Case Study: Midwest Health System recovers $949,000+ in Medicare transfer DRG underpayments with Waystar

Midwest Health Systems - Customer Case Study

Midwest Health Systems, a not-for-profit Midwest hospital organization with more than 1,500 employees and 25 facilities, faced suspected revenue slippage from Medicare transfer DRG underpayments after an internal audit and concerns raised by a secondary vendor. To address incorrect discharge-status coding and missed transfer payments recoverable under CMS rules, the organization engaged Waystar’s Transfer DRG service to audit and remediate transfer-related claims.

Waystar deployed its Transfer DRG software and claims-reopening process—automating a retrospective review (up to four years), validating corrections, and handling payer communications—to identify and file adjustments on behalf of the health system. Waystar uncovered $67,000 in an initial assessment, recovered $175,000+ within three days (with reimbursements in two weeks) during a 2020 audit, and ultimately recouped over $949,000 in Medicare transfer DRG underpayments for the organization over five years.