Athenahealth leverages AI to power RCM offering

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Athenahealth has announced updates to its revenue cycle management (RCM) platform that are designed to streamline administrative processes and reduce workloads for physician practices.

The enhancements include AI-powered tools integrated into the athenaOne platform aimed at improving efficiency, accuracy and financial performance.

One of the key features is the AI-enabled insurance-package selection tool, which automates the process of reading insurance card images and recommending the correct package for claims filing.

Alicia Bassolino, vice president of analytics and AI for athenahealth, explained one of the first steps in the revenue cycle process is collecting insurance information at the beginning of the patient visit.

"It's an administrative burden for staff and a step that, if done incorrectly, can lead to claims denial, delayed payments and redacted payout amounts," she said. "This is an area where AI can help automate." 

The insurance capability feature automatically reads insurance card images and recommends the correct insurance package for later claims filing.

Bassolino said the automation significantly reduces the administrative time spent on manually entering patient insurance information and simplifying claims processing.

"This removes guesswork for practices, ensures accuracy, decreases denials, and helps practices get paid faster," she explained.

Another addition, the Auto Claim Create feature, automates the generation of claims after patient encounters.

To address claim denials, athenahealth has introduced intelligence features that identify and correct potential issues in real time.

The system also assists with classifying denials and assessing the likelihood of successful resubmissions.

"We are using AI to better understand the likelihood of whether a claim will eventually get paid or not," Bassolino said. "Some denials are addressable, others – for instance if a patient wasn't covered by insurance at the time they were seen – are not."

She added athenahealth is also exploring applying AI to simplify the guidance as to what corrections or changes need to be made to a claim before resubmission, including both the determination of the action as well as clear instruction on what needs to be done for corrective action.

"Ultimately, the utilization of AI to help predict and prevent denials before claim submission is the goal so that denials can be avoided entirely," Bassolino said.

The company also launched authorization management services to expedite the prior authorization process, with the aim of reducing patient wait times and improving workflow efficiency.

According to the American Medical Association, physicians reported spending more than two full days processing prior authorizations each week.

Bassolino explained the prior authorization process is one of the largest sources of administrative burden clinicians face on a routine basis.

"They are challenging for practices due to their time-consuming nature, frequent rule changes, difficulty navigating complex forms, and more," she said.

When an order for a procedure is placed through athenaOne, the platform's authorization rules engine automatically checks against payer requirements to determine if an authorization is needed.

"The rules engine is constantly being updated with new knowledge about payer requirements, so practices don't have to keep up themselves," she said.
 
Athenahealth, based in Boston, Massachusetts, is a software and services company that provides cloud-based solutions for healthcare organizations.