athenahealth Medical Billing Review

Why athenahealth Is Best for Reporting

Athenahealth is our pick for the best medical billing service for reporting because it leverages data captured from the more than 150,000 healthcare providers that operate on its network to both improve the medical billing process and inform practices of steps they can take to boost financial performance. Providers can review key metrics, like medical claims, days in accounts receivable or the number of unpaid claims that are due. Athenahealth can monitor key performance indicators (KPIs) like these against a benchmark average on its network. If a client begins falling short of that average, athenahealth can help offer recommendations for improvements. (After all, athenahealth makes more money when its clients do.)

Athenahealth also measures key metrics of top-performing practices to offer clients examples of what works well and how to emulate it. In this way, signing up for medical billing services with athenahealth affords you access to not only outsourced billing, but also a team of experienced, data-driven advisors.

Usability

The athenahealth interface may have a slight learning curve. Implementation shouldn’t be overly challenging, but mastering the interface requires more than just clicking around.

Most of the interface challenges stem from athenahealth’s electronic medical record (EMR) system, which is included with the company’s billing services. The EMR is built in a patient-centric way that requires you to pull up a patient’s file to access most of your features. As a result, you often have to return to your home screen before accessing some features, which isn’t ideal. However, this challenge may not be as prominent in the practice management software (PMS), which is where you access your billing suite.

athenahealth Features

Here are some of the key features of athenahealth’s revenue cycle management (RCM) platform:

Claim Scrubbing

Athenahealth’s claims scrubber uses a rules engine to analyze the claims that your practice has generated. This engine constantly updates and changes based on payer denials and rejections among the more than 150,000 providers on athenahealth’s network. You can also add your own rules if you see that the rules engine doesn’t reflect the preferences of payers.

As a result of the athenahealth rules engine, the company says its first-pass acceptance rate (FPAR) is 99% for electronic claims. Manual claims make up a small amount of the medical billing work athenahealth does, but this statistic is still one of the best we found in our reviews of medical billing services.

Despite athenahealth’s advanced claim scrubbing features, it does have one glaring flaw: It won’t always code or enter your charges. In fact, you’ll sometimes need an in-house medical biller to use athenahealth’s RCM services. This was more often the case in previous years of our medical billing reviews, but as of 2024, athenahealth is changing that. The company is in the process of gradually rolling out fully outsourced RCM services.

Denied-Claim Management

As you can see from the numbers above, athenahealth’s medical billing services rarely result in denied or rejected claims. However, a 99% FPAR isn’t 100% – that just doesn’t exist. Instead, in the rare cases when a claim is denied or rejected, athenahealth often handles revisions and resubmissions.

However, athenahealth won’t always revise or submit denied or rejected claims. In some cases, the company will pass these claims back to your practice instead. Again, this requires you to maintain a medical biller on staff.

That said, this area is another in which athenahealth is making changes. Company representatives have told us that, over time, athenahealth will begin handling all denials and rejections in-house. Currently, our top pick for in-house denial and rejection management is DrChrono. Read our DrChrono medical billing review to find out why its services excel on this front.

EMR and PMS Inclusion

Athenahealth’s RCM services include access to its EMR and PMS technology. Athenahealth’s PMS also goes by the same name as its RCM suite: athenaCollector. In fact, to use athenahealth’s billing services, you must use its PMS. This requirement is standard among medical billing companies. Exceptions exist, though, such as CareCloud. Read our CareCloud medical billing review to learn why it’s our top pick for flexible medical billing.

Athenahealth’s medical software is also our best pick for reporting. To see why, read our athenahealth medical software review.

Integrated Clearinghouse

Whereas other companies may use a third-party clearinghouse, athenahealth’s clearinghouse is fully integrated with its billing services. However, upon scrubbing a claim, athenahealth may not always pass it through a clearinghouse. Athenahealth instead submits more than half of its scrubbed claims directly to payers. In either case, you won’t pay additional fees, as the clearinghouse fees other companies might charge are built into your monthly rates.

Medical Billing Dashboard

On the PMS side, athenahealth is known for its extensive reporting, and that focus is evident in its RCM dashboard as well. There, you’ll see all your financial data so you get a numerical view of your practice’s performance at all times. As a result, you can determine how to make your processes more efficient and maximize your profit.

Follow-Up on Unpaid Claims

If your claims are approved but remain unpaid, athenahealth will follow up so you don’t have to. This follow-up applies equally to payers and patients. Additionally, athenahealth will keep close tabs on the progress of your claims, from submission to approval (or, in rare cases, rejection or denial).

athenahealth Cost

Athenahealth charges a percentage of your practice’s monthly collections for its RCM services. A company representative told us that this rate can reach into the low double digits. These rates are on the higher side among the companies we reviewed.

Unlike with most other providers, athenahealth’s percentage-based structure also applies to its EMR and PMS, which are included with athenahealth’s billing services. Your exact percentage will depend on your claim value, claim volume, practice size, billing cycle complexity and other factors. We like this pricing structure, as it keeps your medical software costs proportional to your revenue, which can make all the difference during periods with fewer patient encounters.

Unlike many other providers we researched in our reviews, though, athenahealth did not share how these percentages would translate to approximate dollar figures.

Customer Service

Athenahealth offers customer service by phone, email and live chat. However, you may be able to find answers to many of your questions by accessing the company’s online resources, which include videos and frequently asked questions.

In addition to these customer service resources, there is an account management team that proactively contacts you to discuss practice improvements. This feature is unique to athenahealth; although other medical billing companies pair you with a dedicated agent, only athenahealth’s agents often contact you before you even think to contact them. From athenahealth’s perspective, you can always improve your operations, and the company is there to help.

This depth of service begins the moment you even consider athenahealth. The company has long sent representatives to interested practices to meet face-to-face before they sign contracts and begin implementation. Athenahealth is happy to send representatives to your practice again if you need further assistance.

Should the reps you meet determine that athenahealth might not fit your needs, they won’t hesitate to let you know. Not only is this a rarity among medical billing services, but it also lets you focus on finding another solution that’s better for your practice.

Drawbacks

Athenahealth’s medical billing services are comprehensive, but there are a couple of drawbacks. The most glaring downside is that the athenahealth user interface isn’t as intuitive as some others we reviewed. It may require some additional training to get staff totally up to speed. [Looking for user-friendly medical billing services and software? Read our review of Kareo’s medical billing service.] 

Another downside is that not all claim types qualify for denial management. Athenahealth is the rare medical billing company that manages only some of your denied claims. This structure could pose problems for practices that are looking to outsource all of their billing; without in-house staff, denied claims that are referred back to you could go unpaid. Additionally, it remains unclear how athenahealth chooses whether to manage certain denials.

Methodology

We spent hours researching medical billing services. That research included software demonstrations, phone interviews and customer service calls, as well as analysis of customer service reviews available online, including those listed on the Better Business Bureau’s website. We spent several months browsing company websites, reading customer reviews and speaking with company representatives. To find our best pick for reporting, we considered the depth and breadth of the reporting tools, the flexibility in sorting data, and the ability to compare practice performance against other healthcare organizations’ benchmarks. Athenahealth offers all of these benefits in athenaCollector, making it our pick for the best medical billing service for reporting.

Overall Value

We recommend athenahealth for …

• Enterprise practices with substantial medical billing needs.
• Large practices that want to outsource most, but not all, of the medical billing process.
• Data-driven practices that thrive on deep reporting and analysis.

We do not recommend athenahealth for …

• Medical practices looking to fully outsource their RCM.
• Small or new medical practices that can’t afford an in-house staff biller alongside outsourced medical billing.