Top ways AI-native athenaOne EHR lifts RCM capabilities

Practices move toward AI for revenue cycle management optimization

The administrative burden on healthcare practices is undeniable, especially when it comes to revenue cycle management (RCM). With increasing demands and complex processes, practices often find themselves buried under tasks that detract from time spent with patients and can slow payment, making it harder for many smaller practices to remain independent.

Physicians are optimistic about the role that purposefully developed AI tools can play to reduce administrative burdens in healthcare. In fact, 83% of physicians surveyed said that they believe that AI could eventually alleviate many of the problems facing healthcare.¹ Building on a decade of AI research and significant R&D investments, our vision for a fully AI-native helps streamline clinical workflows and reduce the administrative burden from RCM-related tasks by 50-70% percent – while improving speed, accuracy, and transparency of every financial process — from faster claims resolution to smarter payer yield management.

The AI-native athenaOne EHR combines a true SaaS architecture with network-wide learning. That means every payer update, every clean claim, and every denial resolution strengthens the platform for all customers in real time – helping all parties move closer to desired outcomes throughout each phase of revenue cycle management.

Here are five ways athenahealth’s current AI integrations and, ultimately, fully AI-native EHR can reduce administrative burden and enhance RCM – from solo start-ups to large enterprise organizations.

1. Smarter insurance selection powered by AI logic

Accurate insurance selection can be one of the most time-consuming aspects of revenue cycle management. Integrated directly into athenaOne®, AI-powered insurance selection processes a picture of the patient's insurance card through a machine learning model that analyzes the image, extracts information from the card, and pairs it with patient data to recommend the correct insurance. Practices using the AI-powered Automated Insurance Selection workflow saw a 7.4% decrease in patient insurance related denials².

Tina Kelley, Director of Operations at Mountain View Medical Center, notes that automating insurance selection with this tool has reduced the administrative time spent on manually entering patient insurance information. "Automating insurance selection removes guesswork for our staff, ensures accuracy, decreases denials, and helps us get paid faster, which is essential for our growing practice."

See the difference integrated tools can make

2. Faster and more accurate claims creation

Manual charge entry can be time-consuming and increase the likelihood of errors. In 2023, athenahealth began investing in additional AI capabilities with an Auto Claim Create feature that generates claims automatically after a patient encounter. This not only helps improve cash flow by speeding up claims submission but also cuts down on the recurring administrative tasks that often overwhelm staff. Creating claims automatically can be especially helpful with high volume, repetitive claims, such as those during flu season or child wellness visits.

The Auto Claim Create feature can help reduce charge entry lag and the time it takes to submit claims to insurance. For example, from January to June 2024, athenaOne clients using Auto Claim Create had a median charge entry lag that was 66% lower than clients not enrolled in that service (2.17 days vs 6.7 days).³ Using this feature in athenaOne can help reduce time spent on claims, improve overall claim accuracy, and improve financial performance.

Explore athenaOne revenue management

3. Reducing claim denials and improving payment recovery

Denial management can take up an enormous amount of practice time and resources. According to a 2024 survey by Premier, nearly 15% of reimbursement claims submitted to private payers were initially denied, leading to $10.6 billion in practice time and resources spent disputing claims that should have been approved from the outset.⁴

athenahealth’s rules engine helps ensure claims are accurate the first time they’re submitted. By analyzing data from over 160,000 providers on the network⁵, our system identifies potential claim issues in real time, allowing staff to correct errors before submission. This vast dataset also helps enable smarter decision-making, classifying claim denials and predicting the likelihood of approval upon resubmission or appeal.

athenaOne's RCM features leverage these insights from the network to help practices quickly identify and resolve potential issues that would lead to a denial in real time, before submission. And, after claims have been submitted, machine learning models automatically suggest when to follow up with different payers based on patterns learned from prior claim history.

