Poor Performance, Little Information

For Dr. Francis Stranick, the biggest problem with most billing systems is their business model. “Billing companies are just that: they bill, and their business plan is constructed to make profit by sending out claims. Fewer resources and staff are committed to the collection arm of the business. Therefore, companies do not aggressively work denials or inaccurately filed claims because profit margins decline rapidly with these high-cost, low-return activities.”

This situation prompted Dr. Stranick and Presbyterian Anesthesia Associates, PA, a 44-physician specialty practice located in Charlotte, North Carolina, to switch to athenaCollector in August of 2008.

athenaCollector Offers Win/Win for Practice

Dr. Stranick was very impressed with the combination of intuitive software, payer intelligence, and results-oriented services that athenahealth offers its clients, but it was the company’s “we get paid when you get paid philosophy” that made the decision to switch to athenahealth even easier.

athenahealth’s business model is based on how much the practice collects, not on how many claims are filed, making the company a motivated partner with a shared interest in filing clean claims and getting practices paid quickly.

As anticipated, the financial impact of switching to athenahealth was immediate and impressive, Dr. Stranick reports. “Collections increased more than 15% despite the fact that the number of billed anesthesia units declined 1% and our payer mix worsened—with an increase in Medicaid patients by 1.5% and an increase in self- pay by 0.75%.”

Clean Claims Decrease Denials and Boost Revenue

Now, thanks to athenahealth’s patented rules engine, which continually updates and inserts new rules into the workflow, the practice’s first pass resolution rate is 90%. Denials, front and back end, have declined by nearly 70% and days in accounts receivable (DAR) have decreased by 10 days, or more than 25%. “No other system in the market is even close,” remarks Dr Stranick. “Clean claims are the secret of our success.”

Plus, he adds, the power of athenahealth to analyze DAR data allows the practice to develop strategies to work outstanding accounts. “Our previous anesthesia billing company’s data management was ill-equipped to analyze the practice’s DAR, let alone provide information to assist in the strategic management of the practice.”

For example, adds Dr. Stranick, almost immediately upon implementing athenaCollector, a problem with filing inpatient versus outpatient claims was uncovered. Outpatient procedures that were being performed in-house were being billed as “outpatient”—and a large majority of these claims were subsequently denied by insurers as a non-approved in-house service. Then the billing company would typically just write off these claims.

“athenahealth corrected this problem, making certain that future claims were filed correctly, and then went back, looked at the rejected claims, and fixed and refiled them. This had a positive impact on both our denials and on revenue,” Dr. Stranick pointed out.

New Service Adds Value Practice-Wide

In addition, Dr. Stranick says, “athenahealth was able to quantify the fact that the rejection rate of a particular insurer was more than four times that of the average of other managed care carriers in our market. We were then able to leverage this information during contract negotiations with this particular carrier.”

Dr. Stranick and his colleagues are so pleased with the services offered by athenahealth that the practice recently implemented athenaClinicals®, the company’s EHR service, in its Pain Clinic. “It has been up and running for a little more than a month so it is too early to generate much data, but we anticipate great results.”

In fact, he never hesitates to recommend athenahealth to other practices. “Bottom line, you collect more of the money owed to you for services delivered—a big plus in today’s environment—and the ability to data mine to support strategic practice objectives is without competition.”

After all, says Dr. Stranick, “If you don’t have control of your financials, you don’t have control of your business. With athenahealth, we have control.”