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athenahealth to Cut Revenue Cycle Management Work for Physician Practices by 50% with AI

Nikki D’Addario
ndaddario@athenahealth.com

athenahealth, a leading cloud platform for health care practices nationwide, announced new automation and AI-based software innovations that simplify and reduce the burden of revenue cycle management (RCM) for thousands of practices. As part of the company’s commitment to curing complexity in the health care system, athenahealth has set a goal to eliminate at le ast half of the work currently handled by athenahealth practices over the next three years while increasing the speed, accuracy, and quality of RCM processing.

A recent survey conducted by athenahealth revealed that 39% of physicians believe that AI can reduce administrative burdens and streamline administrative tasks. athenahealth is already seeing its AI- enabled innovations reduce the administrative work related to RCM processes for practices including making the claims process more efficient.

Creating efficiencies and decreasing claims errors at the front desk

athenahealth's AI-enabled insurance package selection capability, built directly into athenaOne, automatically reads insurance card images and recommends the correct insurance package for later claims filing. In the last 12 months, this feature has delivered a 36% reduction in insurance-related claim holds for practices using the capability and has saved practice staff more than 6,500 hours of administrative time.

"athenahealth’s AI-powered insurance package selection tool has been invaluable for Mountain View Medical, significantly reducing the administrative time spent on manually entering patient insurance information and simplifying claims processing," said Tina Kelley, director of operations at Mountain View Medical Center. "Automating insurance selection removes guesswork for our staff, ensures accuracy, decreases denials, and helps us get paid faster, which is essential for our growing practice."

Making Claims Management smarter and more automated

athenahealth's Auto Claim Create feature helps practices create claims automatically after a patient encounter. This feature has resulted in a 40% reduction in charge entry lag and a 24% reduction in time to submit a claim to an insurance company. The company began testing this feature across 15 practices in 2023. Today, Auto Claim Create is automating 10% of all claims athenahealth processes on behalf of customers.

“The most controlled way to improve practice cash flow is to submit claims as quickly as possible after the patient encounter,” said Paul Brient, chief product officer at athenahealth. “By making the claims process more efficient, automation not only maximizes financial performance for practices but also reduces time-consuming and repetitive administrative tasks for practice staff.”

With Auto Claim Create, charge lag can be hours, not days. This not only improves financial performance but also eliminates significant work and rework associated with the claims review process.

Beyond claims processing, a survey conducted by Premier, reported that nearly 15% of all claims submitted to payers for reimbursement were initially denied, resulting in $10.6 billion of practice time and resources spent arguing over claims that should have been paid from the start.

To help alleviate this challenge for practices, athenahealth has developed extensive intelligence to help practice staff easily identify potential issues and correct them in real time, reducing the median denial rate across all athenahealth practices to just 5.3%. athenahealth is also using AI to help practices classify denials and identify the likelihood of a claim getting paid following a resubmission or appeal. As a result of these investments, athenahealth is reducing administrative burden and ensuring effective payment recovery in instances when denials do occur.

Streamlining Prior Authorizations

According to the American Medical Association, 95% of physicians reported that prior authorization somewhat or significantly increases physician burnout with many physicians reporting they spend nearly two full days processing prior authorizations each week. In 2024, athenahealth launched authorization management services to manage this resource-intensive process to expedite the prior authorization process.

"With athenaOne's Authorization Management, we’ve transformed our authorization process from a bottleneck into a streamlined operation. We reduced patient wait times from 6-8 weeks when prior authorizations were done manually to as little as 5 days, allowing us to provide the tests and procedures our patients need while also improving our financial performance,” said Angela Szymblowski, director of clinical operations, South Texas Spinal Clinic. “To achieve this efficiency without athenaOne, we would need six or more full-time employees dedicated to prior authorizations. This service has freed us to focus on delivering high-quality care without the previous administrative burden."

athenahealth is also partnering with payers to create more automated, electronic prior authorization capabilities, building off learnings from its recent case study with Humana and Availity, which received a KLAS Points of Light award in June of this year.

Learn more about athenahealth’s revenue cycle management capabilities.

About athenahealth, Inc.

athenahealth strives to cure complexity and simplify the practice of healthcare. Our innovative technology includes electronic health records, revenue cycle management, and patient engagement solutions that help healthcare providers, administrators, and practices eliminate friction for patients while getting paid efficiently. athenahealth partners with practices with purpose-built software backed by expertise to produce the insights needed to drive better clinical and financial outcomes. We’re inspired by our vision to create a thriving ecosystem that delivers accessible, high-quality, and sustainable healthcare for all. Learn more at athenahealth.com.

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