As the leader of a large healthcare organization, you know firsthand that it’s getting harder to get paid. In fact, the overall medical claims denial rate in 2023 increased to 12% in 2023, up from 10% in 2020.¹

What’s more, only 38% of physicians believe their organization is on solid financial footing.² Hospitals and large healthcare organizations today face significant issues in medical reimbursement and payment, rising costs of supplies and services, regulatory and compliance costs, and physician burnout and high turnover rates. Some of the biggest barriers to efficiency and growth include difficulty collecting full payment, administrative and operational burdens, and inability to stay on top of healthcare industry changes.

An effective revenue cycle management (RCM) process helps reduce these barriers by streamlining the steps between patient intake and claims processing and payment. Today, it’s more important than ever to reduce complexity when it comes to financial performance, and to use a revenue cycle software tool that takes on administrative work for you, so you can focus on driving efficiency and productivity.

athenahealth can help your organization to transform the healthcare revenue cycle management process to collect more of what’s owed, quickly and efficiently through our portfolio of RCM solutions. Let’s take a closer look.

1) athenahealth takes on revenue cycle management work to help you drive your bottom line

In order to overcome broader healthcare operational and financial challenges, capture appropriate reimbursement, and lay the foundation for long-term sustainability, your organization needs a partner who can take on work for you. With athenahealth’s revenue cycle management solutions, healthcare organizations can help drive revenue, reduce administrative burden, and stay ahead of complex industry changes. In fact, practices that use athenahealth’s online payment solutions through athenaOne³, and have a 44% higher patient pay yield than practices who don’t.⁴

athenaOne includes features like automated medical claim scrubbing, intelligent medical billing rules, and real-time eligibility verification, helping to reduce errors, improve claim accuracy, and accelerate payment cycles. We have over 30,000 rules in our medical billing rules engine⁵ and make more than 4,500+ rule changes every year to help avoid costly claim errors.⁶

The RCM team at athenahealth leverages industry best practices and advanced technology, like AI, to optimize revenue capture and accelerate reimbursement. Advanced analytics and automated workflows help our team to identify and address potential claim errors or issues before submission, reducing the likelihood of claim denials and rejections, and saving your organization valuable time and resources. In case of denials, the RCM team employs effective denial management strategies to help minimize revenue leakage and optimize reimbursement.

2) Drive efficiency and reduce the cost of collections for your enterprise scale organization using athenaIDX

If your enterprise scale healthcare organization is seeking to further drive efficiency to help transform your revenue cycle, athenaIDX can help you do just that. This tool allows your organization to easily navigate fee for service, value-based care, and hybrid payment models, helping ensure that your organization’s financial performance is optimized. Using athenaIDX, organizations have seen a 91% clean claim rate within the first 3 months of implementation.⁷

athenaIDX helps optimize the billing process and drive your organization’s operational efficiency by automating manual administrative tasks and workflows, helps enhance patient and payer connectivity, and helps drive employee performance. Using athenaIDX, your organization can help reduce days in accounts receivable (A/R days), helping to increase collections while simultaneously helping to decrease the cost. The tool is also interoperable and integrates easily with external healthcare IT solutions to help your organization ensure effective communication, data exchange, and informed clinical decision making.

By optimizing and enhancing your revenue cycle, your organization can shift focus from time-consuming administrative tasks to growing your practice through patient engagement and satisfaction.

3) Reduce complexity in both fee-for-service and value-based care models

Whether your healthcare organization operates using a fee-for-service payment model, a value-based care model, or a hybrid model, athenahealth helps connect payers and healthcare organizations to reduce complexity and drive success.

We're an active partner in helping healthcare organizations thrive with quality programs, so they can deliver the best care to patients while also navigating the requirements of value-based reimbursement. athenaOne offers integrated population health management, data aggregation and analytics, quality improvement tools, care coordination, and regulatory compliance support to help customers in VBC models achieve growth. The RCM team works collaboratively with healthcare organizations on an ongoing basis, providing continuous support, training, and optimization strategies, and staying up to date with industry regulations and changes, ensuring compliance and helping to optimize revenue opportunities.

For our customers using fee-for-services models, we help healthcare organizations navigate the intricacies of reimbursement, improve their operational efficiency, and maximize revenue. By creating more efficient documentation and medical coding, automating claims management, optimizing the revenue cycle, offering compliance support, and providing performance analytics and reporting, athenahealth works to reduce administrative burden, minimize claims errors, streamline billing, and more.

4) Get valuable insights to help you analyze and improve business performance using athenahealth’s analytics and reporting

To help healthcare organizations to track and monitor business performance over time, and identify and potential areas of growth, athenahealth’s revenue cycle solutions offer robust analytics and reporting capabilities that provide critical insights into key performance metrics. Monitor and track financial performance, identify areas for improvement, and make data-driven decisions to help optimize revenue cycle operations.

athenahealth’s performance analytics and reporting tool offers real-time dashboards, customizable reports, and benchmarking data that allow customers to track and compare their performance against industry standards and best practices. By visualizing data in a user-friendly format, the tool enables customers to quickly identify areas for improvement and make informed decisions about their organization’s success. Customers can track critical metrics like revenue, collections, and reimbursement rates, enabling them to optimize revenue cycle processes and identify future opportunities for growth. Additionally, athenahealth's performance analytics and reporting help customers monitor clinical quality measures, such as adherence to preventive care guidelines or chronic disease management. Tracking these measures, healthcare organizations can identify gaps in care, implement targeted interventions, and improve patient outcomes.

With reimbursement rates facing downward pressures and operating costs continuing to rise, healthcare providers must optimize their revenue cycle performance in order to succeed in today’s industry climate. athenahealth’s RCM solutions can help large and enterprise scale healthcare organizations to navigate the complexities of revenue cycle management to make the most of profitability, cash flow, patient satisfaction, and long-term sustainability.

By focusing on a partner that can do more, your organization is enabled to not only succeed, but scale and grow. To learn more about how athenahealth can help you drive financial performance, click here.

¹Fierce Healthcare, “Payers’ increasing claims denials, delays ‘wreaking havoc’ on provider revenue cycles”, Dec 2023; https://www.fiercehealthcare.com/finance/payers-increasing-claims-denials-delays-wreaking-havoc-provider-revenue-cycles)

²2023 Physician Sentiment Survey, commissioned by athenahealth and fielded by Harris Poll, Jan 2024

³Based on athenahealth data as of Dec. 2023; compares the number of days it takes practices to get paid with or without the use of athenahealth's online payment solutions; M047

⁴Based on athenahealth data as of Dec. 2023. Patient Pay Yield (PPY) is the percentage of patient balance collected within 6 months of the date of service; M046

⁵Based on athenahealth data as of Mar. 2024; M017

⁶Based on a 3-year average of changes (additions and updates), 2021-2023; M018

⁷athenaIDX Data as of December 2023. Note: This metric is based off the top quartile of IDX ambulatory clients, which see AR days between 26.9 to 39.5 days in the first 3 months. M125