athenahealth's AI Innovations Transform Revenue Cycle Management

athenahealth Leverages AI to Revolutionize Revenue Cycle Management

athenahealth is making significant strides in the realm of healthcare technology. This innovative company has introduced new automation and artificial intelligence (AI)-based software solutions that aim to simplify revenue cycle management (RCM) for physician practices. The goal? To alleviate the complexities and enhance the operational workflow of healthcare providers across the nation.

Achieving Greater Efficiency through Automation

As part of its commitment to improving health care systems, athenahealth has set an ambitious target to cut down the workload of physicians' practices by 50% over the next few years. This initiative is designed to not only boost the speed and accuracy of RCM processing but also maintain the quality of service. Recent findings revealed that a significant number of physicians believe integrating AI can help in reducing the burdens associated with administrative tasks.

Reducing Administrative Time with Intelligent Technology

One of the standout features is athenahealth's AI-driven insurance package selection tool. This capability, integrated within the athenaOne platform, is designed to enhance efficiency by automatically analyzing insurance card images and suggesting the appropriate insurance package for claims. In a remarkable achievement, practices utilizing this feature have experienced a 36% decrease in insurance-related claim holds and a saving of over 6,500 hours in administrative time over the past year.

Testament to this innovation, Tina Kelley, the Director of Operations at Mountain View Medical Center, lauded this AI tool as invaluable. She highlighted that it substantially minimizes the manual work required for entering patient insurance details, leading to faster and more accurate claims processing.

Streamlining the Claims Process

Following this trend of automation, the Auto Claim Create feature introduced by athenahealth allows for the automatic generation of claims post patient encounters. This has resulted in a significant reduction in charge entry delays, with practice waiting times dropping by 40%. Currently, approximately 10% of all claims processed by athenahealth are being automated through this feature.

Paul Brient, Chief Product Officer at athenahealth, emphasizes the importance of expediting claims to optimize practice cash flow. The advantages of automating the claims process are twofold: financial performance is heightened, and the repetitive tasks usually borne by administrative staff are significantly reduced.

Addressing the Challenges of Claims Denial

In healthcare, denial of claims can be an arduous challenge. Reports indicate that around 15% of all claims initially face denial. This not only drains financial resources but also leads to unnecessary conflicts regarding payments. To combat this, athenahealth has embraced intelligence solutions that help identify and rectify issues before claims are submitted, effectively reducing the median denial rate to approximately 5.3%.

Additionally, athenahealth employs AI to assist practices in classifying denials and predicting the likelihood of claims being paid upon appeal or resubmission. Such proactive measures are intended to alleviate administrative workloads while improving successful payment recovery rates.

Enhancing the Prior Authorization Process

The issue of prior authorizations, as reported by the American Medical Association, is a critical concern for many healthcare providers. A staggering percentage of physicians report burnout associated with managing prior authorizations, often dedicating excessive time in a week to this process. In response, athenahealth has launched advanced authorization management services designed to streamline this cumbersome task.

Angela Szymblowski, director of clinical operations at South Texas Spinal Clinic, shared how athenaOne's Authorization Management has transformed their approach to prior authorizations. This innovation has cut the waiting time from several weeks down to a mere five days, allowing practices to provide essential patient care more efficiently.

Partnerships Paving the Way for Future Innovations

athenahealth is also collaborating with payers to innovate further, aiming to enhance electronic prior authorization capabilities. These partnerships are based on insights gained from recent case studies and aim to integrate more automation into the authorization process.

About athenahealth, Inc.

athenahealth is dedicated to simplifying healthcare practices and enhancing efficiency is its primary mission. The company's cutting-edge technology encompasses electronic health records, revenue cycle management, and patient engagement solutions. By partnering with healthcare providers using tailored software and their expertise, athenahealth is creating a framework that promotes accessible, high-quality healthcare for all. For further details about their innovations, visit athenahealth.com.

Frequently Asked Questions

What is athenahealth's main goal with AI innovations?

athenahealth aims to reduce the workload in revenue cycle management for healthcare practices by at least 50%, increasing efficiency and accuracy.

How does the insurance package selection tool work?

This AI-enabled tool analyzes insurance card images to recommend the correct package for claims, significantly reducing administrative errors and time.

What is the Auto Claim Create feature?

Auto Claim Create automates the claims process immediately after patient encounters, resulting in reduced lag and faster submission times.

How does athenahealth address claims denials?

athenahealth helps practices identify claim issues in real-time, leading to a lower denial rate and better recovery upon resubmission.

What improvements have been seen with prior authorizations?

With athenaOne, practices have dramatically decreased the turnaround time for prior authorizations, allowing for quicker patient care and reduced administrative burdens.

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