Maximizing payment accuracy and efficiency with Rivet’s RCM solutions

Navigating the complexities of payment collection

BoulderCentre for Orthopedics & Spine, a high-volume orthopedic practice in Colorado with over 30 surgeons and multiple office, imaging, and ASC locations, faced persistent challenges with collecting patient payments and ensuring accurate payer reimbursement.

Like many healthcare organizations, they relied on manual, time-consuming processes to generate patient cost estimates. One full-time team member was solely responsible for pre-collections but could only process around five orders per day, navigating multiple payer portals and systems.

“The pre-collections our office did garner were never based on a contractual rate,” said Sherri Lewis, Director of Revenue Cycle Management at BoulderCentre. “CPT codes weren’t matched to payer contracts or subtracted from deductibles or coinsurance. This meant our process was very unstructured and tended to be inaccurate.”

And that wasn’t the only challenge. Beyond patient payments, BoulderCentre also lacked the time to audit payer underpayments. Partial denials and downcoding were difficult to track without pulling individual claims, a process that simply wasn’t scalable.

“We know we aren’t getting paid with a denial,” Lewis explained, “it’s difficult to determine if insurance consistently pays you less than you deserve... It is also difficult to audit claims for partial denials and downcoding.” She continued, “I needed results that only a tech solution could give me.”

Rivet maximizes revenue without the headache

To overhaul its revenue cycle strategy, BoulderCentre looked to athenahealth Marketplace partner Rivet, a revenue acceleration platform that integrates with athenaOne, their existing EHR, medical billing and practice management, and patient engagement platform.

With a direct athenahealth API connection, Rivet gave the team access to automated patient cost estimates, real-time eligibility checks, and always-on underpayment detection, all in one platform.

Rivet makes it easy to generate accurate estimates in seconds. Lewis said, “[We] select the appropriate carrier, input billing codes or use a Rivet template, and deliver precise patient estimates effortlessly."

These accurate patient cost estimates make it possible to effectively facilitate patient prepayment and save the estimate as a patient case in athenaOne, so anyone at the practice can print an estimate or answer questions for patients.

On the payer side, Rivet’s payer performance tools helped BoulderCentre identify revenue gaps by automatically grouping underpaid claims into high-priority projects. This eliminated the need for manual audits and enabled the team to focus on recovering large-dollar underpayments faster and more effectively.

“Rivet automatically collects your underpayments into projects so you can attack high dollar value projects.,” said Lewis. “That way, we can bring the fight to the payer and confidently get paid what we deserve.”

Delivering faster payments for both patients and providers

Since leveraging Rivet in September 2022, BoulderCentre saw rapid and measurable improvements across their revenue cycle. Pre-collections climbed to over $2 million, a more than 3.5x increase from their previous performance of $460,000. This growth represented a 160% year-over-year increase in pre-collection cash flow in the first year using Rivet.

Equally important, the practice now collects 90% of patient responsibility at the time of service, significantly reducing patient A/R and improving financial predictability. Rivet’s automation also enabled one full-time team member to handle pre-collections and estimates, plus prior authorizations and MRI department tasks — something that previously would have required multiple staff members.

BoulderCentre used Rivet to uncover and recover thousands of dollars in underpaid claims, recovering nearly $100K in underpayments from contracted payers in total, including close to $30K from Aetna alone.

With Rivet’s underpayment detection features, the team no longer has to rely on manual audits or guesswork. Instead, they can confidently identify revenue gaps and act quickly.

“Rivet is a platform our team could never live without. It pays for itself over and over again,” said Lewis.

Ready to modernize your revenue cycle and maximize every dollar you’re owed?

Explore our marketplace solutions and join other athenahealth customers who are already seeing the benefits of Rivet.

As Sherri said best, “We use Rivet with athenahealth every single day and it saves us a ton of time and manual effort.”

Let’s chat about how we can partner for your success, too.