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Home » Athenahealth leverages AI to power RCM offering
AI in Finance

Athenahealth leverages AI to power RCM offering

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Athenahealth announced updates to its revenue cycle management (RCM) designed to streamline administrative processes and reduce the workload of medical practices.

Enhancements include AI-driven tools integrated into the athenaOne platform aimed at improving efficiency, accuracy and financial performance.

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

Alicia Bassolino, vice-president of analytical and AI for athenahealth, explained that one of the first steps in the revenue cycle process is to collect insurance information at the start of the patient’s visit.

“This is an administrative burden on staff and a step that, if not done correctly, can result in claim denials, payment delays and redacted payment amounts,” she said. “This is an area where AI can help automate.”

The Insurance Capacity feature automatically reads insurance card images and recommends the appropriate insurance package for subsequent claims filing.

Bassolino said automation significantly reduces administrative time spent manually entering patient insurance information and streamlining it. processing of complaints.

“This takes the guesswork out of practices, ensures accuracy, reduces denials and helps practices get paid faster,” she said.

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

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

The system also helps classify rejections and assess the likelihood of successful resubmissions.

“We use AI to better understand the likelihood that a claim will ultimately be paid or not,” Bassolino said. “Some refusals can be resolved, others – for example, if a patient was not covered by insurance at the time they were seen, they will not be covered.”

She added that athenahealth is also exploring the application of AI to simplify advising as to what corrections or changes need to be made to a claim before it is resubmitted, including both action determination as well as clear instructions on what needs to be done for corrective action.

“Ultimately, using AI to help predict and prevent denials before applications are submitted 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, aiming to reduce patient wait times and improve workflow efficiency.

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

Bassolino explained that the prior authorization process is one of the largest sources of administrative burden that clinicians regularly face.

“They are challenging for practices because of their length, 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 the payer’s requirements to determine if authorization is necessary.

“The rules engine is constantly updated with new knowledge about payer requirements, so practices don’t have to keep track themselves,” she said.

Athenahealth, based in Boston, Massachusetts, is a software and services company that provides cloud-based solutions to healthcare organizations.

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