4 ways athenahealth supports better medical coding

4 opportunities to partner with athenahealth to improve medical coding and billing

AAPC—the largest professional education and credentialing organization for medical coders, billers, auditors, practice managers, and revenue cycle managers—says that coding is like “walking on a tightrope between accuracy and productivity. On one end lies the integrity of the medical record, and on the other, the demand to meet production quotas.”¹

In medical coding, accuracy is paramount—most organizations strive to achieve 95 to 100 percent accuracy². A coder must translate complex clinical information about encounters into accurate codes so the clinician and practice get paid. At the same time, there’s an expectation of speed. The faster coding is completed, the sooner claims can be submitted. Improving accuracy while keeping pace is the goal, but it can be difficult to do. Coding teams face problems including:

• Complex and changing coding requirements
• Payer-specific rules
• Incomplete clinical documentation
• Staffing challenges
• Pressure to reduce denials
• The need to increase productivity while avoiding compliance issues and audits.  

There’s no one-size-fits-all methodology or medical coding support model that works for everyone. Some practices want to handle everything in-house, but need better technology and coding automation to help reduce manual labor. Other practices need specialized guidance or a partner who can take over some or all the coding work. Still others may need guidance and consulting to improve processes, technology, and staff competencies.  

For all of these practices, athenahealth offers a model to address these needs, improving both accuracy and efficiency thanks in part to AI medical coding. Here are four solutions that practices can explore.  

1. Express Coding: expert tools to support internal coding teams

Practices that want to keep coding in-house can take advantage of the automation embedded in athenaOne® to reduce manual labor while maintaining visibility and control.  

Express Coding, for example, is an artificial intelligence (AI) powered coding automation capability that’s built into the athenahealth platform. It operates seamlessly, acting as a lever to speed a claim along.  

After an appointment is completed and the provider adds encounter documentation to athenaOne, the technology analyzes the clinical inputs, uses coding logic, and automatically populates charge lines using current standards for CPT, E&M, ICD, and HCPCS codes and modifiers. Humans still have the final word on the medical billing and coding and are the ones who move the encounter to the claim creation phase.  

Once this is complete, the athenaOne proprietary rules engine, which is supported by research and AI-enabled payer surveillance, automatically scrubs claims prior to submission. The technology looks for potential issues so they can be resolved prior to submission, preventing claims rejections and delays.  

This model may be a good fit for healthcare organizations that have internal coding knowledge and enough staffers to handle the caseload. Using embedded automation support may make the coding team more efficient while leaving control in their hands. And, since the functionality is embedded in the EHR and billing workflow, there’s less of a chance of duplicate data entry and mistakes that can happen during this process.  

The best candidates for this business model are practices with high encounter volumes that require accurate E&M selection such as urgent care and primary care organizations. For these practices even small reductions in work per encounter may add up quickly, improving revenue cycle management, and freeing up coding staff to devote more attention to complicated cases, documentation questions, denials, and other work that requires human judgment.

2. athenaOne Medical Coding: outsource coding to certified experts

The American healthcare system has a shortage of medical coders. About 30% of medical coder jobs remain unfilled³. Practices still need to get their medical coding completed. Outsourcing via athenaOne Medical Coding is a way to solve the staffing problem.  

Using AAPC- or AHIMA-certified coders supported by technology-enabled workflows and a multilayered quality assurance program, athenahealth’s Medical Coding service provides accurate, prompt coding. The process is simple. The practice completes documentation, assigns CPT II codes, signs, and closes an encounter. The claim is then auto routed to Medical Coding staff with the goal of a two-day service turnaround.  

The service boasts 99.4% coding accuracy, well above the industry standard of 95%⁴. In addition, the athenaOne Medical Coding service has a 1.55% median coding-related denial rate⁵, and our certified coders work those denials on clients’ behalf.

This model, which may appeal to organizations with small billing teams, coder vacancies, persistent backlogs, or fast patient caseload growth, reduces the need for code entry. It also reduces the need for recruiting and may help practices save money on training, purchasing new coding tools, internal audits, and maintaining a coding compliance program.  

3. athenaOne Advisory Services: get tailored guidance to optimize performance

Some practices have enough coders, but their processes may be lacking. Inefficient workflows, poor use of technology, and an uncertain chain of command drags down performance. Completion times may be too long, and the practice may struggle with claim denials or mistakes.  

The athenahealth Advisory Services can help fix these issues. It works with healthcare organizations, bringing in expertise that will look at their workflows, staffing, processes, and data, identifying opportunities for improvement. Services include operational consulting, managed services, data and analytics support, and integration assistance. Advisory Services’ managed services offering can include outsourcing coding work, similar to athenaOne Medical Coding, but as part of a broader engagement that may also cover credentialing, authorization, or call center functions, making it a fit for practices that want to offload multiple operational functions at once, not just coding.  

Once practices start working with athenahealth Advisory Services their processes will be examined to find out where bottlenecks and issues exist. This starts with how documentation is created at the clinician level, the way it moves to coding and billing teams, and whether technology is being configured and used correctly. Coding delays, denials, and documentation deficiencies are also assessed.  

This model is appropriate for any organization that knows its performance needs to improve but doesn’t know where to start or where the issues lie. It’s an important step for any organization considering adding staff or purchasing new tools since neither of these things can solve the problem of inefficient or broken processes, issues with governance, or the inability to understand substandard performance.  

Advisory services can also be beneficial for healthcare organizations that have recently acquired practices, have been acquired, or that are growing rapidly. Practices that are opening additional offices, expanding into new specialties, or hiring new clinicians may face issues with processes that work fine for smaller organizations but may not scale appropriately. As healthcare organizations grow it’s important to standardize workflows and create best practices.  

4. Extend capabilities through the athenahealth Marketplace

Some practices may have needs that are specific to their clinical specialty, business model, workflow, or patient population. They may have coding issues that are unique. The athenahealth Marketplace has more than 500 partners with expertise in more than 60 capabilities. These partners augment the extensive benefits of athenahealth’s other coding services and resources.  

The benefit of working with an athenahealth Marketplace partner is integration. Partner solutions connect with or complement the athenahealth platform with plug-and-play functionality. This allows healthcare organizations to explore and add specialized capabilities without having to switch to a completely separate and autonomous application or service. This keeps workflows together and stops data loss and data silos from occurring. Instead of just adopting another third-party, disconnected tool that creates an additional burden of separate workflows and manual data transfers, practices have access to the athenahealth partner solutions that already work with the athenahealth platform.  

Partner with athenahealth in the way that fits your practice

There is no single right way to solve medical coding challenges. Some practices want to keep coding in-house while reducing repetitive work. Others want to hand coding off to certified experts. Some need strategic guidance to improve revenue cycle performance. Others want to extend athenaOne with specialized partner solutions. No matter what their need, athenahealth gives practices multiple paths to better coding accuracy and efficiency, based on how much control, support, and customization they need.  

Having and making the choice that works best for an organization can help a practice improve accuracy and productivity while reducing claim backlogs, the need for rework, and the staff burden that comes from a deluge of work. It can also create a throughline between clinical documentation, coding, claim creation, denial management, and financial performance.

Learn more about how athenaOne can support your medical coding needs.