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athenahealth Medical Billing Review

Max Freedman
Max Freedman
  • Athenahealth's revenue cycle management solution delivers extensive reporting and offers to benchmark against other similar practices in its network. 
  • Athenahealth's revenue cycle management platform includes all medical billing services from charge entry and coding to denial management.
  • Experts on athenahealth's staff will work with your practice regularly to improve financial performance, as well as offer support if a key metric begins to slip.
  • This review is for medical practice owners who are thinking of outsourcing their medical billing to athenahealth.

Athenahealth Editor's Score: 87/100

Overall value 75/100
Medical software 90/100
Billing 80/100
First-pass acceptance rate (FPAR) 97/100
Customer service 95/100

Why athenahealth Is the Best for Reporting

Athenahealth is our pick for the best medical billing service for reporting because it leverages data captured from the more than 160,000 healthcare providers that operate on its network to both improve the medical billing process and inform practices of steps they can take to boost financial performance. Providers can review key metrics, like medical claims, days in accounts receivable or the number of unpaid claims that are due. Athenahealth can monitor key performance indicators (KPIs) like these against a benchmark average on its network. If a client begins falling short of that average, athenahealth can help offer recommendations for improvements. (After all, athenahealth makes more money when its clients do.) 

athenahealth Medical Billing

athenahealth Medical Billing

The Verdict

Athenahealth is a top-notch outsourced medical billing provider for practices that want data-driven reports and benchmarks. The company also offers consultative support to improve practices' overall financial performance.

Athenahealth also measures key metrics of top-performing practices to offer clients examples of what works well and how to emulate it. In this way, signing up for medical billing services with athenahealth affords you access to not only outsourced billing but also a team of experienced, data-driven advisors. 

Pros

  • Athenahealth's extensive database improves the medical billing process and provides detailed reports.
  • The consultative approach gives healthcare organizations support and expert insight.

Cons

  • The medical software's user interface likely requires guided training.

Usability

The athenahealth interface may pose a slight learning curve. Implementation shouldn't be overly challenging, but mastering the interface requires more than just clicking around.

Most of the interface challenges stem from athenahealth's electronic medical record (EMR) system, which is included with the company's billing services. The EMR is built in a patient-centric way that requires you to pull up a patient's file to access most of your features. As a result, you often have to return to your home screen before accessing some features, which isn't ideal. However, this challenge may not be as prominent in the practice management software (PMS), which is where you access your billing suite.

athenahealth
This view shows athenahealth's charge entry screen, which an in-house medical biller or coder must fill out before the outsourced billing process begins.

Features

Here are some of the key features of athenahealth's revenue cycle management (RCM) platform:

Claim scrubbing Athenahealth uses a rules engine to keep its first-pass acceptance rate above the industry standard.
Denied-claim management Athenahealth will manage some of your denied or rejected claims, but unlike the other providers we reviewed, athenahealth won't manage all of your denials.
EMR and PMS inclusion Athenahealth includes its EMR and PMS with its billing services.
Integrated clearinghouse Athenahealth files claims either through its integrated clearinghouse (meaning no additional fees) or directly to payers.
Medical billing dashboard Athenahealth's RCM dashboard shows all your financial data so you get performance insights around the clock.
Unpaid-claim follow-up If payers or patients aren't paying what they owe you, athenahealth will handle all follow-up.

Claim Scrubbing

Athenahealth's claims scrubber uses a rules engine to analyze the claims that your practice has generated. This engine constantly updates and changes based on payer denials and rejections among the more than 160,000 providers on athenahealth's network. You can also add your own rules if you see that the rules engine doesn't reflect the preferences of payers.

As a result of the athenahealth rules engine, the company says its first-pass acceptance rate (FPAR) is 99% for electronic claims. Manual claims make up a small amount of the medical billing work athenahealth does, but this statistic is still one of the best we found in our reviews of medical billing services.

Despite athenahealth's advanced claim scrubbing features, it does have one glaring flaw: It won't code or enter your charges. In fact, you'll need an in-house medical biller to use athenahealth's RCM services.

Key TakeawayKey takeaway: Unlike some other revenue cycle management companies we reviewed, athenahealth won't code or enter your charges, so you'll need to keep a medical biller on staff.

Denied-Claim Management

As you can see from the numbers above, athenahealth's medical billing services rarely result in denied or rejected claims. However, a 99% FPAR isn't 100% – that just doesn't exist. Instead, in the rare cases when a claim is denied or rejected, athenahealth often handles revisions and resubmissions.

However, athenahealth won't always revise or submit denied or rejected claims. In some cases, the company will pass these claims back to your practice instead. Again, this requires you to maintain a medical biller on staff.

Did you know?Did you know? Unlike most other revenue cycle management services, athenahealth will sometimes defer the need to revise or resubmit denied or rejected claims to your team.

EMR and PMS Inclusion

Athenahealth's RCM services include access to its EMR and PMS technology. Athenahealth's PMS also goes by the same name as its RCM suite: athenaCollector. In fact, to use athenahealth's billing services, you must use its PMS. This requirement is standard among medical billing companies.

Athenahealth's medical software is also our best pick for reporting. To learn more about why, read our athenahealth medical software review

athenahealth
Athenahealth's medical software offers an overview of the patient encounter before the note is signed and sent to the practice's in-house medical biller.

Integrated Clearinghouse

Whereas other companies may use a third-party clearinghouse, athenaheath's clearinghouse is fully integrated with its billing services. However, upon scrubbing a claim, athenahealth may not always pass it through a clearinghouse. Athenahealth instead submits more than half of its scrubbed claims directly to payers. In either case, you won't pay additional fees, as the clearinghouse fees other companies might charge are built into your monthly rates.

