How AI-native RCM solutions can help change the game

A true, AI-native solution for RCM

The business of healthcare shouldn’t overshadow the practice of care, but outdated billing systems force many organizations to devote disproportionate energy to revenue cycle tasks. Staff spend hours logging into payer portals, fixing rejected claims, managing denials, and catching up on documentation long after the day is done. 

This administrative drag drives up costs, strains teams, and slows down reimbursement. With denial rates across the industry exceeding 10%¹ and margins under constant pressure, billing complexity has become one of the most persistent barriers to delivering care efficiently — and one of the greatest risks to practice sustainability in today’s margin-tight environment.

The challenge: revenue cycle processes that drain time and margin 

Most billing workflows were built for a different era. They rely on manual work, disconnected systems, and reactive problem-solving. Staff spend valuable hours coding encounters, correcting errors, and following up on underpayments — time that could be better directed toward patient care or practice growth. 

This dynamic creates a loop that is hard to escape: administrative burden leads to errors, errors lead to denials, and denials lead to rework. As payer rules grow more complex, organizations must devote more staff and resources just to keep pace. The cycle repeats, and the costs compound. Overhead goes up, margins get thinner, and the front doors of America’s hometown doctors close. 

The athenaOne® solution: AI-native revenue cycle management 

athenaOne delivers a highly tuned, automated, AI-native revenue cycle — an intelligent, adaptive, self-healing system that eliminates manual friction and helps reduce denials while accelerating reimbursement. Yield goes up, days in accounts receivable and operating costs go down. 

Because athenaOne was built as a single-instance SaaS platform, intelligence is embedded at the core rather than tacked on later. Every clean claim, payer update, and denial resolution strengthens the system in real time, across the entire network. That means every practice benefits from shared learning without configuring bolt-ons or juggling multiple vendors. 

AI-native RCM turns billing from a fragmented, reactive process into a proactive performance engine that continuously improves. 

How AI-native revenue cycle automation works day to day 

With athenaOne, automation is not a patchwork of tools but a unified experience across the revenue cycle.  

• Ambient documentation and coding: Clinical conversations generate notes that support providers in complying with clinical documentation requirements, as well as real-time, accurate billing codes for more complete revenue capture and seamless information sharing from the encounter to the claim.
• AI-driven claims engine: Payer behavior is monitored across the network, allowing the system to discover patterns and make predictions. Claim rules are updated for every practice on the network and help prevent rejections or denials before submission.
• Proactive denial prevention: Claims are scrubbed against nearly 30,000 data points learned from processing 315 million claims annually and go out clean the first time, reducing rework and delays. We continuously look to improve our industry leading 98.4% clean claim rate.²
• Contract intelligence: Underpayments, outdated fee schedules, and missed revenue are surfaced automatically, helping practices get paid all that they’re owed. 

AI-native design means these capabilities won’t operate in silos. They learn from each other, adapt continuously, and keep improving without disruption. Staff are supported, not sidelined, as repetitive work fades into the background.

Outcomes that demonstrate financial and operational impact 

Practices using athenaOne see measurable improvements that show the power of an AI-native approach: 
 

• 5.7% median denial rate³ compared to an industry average of 10-18%
• 12.8% reduction in insurance-related denials⁴
• 35% reduction in insurance-related claim holds⁵
• 78% median patient pay yield⁶

At athenahealth, we’re committed to the goal of helping practices drive a 50-70% reduction in administrative workload for clinicians and billing staff. 

These results matter because they combine financial performance with human outcomes. Less administrative drag means more predictable days, reduced burnout, and more time spent with patients – and with families.

Across audiences, the benefit is clear: AI-native RCM transforms billing from a source of friction into a source of competitive advantage.

Why athenaOne stands apart from other RCM platforms 

Many vendors today claim “cloud” or “AI,” but the underlying architecture determines whether those claims deliver results. 

