athenahealth, a provider of network-enabled software and services for healthcare practices and systems, has introduced new AI-powered innovations for practice and revenue cycle management (RCM). These advancements aim to streamline administrative tasks across the revenue cycle, enabling ambulatory practices to optimize payment processes and reduce manual effort.
These capabilities are part of the company’s expanding suite of AI-native athenaOne features, designed to enhance revenue cycle outcomes for practices. athenahealth’s ongoing focus is to leverage innovation to reduce administrative burdens in healthcare, allowing practices to prioritize patient care and ensure fair compensation for their services.
Paul Brient, chief product and operations officer at athenahealth, stated, “Curing complexity across the revenue cycle has always been core to athenahealth. Rapid advances in AI, coupled with our decades of experience are enabling us to make another transformative leap in reducing customer workload and improving revenue cycle outcomes for our practices.” He added that their AI-native, cloud-based co-sourcing model is expected to achieve nearly 99% clean claim rates, reduce time to bill to low single-digit days, and secure full payment for practices, while also cutting their workload by half.
Built on athenahealth’s single-instance, SaaS infrastructure, these AI capabilities leverage the company’s network and direct integrations with major nationwide and regional payers. The RCM solution continuously learns by analyzing billions of claims, payer policy updates, and denial resolutions, applying these insights to automate tasks, create cleaner claims, and accelerate reimbursement.
Key athenaOne features utilizing these new AI capabilities to improve RCM performance include:
Automated Insurance Selection: Recently available, this next-generation feature uses AI to select appropriate coverage from insurance card images. This has resulted in a 13% reduction in patient insurance-related denials and a 35% reduction in insurance-related claim holds. Michelle Gilreath, Owner/PMHNP-BC at Mindwell, commented, “athenahealth’s automated insurance capabilities make it easier for me to quickly find the right insurance package, register patients more quickly and avoid surprise downstream denials that negatively impact my practice and the patient’s experience.”
Patient Liability Estimation: Currently in pre-Alpha development, AI models will estimate a commercially insured patient’s financial responsibility based on payer contracts and anticipated services. This aims to provide greater transparency for patients and increase patient payment collection for practices.
Waitlist Scheduling: Soon to enter Alpha testing, this feature will use AI to automatically identify open appointment slots due to cancellations and send text messages to patients to fill these openings. The goal is to improve access to care and patient satisfaction while maximizing provider schedules.
Express Coding with Real-time Clinical Documentation Improvement: Currently in Alpha testing and development, AI models will recommend procedure codes for billers and provide real-time documentation and diagnosis nudges to clinicians. This is intended to enable comprehensive billing for the full scope of care provided.
AI Payer Portal Agents and Voice AI: Currently in Alpha testing, AI agents search payer websites for policy changes to facilitate timely rule modifications and prevent rejections and denials. athenahealth is also employing agentic AI and voice AI to assist with capturing claim status, downloading remittances, and determining prior authorization status, aiming for faster and more accurate documentation.
Automated Denial Advice: Currently available, this feature uses AI models to generate real-time claim correction suggestions for coding-related denials, leading to a 26.4% increase in payment recovery compared to manual corrections alone.
athenahealth, recognized for 19 years in Best in KLAS, has a history of addressing complex challenges in the revenue cycle for physician practices nationwide. Its RCM solution demonstrates a 5.7% median initial denial rate (compared to an industry average exceeding 10%), a 98.4% clean claim rate, and a 78% patient pay yield.
Bob Segert, chairman and chief executive officer at athenahealth, stated, “Since our founding, athenahealth has focused on leveraging innovation to drive administrative work out of the business of medicine, so that practices can focus on their patients and get paid fairly for the care they’re providing to their communities.” He added, “Our cloud-based, AI-native architecture allows the rapid deployment of AI features, and this approach enables us to innovate more quickly, revolutionizing RCM work for our practices and positioning them for long-term growth.”
athenahealth, founded in 1997, provides clinical, financial, and patient engagement solutions that connect practices, health systems, payers, partners, and patients.
