Healthcare practices lose billions of dollars every year due to inefficient revenue cycle processes, growing administrative burdens, and the lack of automation in healthcare technology. According to the American Hospital Association (AHA), 89% of hospitals and health systems have seen an increase in claim denials over the last few years.
To address these issues, many practices rely on athenahealth’s revenue cycle management solution, which helps streamline billing processes, reduce errors, and improve payment collection.
In this guide, we will explore best practices and practical tips for optimizing the revenue cycle with athena billing software. These insights are based on in-depth interviews we conducted with 20 athenahealth users from small to mid-sized practices, all with over five years of experience using the vendor’s billing platform.
Revenue cycle management is a complex process that begins when a patient schedules an appointment and continues through to accounts receivable (A/R) follow-up. Each step in this process affects your practice's cash flow, so it's important to optimize every stage for maximum efficiency.
athenahealth helps streamline the scheduling process by offering automated tools and self-service options for patients. With features like self-scheduling and online payment options, patients can have more control over their appointments. This reduces the burden on office staff, reduces patient no-shows, and improves schedule density.
Many of our interview respondents shared positive experiences with athenahealth's scheduling solution, noting that it integrates seamlessly with the rest of their practice's operations and helps ensure smooth patient flow. One provider from a women’s specialty care clinic specifically mentioned that it helps them quickly move patients between providers and notify them instantly when charges are made.
However, some clinicians from another mid-sized practice expressed concerns about the system's requirement to select a patient before proceeding with scheduling or other front-office tasks. While this is useful for patient management, it can cause delays and increase reliance on front desk staff.
Practices looking to minimize this issue might consider providing additional training or adjusting workflows to reduce bottlenecks.
Medical billing can be complex and time-consuming, but athenahealth simplifies the process with a billing rules engine that uses over 30,000 rules to check for errors before claims are submitted. This helps reduce claim denials, minimize rework, and ensure your practice gets paid faster and more accurately.
Nearly three in four respondents said that they noticed a significant improvement in claim accuracy after using the billing rules engine. A small, family-oriented practice shared during the interview that it was able to increase collections by up to 4% and reduce overhead costs. However, some practice administrators felt that as their practice scaled to over 50 users, athenahealth's billing features didn’t fully meet the needs.
For larger healthcare organizations, athenaIDX offers a robust solution. This tool supports various payment models, such as fee-for-service and value-based care, and helps optimize financial performance. Most respondents who implemented athenaIDX noted a 91% clean claim rate within just three months.
Optimize Claims Creation And Management For Faster Processing
The medical claims process presents various challenges in medical practice management. It involves multiple steps across the entire revenue cycle, including:
athenahealth offers sophisticated claims creation and management tools that streamline this complex process. With its fully integrated solution, the platform reduces turnaround time and accelerates cash flow for practices. This end-to-end claims solution is designed to handle every part of the claims process, which helps eliminate common bottlenecks and minimizes delays.
Of the 20 respondents we interviewed, nearly half noted significant improvements in billing turnaround times with athena medical billing software. Some practice managers also mentioned that the system helps ensure claims are processed quickly, reduces delays, and keeps revenue flowing without prolonged hold times.
The overall medical claims denial rate increased to 12% in 2023, up from 10% in 2020. This rise in denials highlights the ongoing challenge practices face in maintaining healthy cash flow and minimizing revenue loss. Therefore, it is important for providers to adopt efficient tools and strategies for managing claim denials to reduce delays in reimbursement and improve overall financial performance.
athena billing takes a proactive approach to denials management, helping practices identify potential issues before they result in denied claims. It offers automated tools and dashboards that flag claims early in the process to address errors quickly and prevent denials from occurring.
However, while most respondents appreciated athenahealth’s built-in denial management tools, some felt that these features alone were not enough to fully address their needs. A few practice administrators noted that athenahealth’s denial management tools could still rely on manual processes in certain situations and lacked the customization options they needed to tailor workflows to their specific needs.
Revenue cycle analytics help healthcare facilities assess their financial health by providing key performance indicators (KIPs) such as collections and reimbursement rates. These insights enable users to identify inefficiencies and implement corrective actions to optimize financial performance.
athenahealth’s performance analytics and reporting tools provide practices with real-time dashboards and customizable reports to help track and compare financial metrics against industry benchmarks.
In our interviews, a provider from a Texas-based pediatric practice highlighted that athenahealth’s analytics tools improved denial visibility and helped them identify missed financial opportunities that had previously been overlooked with older, disjointed systems.
According to industry reports, approximately 90% of claim denials are due to preventable issues, such as missing information in the patient’s chart or improper coding. This highlights the importance of integrating clinical insights with revenue cycle management to reduce billing errors and improve claim accuracy.
athenahealth’s athenaOne platform supports this integration by combining scheduling, billing, and clinical data into a unified platform. Respondents in our interviews highlighted this as one of athenahealth’s key strengths. A billing manager shared that the blend of clinical and financial data improved their practice's efficiency by minimizing administrative work involved in processing claims.
After analyzing feedback from our interviews, it is clear that athenahealth’s RCM solution has generally received positive reviews. The software has proven to be a reliable partner for many practices, supporting core billing functions from the initial appointment scheduling stage all the way to securing full payment.
For small to medium-sized practices, we believe this software is a reliable choice. The best practices for athena billing and user insights outlined in this piece can further help these facilities realize the full potential of the software and improve financial outcomes.
However, larger, multi-location practices with more complex needs may find athenahealth’s built-in billing solution less suited to their requirements. They might want to explore its extended RCM services, the athenaIDX solution, or a combination of both to ensure scalability and better support.