act extends telemedicine flexibilities

Slide 7: Telemedicine flexibilities allowed and continued

Slide 8: Telemedicine

Slide 9: Virtual Check-In G2012 / 98016

Slide 10: American Medical Association CPT Manual

Slide 11: CPT Codes Future

Slide 12: Medicare Conversion Factor decline by 2.83%

Slide 13: Hospital and community health center payment updates

Slide 14: Medicare Patient Access and Practice Stabilization Act

Slide 15: Specialty payment impacts

Slide 16: Source: https://public- inspection.federalreg

Slide 17: Source: https://public- inspection.federalreg

Slide 18: CARC CO253

Slide 19: Free tool for 2025 rate for any CPT code

Slide 20: Reality and Future

Slide 21: Safety Planning Interventions Post-ED

Slide 22: G0444

Slide 23: G0537 ASCVD risk assessment service

Slide 24: Colorectal cancer screening and Hepatitis B vaccination changes

Slide 25: G2211 visit complexity add-on code

Slide 26: G0545 for infectious disease care

Slide 27: Advanced Primary Care Management

Slide 28: Advanced Primary Care Management considerations

Slide 29: Performance Year 2024 and 2025

Slide 30: Exceptional performance bonus ended

Slide 31: MIPS exception applications

Slide 32: PY2025 MIPS changes

Slide 33: New CPT codes, deletions, and revisions

Slide 34: Opportunity

Slide 35: Retailers in healthcare: A catalyst for provider evolution

Slide 36: 281.01 uso eee

Slide 37: Experian state of claims report

Slide 38: Kaufman Hall M&A quarterly activity report

Slide 39: Physician Shortage

Slide 40: Trump announces RFK Jr. for HHS, Dr. Oz as leader of CMS

Slide 41: Telemedicine, Medicare Reimbursement, Medicare Services, CPT 2025, Future

Slide 42: Question & Answer Session

Slide 43: Industry Data about Medicare Patients

Slide 44: Sample APCM revenue analysis

Slide 45: Polling Question #1

Slide 46: Polling Question #2

Slide 47: Thank you