athenahealth Introduces AI Innovations to Simplify Revenue Cycle Management

A survey conducted by athenahealth revealed that 39% of physicians believe AI can significantly reduce administrative burdens.

athenahealth, a leading provider of cloud-based solutions for healthcare practices across the US, has unveiled a suite of automation and AI-powered software tools aimed at streamlining revenue cycle management (RCM).

These innovations are part of the company’s mission to reduce administrative burdens in healthcare and improve financial outcomes for providers.

Over the next three years, athenahealth aims to cut the workload for practices by at least 50% while enhancing the speed, accuracy, and quality of RCM processes.

AI’s Role in Reducing Administrative Tasks

A survey conducted by athenahealth revealed that 39% of physicians believe AI can significantly reduce administrative burdens.

The company’s AI-driven RCM tools are already yielding results, simplifying processes like claims management and prior authorizations while improving operational efficiencies for healthcare practices.

athenahealth’s AI-powered insurance package selection tool, integrated into its athenaOne platform, automatically reads insurance card images and recommends the appropriate insurance package for claims filing.

This feature has led to a 36% reduction in insurance-related claim holds and saved more than 6,500 hours of administrative work in the past year.

“Automating insurance selection removes guesswork for our staff, ensures accuracy, decreases denials, and helps us get paid faster,” said Tina Kelley, Director of Operations at Mountain View Medical Center.

Advancing Claims Management Automation

The company’s Auto Claim Create feature, which automates the creation of claims after patient encounters, has been transformative for practices.

Tested across 15 sites in 2023, this tool has resulted in a 40% reduction in charge entry lag and a 24% decrease in the time needed to submit claims to insurance companies.

Currently, 10% of all claims processed by athenahealth are handled using this feature.

“Submitting claims promptly after patient encounters is essential for improving cash flow,” said Paul Brient, Chief Product Officer at athenahealth.

“Automation not only boosts financial performance but also alleviates repetitive administrative tasks for staff.”

Beyond streamlining claims submission, athenahealth’s intelligence-driven solutions have reduced the median denial rate across all practices to 5.3%.

These tools classify denials, predict the likelihood of successful resubmissions, and provide real-time error correction.

Addressing the Challenge of Denied Claims

Industry data shows that nearly 15% of claims are initially denied, costing practices $10.6 billion annually in appeals and resubmissions.

athenahealth’s tools tackle this issue by identifying potential claim errors upfront and assisting practices in correcting them before submission.

These measures ensure effective payment recovery when denials do occur, significantly reducing the administrative workload associated with the claims process.

Prior authorizations, cited by 95% of physicians as a major contributor to burnout, have traditionally been a time-intensive process.

In response, athenahealth launched its Authorization Management services in 2024 to expedite and simplify this bottleneck.

According to Angela Szymblowski, Director of Clinical Operations at South Texas Spinal Clinic, the new service has cut patient wait times for prior authorizations from 6-8 weeks to as little as five days.

“This efficiency allows us to focus on high-quality care without the previous administrative burden,” she said, adding that the service eliminates the need for six full-time employees.

athenahealth is also partnering with insurers to create more automated and electronic prior authorization capabilities.

Insights from a case study with Humana and Availity earned the company the prestigious KLAS Points of Light award in June 2024.

athenahealth’s RCM solutions are part of a broader initiative to cure systemic complexity in healthcare.

By leveraging AI and automation, the company is not only reducing the administrative burden on healthcare providers but also ensuring better financial performance and improved patient outcomes.

“These innovations are not just about automation—they are about creating a smarter, faster, and more accurate revenue cycle system that benefits both providers and patients,” Brient emphasized.

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