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Englender, Sper, & Drasnin

Pediatric Practice Uses Real-Time Adjudication to Reduce Self-Pay Balances

 

Before joining the athenahealth network, a five-physician pediatric practice struggled with their medical billing and practice management. After adopting athenahealth's practice management service, athenaCollector®, the group reduced self-pay balances and improved their daily workflow.

 



Organization

  • Located in Milford, OH
  • 5 physicians
  • 1 nurse practitioner

Issues

  • Lack of timely insight into practice performance
  • Inability to adequately check patient eligibility and coverage before sending out claims
  • Long claims processing time
  • Wasted staff time

Solutions

Results

  • Instant access to practice performance data and eligibility status
  • Reduced self-pay balances
  • More efficient staff
  • Improved workflow
Englender, Sper & Drasnin MDs, Inc. has been seeing patients for over 40 years, but before joining the athenahealth network they struggled with many of the billing and practice management issues other practices commonly face.

“We would fill out each claim, send it in, and hope for the best. But we were getting insurance IDs that were no longer valid, and we’d wait on claims that took a long time to process,” said Brenda Dunham, Billing Manager. “We’re a busy office, and our staff had to spend time on the phones checking on eligibility, denials, appeals, and missing payments.”

The practice also had to pay an outside company to run reports for them. “Whenever we wanted to see practice performance data, we had to request a report and wait for weeks before getting it,” said Dunham.

Starting on a new system

The group decided to look for a new billing and practice management system. “We wanted a system that was up-to-date and had more capabilities,” said Dunham. “We needed to be able to check eligibility immediately and see where we were running into problems.”

The practice implemented athenahealth’s athenaCollectorSM in 2007. With athenaCollector, staff could catch and correct billing errors before they became problems. athenahealth’s proprietary rules engine houses an unprecedented collection of real-time payer rules. When the practice submits a claim, the most up-to-date payer requirements are flagged on the screen so staff can fix those errors immediately.

“I figured we would be a little slow starting out with the new system,” said Dunham. “But the implementation went unbelievably well. In fact, just a few months after we started with athenaCollector we were already performing better than we had been with the old system.”

“When we started with athenahealth, I thought our employees would have a hard time getting used to the new system,” she said. “But we didn’t lose a single employee. The system is that easy to use.”
All practices should do business this way

The practice was also able to take advantage of a unique benefit of joining the athenahealth network—real-time adjudication (RTA) of medical claims.

“The way insurance coverage is going, patients are responsible for higher and higher balances,” explained Dunham. “We needed to keep self-pay balances down, but it’s hard in a busy practice. For years, we wanted a system that would help us stay on top of this with patients.”

Then the practice heard that athenahealth launched the first ever fully-integrated platform enabling the entire client base to perform real-time adjudication at the point- of-service for participating payers.

“We thought this was great,” said Dunham. “We decided to start using it right away.”

The practice uses the RTA functionality within athenaCollector to submit a claim electronically to a payer’s adjudication system. Within seconds, the practice receives a response including the adjudication details. Receiving that adjudication response in real time means that the practice knows the patient responsibility of any given claim almost instantly. Ideally, the practice then collects this amount from the patient at check-out.

Dunham and the front desk staff explain how the system works to their patients. They provide handouts, print out each RTA response, and walk through it with each patient. With this kind of support and some time to understand the process, the practice is finding that patients are generally open and willing to pay their full balances at check-out.

“Using RTA is fantastic. We’re so glad we’ve started it,” said Dunham. “There are some claims that we can’t send through RTA, but it has definitely improved our workflow—and cash flow—since we’re not waiting and following up on a lot of self-pay balances anymore.”
Access to key practice data

As soon as they were up and running with athenaCollector, the practice enjoyed tracking and accessing information on any claim, from its starting point to its payment date with simple, point-and-click reports.

“We haven’t had to pay an outside company for a special report,” said Dunham. “We now regularly check our days in accounts receivable (DAR), self-pay balances, and run reports on all aspects of our practice’s performance.”

By joining the athenahealth network, the practice also joined thousands of providers across the nation in a powerful industry network that no single practice can achieve independently.
Staying ahead

athenahealth regularly upgrades its system without cost to clients, and offers clients training on any new aspects of the program.

“athenahealth is a top notch company—they keep us up to date on everything,” said Dunham. “They are constantly alerting clients when there is anything new. They hold regular trainings online that are easy to participate in.”

“We feel so on top of it,” said Dunham. “athenahealth is definitely there for clients.”

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