athenaOne for fee-for-service payment models

Did you know that 62% of physicians surveyed don’t believe that their medical practice is financially secure?¹ This may come as a shock to those outside the healthcare industry, but to many medical practices and healthcare organizations across the U.S., they’re experiencing this doubt about revenue on a regular basis.

Medical practices today are struggling to manage their revenue cycle and ensure they’re being paid for services rendered to patients. Working with payers, medical coding, claims denials, and regulatory changes all add layers of complexity to the healthcare revenue cycle and process of reimbursement. If your healthcare organization is one of the many using a fee-for-service (FFS) payment model, or a hybrid between fee-for-service and value-based care models, you know these challenges all too well.

Considering that over 86% of practices in the U.S. today are using at least a partial FFS model to receive revenue, it still remains the most common payment method.² In order to succeed, practices using a fee-for-service model need to ensure they’re getting paid for services rendered to patients, minimizing the administrative burden with medical billing and coding, and seeing a minimum number of patients per day to keep their doors open. This puts a significant amount of pressure on medical practices to maintain the right volume of patients on their daily schedule and patient roster and ensure that those patients keep coming back to get the care they need.

athenaOne® can help practices using a fee-for-service payment model to drive clinical and revenue cycle efficiencies, keep patients returning for care, maintain financial stability, and create a foundation for future growth. Let’s examine the key pain points in market for fee-for-service practices today before reviewing the benefits of athenaOne.

If your medical practice uses a combination of value-based care and fee-for-service models, read our article here.

Top challenges and priorities for practices using a fee-for-service model

1. Difficulty collecting full payment – It’s getting harder to get paid:

• By payers: the overall denial rate has increased to 12% in 2023, up from 10% in 2020
• By patients: practices and healthcare organizations often struggle with collecting timely payments from patients for care provided.

The biggest reasons for these barriers to payment are issues with payers, claim denials, and outdated patient engagement capabilities.

2. Administrative and operational burden – Like many providers in the U.S. today, medical practices and healthcare organizations struggle with the systemic issue of burnout and the phenomenon known as “pajama time”, which describes time spent by care providers doing clinical notetaking and documentation after hours. These trends – alongside unsustainable administrative tasks for the rest of a practice’s staff, lack of operational rigor across the organization, and lack of automation in healthcare technology—are all major challenges that healthcare organizations must overcome if they seek to drive efficiency and growth.

3. Struggling to stay on top of industry changes – Staying in the know about industry changes like new medical codes, billing requirements, and lack of interoperability standards are also preventing healthcare organizations from achieving progress toward financial stability. With literally thousands of medical codes and regulations to keep track of, it can be hard to keep up. The growing burden of regulatory and compliance changes has tacked on added administrative work and expenses that affect the bottom line.

How athenahealth helps you succeed using a fee-for-service model

These core challenges pose a serious threat to medical practices using a FFS or hybrid model, but an HIT solution designed to help organizations collect full payment quickly and easily can help create success. Using athenaOne, medical practices can help optimize medical billing and medical coding, track financial performance, discover opportunities to increase patient volume, and save time during patient encounters. athenaOne’s billing rules engine contains 30,000+ rules to help proactively identify and reduce claim errors, and makes 4,500+ rule changes every year to help avoid costly claim errors.³

Below, we’ll show you exactly how athenaOne works to help your medical practice thrive under a fee-for-service or hybrid model.

Optimize medical billing and healthcare revenue cycle management to get paid faster

Creating new ways to streamline and drive efficiency can have a massive impact on the healthcare revenue cycle, allowing medical practices to spend more time with patients and less time trying to get paid. Using athenaOne, FFS practices can optimize medical billing and medical coding to create cleaner claims from the start, minimizing denials and speeding up the path to payment.

Benefits of athenaOne to help FFS practices improve the revenue cycle and collect more:

• Streamlined practice workflows: Simple, intuitive workflows ensure staff can easily capture essential information and complete necessary actions that set the revenue cycle up for success.
• Collective knowledge that drives results: our proprietary billing rules engine leverages the power of our provider network, payer knowledge, and billing experts to automatically scrub claims and resolve errors, reducing rejections and accelerating reimbursement.
• Prompt, accurate medical coding: a seamlessly integrated AHIMA/AAPC certified coding service takes on the manual effort of coding claims, resulting in quality-assured submissions that thoroughly capture the care delivered.
• Authorizations made easy: our continuously updated authorization determination engine and team of specialists work in concert to solve the authorization management challenge and obtain required authorizations as quickly as possible.