Medical Billing Dashboard

On the PMS side, athenahealth is known for its extensive reporting, and that focus is evident in its RCM dashboard as well. There, you'll see all your financial data, so you get a numerical view of your practice's performance at all times. As a result, you can determine how to make your processes more efficient and maximize your profit.

Unpaid-Claim Follow-Up

If your claims are approved but remain unpaid, athenahealth will follow up so you don't have to. This follow-up applies equally to payers and patients. Additionally, athenahealth will keep close tabs on the progress of your claims, from submission to approval (or, in rare cases, rejection or denial).

Pricing

Athenahealth charges 7% to 8% of your practice's monthly collections for its RCM services. These rates are on the higher side among the companies we reviewed.

Unlike most other providers, athenahealth's percentage-based structure also applies to its EMR and PMS, which are included with athenahealth's billing services. Your exact percentage will vary depending on your claim value, claim volume, practice size, billing cycle complexity and other factors.

Unlike many other providers we researched in our reviews, athenahealth was unwilling to share how these percentages would translate to approximate dollar figures. One thing is for certain, though: You won't encounter any extra hidden fees.

Customer Service

Athenahealth offers customer service via phone and email but not live chat. However, you may be able to answer many of your questions by accessing the company's online resources, which include videos and answers to frequently asked questions.

In addition to these customer service resources, there is an account management team that proactively contacts you to discuss practice improvements. This feature is unique to athenahealth; although other medical billing companies pair you with a dedicated agent, only athenahealth's agents often contact you before you even think to contact them. From athenahealth's perspective, you can always improve your operations, and the company is there to help.

This depth of service begins the moment you even consider athenahealth. The company has long sent representatives to interested practices to meet face to face before they sign contracts and begin implementation. Athenahealth is happy to send representatives to your practice again if you need further assistance. 

Should the reps you meet determine that athenahealth might not fit your needs, they won't hesitate to let you know. Not only is this a rarity among medical billing services, but it also lets you get back to finding another solution that's better for your practice. Looking for a user-friendly medical billing service and software? Read our review of Kareo's medical billing service

Drawbacks

Athenahealth's medical billing services are comprehensive, but there are a couple of drawbacks. The most glaring downside is that the athenahealth user interface isn't as intuitive as some others we reviewed. It may require some additional training to get staff totally up to speed. Looking for a medical software that's easy to use? Consider our review of DrChrono's medical billing service.

Another downside is that not all claim types qualify for denial management. Athenahealth is the rare medical billing company that manages only some of your denied claims. This structure could pose problems for practices that are looking to outsource all of their billing; without in-house staff, denied claims that are referred back to you could go unpaid. Additionally, it remains unclear how athenahealth chooses whether to manage certain denials.

Methodology

We spent hours researching medical billing services. That research included software demonstrations, phone interviews and customer service calls, as well as analysis of customer service reviews available online, including those listed on the Better Business Bureau website. We spent several months browsing company websites, reading customer reviews and speaking with company representatives. When choosing our best pick for reporting, we considered the depth and breadth of the reporting tools, the flexibility in sorting data and the ability to compare practice performance against other healthcare organizations'. Athenahealth offers all of these benefits in athenaCollector, making it our pick for the best medical billing service for reporting.

What Is a Medical Billing Service?

A medical billing service is a company that maintains a staff of medical billers (and sometimes coders) to prepare and track claims on behalf of client healthcare organizations. Medical billing services often hire certified medical billers with credentials such as AAPC or AHIMA certification. These organizations tend to offer specialty experience and consultation to a healthcare organization, removing the burden of managing billing while maintaining transparency into financial performance. The best medical billing services excel at not only managing a healthcare organization's billing but also improving collections and boosting revenue. 

Athenahealth Medical Billing FAQs

How much does athenahealth's medical billing solution cost?

AthenaCollector, athenahealth's medical billing service, generally costs 7% to 8% of monthly practice collections, which is on the high end for the medical billing services we reviewed. However, with athenaCollector, clients gain access to a wide range of data and consultative support from expert analysts on athenahealth's team. 

Does athenahealth offer medical coding?

Yes. Athenahealth manages charge entry and medical coding before passing claims off for scrubbing and submission. 

What is athenaNet?

AthenaNet is athenahealth's network of more than 160,000 healthcare providers across thousands of organizations. The company uses the data collected by these clients to inform the claim scrubbing and billing processes, thereby increasing the likelihood that payers remit on the first submission. AthenaNet also shows benchmarks and top performers among similar practices and specialties, thus helping healthcare organizations gauge their success and see what is working for other practices. [Read Related: The Benefits of EFT and ERA in Medical Billing]

Bottom Line

We recommend athenahealth for ...

  • Enterprise practices that have substantial medical billing needs.
  • Large practices that want to outsource most, but not all, of the medical billing process.
  • Data-driven practices that thrive on deep reporting and analysis.

We don't recommend athenahealth for ...

  • Medical practices that are looking to fully outsource their revenue cycle management.
  • Smaller or newer medical practices that can't afford an in-house staff biller alongside outsourced medical billing.

Image Credit: Getty Images
athenahealth Medical Billing

athenahealth Medical Billing

The Verdict

Athenahealth is a top-notch outsourced medical billing provider for practices that want data-driven reports and benchmarks. The company also offers consultative support to improve practices' overall financial performance.

Max Freedman
Max Freedman
Business News Daily Contributing Writer
Max Freedman is a content writer who has written hundreds of articles about small business strategy and operations, with a focus on finance and HR topics. He's also published articles on payroll, small business funding, and content marketing. In addition to covering these business fundamentals, Max also writes about improving company culture, optimizing business social media pages, and choosing appropriate organizational structures for small businesses.