By scrubbing claims for potential errors prior to submission and automating smart alerts to follow up with payers, athenaOne helps practices reduce the administrative headache associated with rework and improves overall financial outcomes, so they can have more confidence in the quality and efficiency of their claims. Across the network, athenaOne practices enjoy an industry-leading clean claims submission rate of 98.4%.⁶

AI-powered tools help identify potential claim issues in real time, allowing staff to correct errors before submission.

In addition to the AI and automation capabilities within the software, athenahealth partners with practices to take on the burden of working claims denials. athenahealth's Enhanced Claim Resolution (ECR) service integrates seamlessly with athenaOne to manage complex and denied claims, allowing your staff time to focus on patient care.

Practices using Enhanced Claim Resolution saw a 2.3 percentage points increase in collections per visit⁷ and practices that also added our Medical Coding service saw a 7.6 percentage points increase compared to similar athenahealth network clients not live on these services⁸ thanks to decreases in denial rates, increases in effective resubmission of denials, and higher patient pay performance.

Finally, AI models work to digitize EOBs and distribute them to the appropriate channels. From claim creation to resolution, the capabilities within a fully AI-native EHR help practices maximize revenue cycle management and get the full amount of what they are owed.

Reduce claims denials & rework

4. Streamlining prior authorization processes

Prior authorization has long been one of the most burdensome tasks for physicians and their staff. According to the American Medical Association, physicians reported they spend nearly two full days processing prior authorizations each week and 95% of physicians attributed prior authorization to increased physician burnout.⁹

In response, we launched Authorization Management services to automate and streamline prior authorization workflows. Practices using our services enjoy a >98% success rate in managing authorizations.¹⁰ Our prior authorization capabilities are enhanced by Authorization Prediction and Chart Analysis. These capabilities help identify prior authorization requirements and relevant chart information, improving efficiency and accuracy.

For example, South Texas Spinal Clinic has transformed its prior authorization process using athenahealth’s tools. What once took 6-8 weeks for approval can now be completed in as little as five days, reducing administrative overhead and improving financial performance.¹¹

According to Angela Szymblowski, Director of Clinical Operations, achieving this level of efficiency without athenahealth would require six or more full-time employees. “We went down from having four people to do authorizations to one person being the gatekeeper for this platform,” said Szymblowski.

The athenaOne AI-native platform will help determine when a prior authorization is required. And, if a prior authorization is required, AI agents gather necessary clinical information and help pre-fill authorization forms.

Customers leveraging Authorization Management tools embedded in athenaOne saw a 45% decrease in time spent on the prior authorization process¹². That’s a real reduction in administrative burden where clinicians have an opportunity to reallocate those hours to the most meaningful elements of patient care.

See authorization management in action

5. Streamlining clinical documentation with ambient listening technology 

athenahealth's Ambient Notes is an AI-powered feature embedded within athenaOne Mobile that simplifies clinical documentation by recording patient visits and using generative AI to create comprehensive note summaries, which are then seamlessly integrated into patient records.

This automation allows clinicians to focus more on patient care during encounters, enhancing the overall experience for both providers and patients. Using ambient AI technology in athenaOne, one orthopedic practice saw a 40% reduction in documentation time.¹³ With multiple ambient models available, individual clinicians can select the one that best aligns with their specialty and documentation style, ensuring flexibility and personalization, rather than a one-size-fits-all solution.

Documenting your notes faster means you can close more patient encounters, which gets the billing process started sooner.

Explore Ambient Notes

Using AI in healthcare tech to help clinicians and improve outcomes

athenahealth's AI innovations are revolutionizing how healthcare practices manage their revenue cycles. Automating tasks like insurance selection, claims creation, denial management, and prior authorization can help speed up claims processing and improve financial outcomes. While we are already using AI to drive outcomes, such as cutting document processing time by 91%, reducing claim holds by 33% and decreasing insurance related denials by 13%, there is more that can be done to unlock the potential of the practice.

Learn more about how athenahealth is continuing to drive AI innovation in healthcare and explore more about plans for a fully AI-native athenaOne.