Smarter orthopedic intake, scheduling, and collections

Operationalizing businesses with a scalable orthopedic software

Few orthopedic practices are immune to the operational and financial challenges across intake, scheduling, and collections.

On the intake side of administration, everything from complex patient histories to the need to verify insurance can slow the process and disrupt patient throughput. Without adequate systems and processes, a trauma referral from a different hospital system or the need for imaging results from an off-site urgent care facility can throw a wrench into a clinic's front desk operations.

Scheduling can be similarly troublesome as practices work to balance provider availability with the necessary time blocks linked to varying appointment types. From requests for prior authorization to scheduling multiple patient visits all at once, the tasks can pile up fast.

When it comes to collections, challenges may stem from coding issues that can drive denied claims and put pressure on cash flow. Consider the quality program requirements your practice must meet for bundled payments for joint replacements—a simple mistake could mean your practice isn't paid.

These bottlenecks affect the people at the front desk, but they also impact patient care. Orthopedic providers now report they spend more than a quarter of all office time on paperwork and administrative duties, and somewhere around half say they're burned out.¹

So how can practices improve revenue cycle management, maintain financial stability, and ensure they can continue to provide high-quality patient care? Our solution athenaOne®, is an automated, AI-native platform with integrated EHR, RCM, and patient-engagement functionalities. Here's how it works and how your practice might benefit.

Intake: Reducing holdups to maximize throughput

Orthopedic intake is often bogged down by case complexities and detailed paperwork, from medical histories to imaging studies to the documentation required for workers' compensation.

With features like specialty-specific templates, automated insurance verification, and integrated pre-visit workflows, athenaOne for Orthopedics can streamline intake and maximize patient throughput. Here's a breakdown.

• Mobile check-in and insurance verification: With Enhanced Self Check-in (ESCI), patients can complete necessary forms and documentation prior to their appointments. Once patients get to the office, coverage confirmation is simplified through real-time automated eligibility checks.
• Orthopedic-specific workflows: Pre-built workflows tailored for orthopedic visits capture patient medical histories, imaging notes, and other important details.
• Efficient documentation tools: Using custom text macros and saved templates, physicians can prepare charts and start documentation before the encounter with just a few keystrokes. Later, during the appointment, they can leverage Ambient Notes to simplify clinical note-taking, and Chart Assistant with Sage, which has a chatbot that can respond to questions and generate quick summaries. Finally, with a tool called ChartSync, clinicians can automatically integrate information like external medications and imaging data from the patient's other providers.

Orthopedists now report they spend more than a quarter of all office time on paperwork and administrative duties, and somewhere around half say they're burned out.

Scheduling: Improving efficiency through automation

Patient no-shows, last-minute cancellations, diverse appointment types with varying durations—for orthopedic practices that haven't completely mastered the scheduling part, these are just a few of the common obstacles that threaten to slow daily clinical operations.

With automation and real-time visibility into provider and room availability, athenaOne can improve scheduling and resource utilization to ultimately help clinics treat more patients. Here's an explanation of the features.

• Rule-based scheduling and templated appointment types: The system allows practices to define appointment types (new injury, injection, etc.) and pair them with time blocks that optimize the use of clinical resources.
• Mobile-friendly functions: Clinicians and staff can access scheduling and documentation tools from any device at any time.
• Automated reminders and patient self-service: Automated text or email reminders reduce no-shows to help keep schedules full. Patients can check in, confirm appointments, and message clinics securely through the patient portal or mobile app.
• Authorization workflow integration and customer support: athenaOne can flag needed pre-authorizations during scheduling in order to trigger the workflows required to secure approvals. Ortho-focused customer success and authorization specialists are available to help navigate the approval process as needed.

Collections: Leveraging technology to maximize reimbursement

With claim-denial rates for orthopedic procedures hovering around 10 percent, the collections arena is a natural starting point for practices looking to enhance revenue.² While athenaOne can't promise full and timely reimbursement for all the clinical services orthopedic practices provide, it can make the collections process easier with automated claims scrubbing, coding support, and tools that help patients with their payments. Here are the key benefits that could help your practice.

• Automated claims scrubbing: The system's AI-driven proprietary billing engine (with 30,000-plus billing rules) reviews claims before submission. This helps reduce coding errors and other common reasons for claims denials for high-dollar, high-complexity procedures like joint replacements, arthroscopy, and spinal interventions.
• Orthopedic-specific billing workflows, coding support, and payer expertise: When billing gets complicated, athenaOne ensures that everything is correctly reported with AI-enabled charge-capture tools and payer-rules integration tailored for orthopedic practices. ACL reconstructions, rotator cuff repairs, total joint replacements—no matter the procedure, practices no longer have to worry about billing procedures holding up payment.
• Authorization management: The system's authorization-determination engine not only identifies when prior authorizations are required (think MRIs, CT scans, joint injections, and elective surgeries), it integrates the authorization process into the administrative workflow.
• Patient payment tools and billing transparency: Out-of-pocket estimates help patients understand their financial responsibilities, while digital and traditional payment capabilities (and payment-plan options) help them pay their bills on time.
• Analytics, network-driven insights, and benchmarking: The system includes reporting dashboards and benchmarking data from thousands of providers across the athenahealth network. Practices can use this information to identify opportunities to improve reimbursement for high-volume services, reduce denials related to authorizations or documentation, and optimize revenue across surgical and non-surgical lines of care.
• Customer Success Manager support: Practices are paired with a dedicated customer success manager who understands the unique operational challenges associated with running an orthopedics practice. The CSM works closely with practice administrators to streamline workflows and adapt billing strategies as payer policies and orthopedic coding requirements evolve.

The bottom line? Few orthopedic practices have the time or expertise to fine-tune intake, scheduling, and collections while also managing complex procedures and the challenges of pre- and post-op care. With athenaOne for Orthopedics, orthopedic teams can improve performance in all three areas at once so they can get back to what matters—providing high-quality, one-on-one care to every patient who comes through the door.

Learn more about athenaOne for Orthopedics.