Legacy systems often force AI capabilities onto outdated workflows. These tools remain isolated, reactive, and dependent on manual configuration. They may automate a few tasks, but they don’t reduce the overall burden of billing.

athenaOne is AI-native. Intelligence is embedded across the platform itself, not added on piecemeal. Built on a single, shared-intelligence SaaS architecture, athenaOne continuously learns from billions of network transactions. And with built-in integrations to America’s largest nationwide insurers and regional payers, rules, updates, and policies and fee schedules are applied across the entire network, so every customer benefits from collective intelligence. 

This AI-native foundation allows new capabilities, payer integrations, and marketplace solutions from our more than 500 partners to be deployed seamlessly for all users. Practices adopt innovation quickly, without disruption or expensive upgrades, because the system is designed to evolve in real time. 

The result is a continuously learning revenue performance engine that reduces complexity, scales easily, controls operating costs, and frees organizations to refocus on serving their patients, communities, and owners. 

Revenue cycle benefits for physicians, administrators, and executives 

The impact of AI-native RCM is felt differently across roles, but the combined effect is the same: healthier practices, improvements in operational performance, and more time for care. 

• For physicians: AI-native documentation and coding reduce after-hours charting. Powerful AI-models generate draft clinical notes automatically, ICD-10 codes are applied in the background and surfaced to the claims engine. AI agents triage incoming communications from other providers and patients, and inbox clutter is minimized. The impact is more face time with patients and less administrative fatigue. Tasks that previously took hours are resolved in minutes.  
• For practice administrators: fewer claim errors and less manual work free teams from repetitive tasks and chart chasing. AI agents work behind the scenes to help prevent denials upstream and streamline payer follow-up, allowing staff to focus on patient service, scheduling, and growth.
• For revenue cycle leaders: smarter automation means cleaner claims, more predictable outcomes and accelerated and more stable cash flow. Denials are identified and prevented earlier, payer performance is easier to track, and the revenue cycle shifts from firefighting to financial strategy.
• For executives and CFOs: AI-native revenue cycle management reduces cost to collect, strengthens cash flow, and eases margin pressure. A more reliable revenue engine supports sustainable growth and new investment. Customized reporting and network benchmarks let you see, at-a-glance your organization’s financial health, with surfaced suggestions to optimize even further. 

Across audiences, the benefit is clear: AI-native RCM transforms billing from a source of friction into a source of competitive advantage.

The shift to AI-native revenue cycle management is game changing 

Moving from manual billing to AI-native automation creates a dramatic shift in daily operations.

Before athenaOne, staff chased denials, entered insurance data by hand, and stayed late to complete charts. Coding and claim edits were repetitive, error-prone, and reactive to payer behavior. 

With AI-native athenaOne, embedded AI can help flag, fix, and submit claims proactively. Insurance data is captured automatically from scanned cards, data extraction and insurance plan verification. Native AI will help update payer rules update in real time across the network. EOBs can be automatically analyzed against contracts, and fee schedules will be updated to mitigate the lesser-of rule, helping ensure the right procedures are billed at the full amount and paid properly and promptly. Documentation and codes are generated during the visit, not hours afterward.

The before-and-after difference of moving from a legacy RCM system to an AI-native one is tangible: fewer manual tasks, cleaner claims, faster payments, and healthier practices and bottom lines. 

From manual billing to strategic growth with AI native athenaOne

athenaOne replaces manual billing with intelligent, continuously learning workflows that deliver stronger financial outcomes and a more sustainable day-to-day for clinicians and staff.

By curing complexity, preventing denials, and freeing practices from administrative drag, athenaOne creates the space for organizations to grow, innovate, and focus on delivering better healthcare.

RCM doesn’t have to be a drain on time and resources. With an AI-native platform like athenaOne, the revenue cycle becomes a growth engine that fuels financial stability, provider satisfaction, and patient trust. Decide for yourself whether it’s time to bring your practice into the future of medical billing and revenue cycle management. If you want to see how friction-free it can be, drop us a line and we’ll show you around.