Market-leading AI features streamline practice operations from the front to the back office -including automated insurance selection and AI agents that improve the speed and quality of prior authorizations and claims processing

athenahealth, a leading provider of network-enabled software and services for healthcare practices and systems nationwide, today announced new industry-leading, AI-powered, practice and revenue cycle management (RCM) innovations to help ambulatory practices eliminate much of the manual work across the revenue cycle so they can get paid fully, faster, and with less effort. These recent and upcoming capabilities are part of the company’s expanding suite of AI-native athenaOne features that will transform revenue cycle outcomes for practices.

“Curing complexity across the revenue cycle has always been core to athenahealth. Rapid advances in AI, coupled with our decades of experience are enabling us to make another transformative leap in reducing customer workload and improving revenue cycle outcomes for our practices,” said Paul Brient, chief product and operations officer at athenahealth. “Our AI-native, cloud-based co-sourcing model will yield revenue cycle results that were unimaginable only a year ago – clean claim rates at nearly 99%, time to bill in low single digit days, and assurance that our practices receive every dollar that they should. We can do all this while also wicking away half of the work our practices have historically done.”

New AI capabilities are fueling athenahealth’s revenue cycle management transformation for practices. Built upon athenahealth’s single-instance, SaaS infrastructure, these AI capabilities leverage the power of athenahealth’s network and direct integrations with the largest nationwide and regional payers. athenahealth's revenue cycle management solution continuously learns from analyzing billions of claims, payer policy updates, and denial resolutions, then applies those insights across the revenue cycle to automate previously manual tasks, create cleaner claims, and accelerate reimbursement.

athenaOne features utilizing these new AI capabilities to improve RCM performance include the following:

• Automated Insurance Selection – Recently available in the athenaOne platform, the next generation of automated insurance features uses AI to select appropriate coverage from an insurance card image, resulting in a 13% reduction in patient insurance-related denials and a 35% reduction in insurance-related claim holds.
  
  
  
  “athenahealth’s automated insurance capabilities make it easier for me to quickly find the right insurance package, register patients more quickly and avoid surprise downstream denials that negatively impact my practice and the patient’s experience.” - Michelle Gilreath, Owner/PMHNP-BC, Mindwell

• Patient Liability Estimation – currently in pre-Alpha development, AI models will estimate a commercially insured patient's financial responsibility, based on payer contracts and services likely to be provided during the encounter, enabling better transparency for patients while allowing practices to collect more patient payments.

• Waitlist Scheduling – soon to be in Alpha testing, waitlist scheduling will use AI to automatically identify open time slots due to cancellations and will send patients text messages to fill open appointment slots, improving access to care and patient satisfaction while maximizing provider schedules.

• Express Coding with Real-time Clinical Documentation Improvement – currently in Alpha testing and development, respectively, AI models will surface recommended procedure codes for billers and provide real-time documentation and diagnosis nudges to clinicians to enable comprehensive billing for the true extent of the care provided.

• AI Payer Portal Agents and Voice AI – currently in Alpha testing, AI agents search payer websites for policy changes to help timely modification or development of rules to prevent rejections and denials. athenahealth is also using agentic AI and voice AI to support the capture of claim status, remit downloading, and discern prior authorization status, delivering faster and more accurate documentation and results for practices.

• Automated Denial Advice – currently available in the athenaOne platform, automated denial advice uses AI models to generate real-time claim correction suggestions for coding-related denials, leading to a 26.4% increase in payment recovery compared to manual corrections alone.

athenahealth has a long history of solving previously unsolvable problems across the revenue cycle for physician practices nationwide and has been recognized for 19 years in Best in KLAS. With its decades of experience in practice and revenue cycle management, athenahealth continues to lead the industry with a product that delivers quantifiable practice success: 5.7% median initial denial rate (compared to the industry average of the greater than 10%), 98.4% clean claim rate, and a 78% patient pay yield.

“Since our founding, athenahealth has focused on leveraging innovation to drive administrative work out of the business of medicine, so that practices can focus on their patients and get paid fairly for the care they’re providing to their communities,” said Bob Segert, chairman and chief executive officer at athenahealth. “Our cloud-based, AI-native architecture allows the rapid deployment of AI features, and this approach enables us to innovate more quickly, revolutionizing RCM work for our practices and positioning them for long-term growth.”

To learn more about athenahealth’s AI-native athenaOne, click here.

About athenahealth

Since 1997, athenahealth has been curing complexity for ambulatory healthcare practices and the patients they serve, empowering them to deliver the best possible care and business outcomes through innovative clinical, financial, and patient engagement solutions. athenahealth connects practices, health systems, payers, partners and patients to create a thriving ecosystem that delivers accessible, high-quality, and sustainable healthcare for all. Learn more at www.athenahealth.com.

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Since our founding, athenahealth has focused on leveraging innovation to drive administrative work out of the business of medicine, so that practices can focus on their patients and get paid fairly for the care they’re providing to their communities