Identify revenue cycle inefficiencies with critical financial performance insights

In order for your medical practice to not only collect full payment, but also thrive financially, you need to know how your practice’s performance stacks up to the others and where the opportunities lie. Fortunately, athenaOne can help your organization obtain insights into critical financial performance metrics, helping you make data-driven decisions that impact the growth of your business.

Benefits of athenaOne to help FFS practices measure financial performance:

• Insights Dashboards: view an instant snapshot of your financial performance and actionable advice with our user-friendly Insights Dashboards. The dashboards use graphs and widgets to show revenue, collections and charges posted, total RVUs, visit volume, and more, spotlighting ways your practice can drive more revenue.
• Get the data you need to make informed decisions: key metrics like days in accounts receivable (DAR), claim denial rate, and net collection rate help you track where your healthcare organization could be underperforming compared to competitors and the broader industry.

Increase patient volume while reducing burden for both front-of-office staff and clinicians

Targeting clinician burnout at the source is a key benefit of athenaOne. Our tools and functionality were designed to reduce documentation time for clinicians and create more efficient patient encounters, all while empowering the patient. Using athenaOne, your medical practice can allow patients to take control of their own scheduling and intake, while your practice frees up time to deliver quality care. And as an added bonus, practices that offer athenahealth’s online patient payment solutions have a 44% higher patient pay yield (PPY) than those who don’t.⁴

Benefits of athenaOne to help FFS practices streamline clinical tasks and see more patients:

• Efficient clinical management: athenaOne features a dynamic central hub for clinical tasks, surfacing automatically classified and routed documents, connects health information to the right patient, and triages to the most appropriate member of the care team.
• Convenient self-service options: secure online scheduling, check-in, intake, messaging, and payment via the patient portal help meet patients where they are, encouraging patient engagement and reducing front of office workload.
• Proactive communication: targeted messages via text, email, and phone help remind patients when they’re due for an annual wellness visit or an upcoming appointment, or when they have bills to pay.

athenaOne helps you open access to care and increase patient volume with telehealth visits:

Telehealth has seen a 23x rise in utilization since 2020, and there’s a reason for its popularity.⁵ The convenience of getting care at home is perfect for patients who are unable to see clinicians in-person, and those who manage chronic conditions. Telehealth also benefits providers, by helping clinicians to see more patients while also scheduling appointments around their needs. By offering telehealth visits as an option, your organization can both acquire new patients and increase patient satisfaction.

• Maintain schedule density: telehealth allows practices to meaningfully engage with patients and meet them wherever they are. athenaTelehealth is fully integrated with athenaOne and helps you support vital patient care and help maintain your practice’s schedule density with HIPAA-compliant telehealth visits.
• Grow your patient roster: offering telehealth as well as in-person appointments allows medical practices to grow their patient roster by expanding access to care for patients who can’t travel to the office. This allows organizations to accommodate new patients and fit more appointments in a day.

Save time during patient encounters via interoperability and intuitive clinical workflows

62% of physicians surveyed cite excessive documentation requirements as one of the key contributors of burnout.⁶ Outdated EHR solutions make it more difficult for care providers to surface patient data at the right place and time, requiring clinicians to sift through excessive, redundant data, and spend more time and effort prepping for patient encounters. athenaOne was built with interoperability in mind, helping medical practices to make more informed care decisions and prep for patient encounters faster.

Benefits of athenaOne to help FFS practices get curated medical data for efficient patient encounters:

• Save time with efficient and intuitive clinical workflows: easily view and add relevant clinical information from external labs, clinics, and care facilities into your patient’s chart directly within your existing clinical workflow. athenaOne proactively identifies and deduplicates key clinical data and surfaces new information within the clinical workflow, allowing clinicians to control which data gets added into a patient’s chart.
• Insightful longitudinal record: a thoroughly informed patient chart helps curate patients’ health histories, augmenting practice-specific data with relevant, automatically sourced records, orders, and results from care sites nationwide.
• Better user experiences: instead of data-dumping, athenaOne allows users to interact with external information when and where they need it, helping improve patient outcomes and administrative efficiency.
• Built-in connections to the healthcare ecosystem: we proactively build and manage the athenahealth network so interoperability is optimized, connecting all practices to nationwide and local labs, imaging centers, pharmacies, registries, payers, hospitals and other care sites to support informed care and practice operations.

If your medical practice currently uses a FFS model, it’s time to think about whether your current EHR software and HIT tools enable you to drive clinical efficiency, free up staff resources, increase patient volume, capture revenue, and measure performance. athenaOne can help your FFS practice to streamline the revenue cycle, enabling you to collect more so you can thrive and continue to provide quality care. Ready to learn more?