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athenaCollector Review

By
Adam C. Uzialko
,
business.com writer
| Updated
Jul 24, 2019
Home
> Technology
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Medical billing services offer practices the option of outsourcing their billing, ideally in a bid to increase collections while controlling expenses associated in-house billing operations. AthenaCollector, athenahealth's practice management software and medical billing service, aims to reduce the number of denials by using a rules engine and human medical billers that scrub each claim. However, practices are still responsible for managing charge entry and coding. Athenahealth generally works with large practices, though the company does have many clients in the small practice space of one to 10 providers.

athenaCollector

athenaCollector

The Best Medical Billing Service Providers of 2019

The Verdict

AthenaCollector, athenahealth's practice management software and medical billing service, boasts a high first-pass claims rate and is geared toward larger practices, though the company does service small, independent providers as well.

View all our recommendations for medical billing services on our best picks page.

Billing Process

Unlike most of the other medical billing services in our review, athenahealth does not manage charge entry or coding. Athenahealth's billing process begins with taking claims that have already been generated by the practice and scrubbing them for errors. The company uses a rules engine to scrub claims, which is continuously updated based on the experiences of the nearly 7,000 practices in the athenahealth network. For example, if a dermatologist in Ohio has a claim rejected for an error that is not already in the system, the rules engine will be updated so dermatologists' claims nationwide are scrubbed for that same error in the future. Practices can also create custom rules on the system if they are aware of payer preferences that are not already reflected within the rules engine.

Once athenahealth scrubs a claim, it will submit it through a clearinghouse or directly to the appropriate payer. About 46% of athenahealth claims are submitted through a clearinghouse; any fees incurred are not charged to the practice but instead built into the percentage of collections the company charges for managed billing services. The remainder of claims are submitted directly to a payer. Athenahealth monitors all the claims it has submitted to ensure they are paid in a timely manner, and the company will follow up on unpaid claims.

If a claim is rejected, athenahealth has a denial management process in place that covers most claims. There are some types of claims that the company doesn't revise and resubmit, however, making those claims the responsibility of the practice. At the time this review was written, we were unable to obtain a specific list of the types of claims available for denial management.

Athenahealth's organization-wide first-pass claims rate for electronic claims is an impressive 99%. Electronic claims make up about 93% of all claims submitted by the company.

Athenahealth Pricing

Athenahealth, like the other medical billing services in our review, charges a percentage on the net collections secured for a practice. Unfortunately, athenahealth was unwilling to provide the range of pricing for a typical client, instead opting to point out the factors that influence cost. It is the only medical billing service for which we were unable to obtain a ballpark pricing estimate.

These are some of the criteria athenahealth uses to determine pricing for medical billing services:

  • Practice size: The number of providers in a practice will generally influence the price athenahealth charges. More providers typically mean more claims but also more complexity, so how much it pushes pricing down or up remains a case-by-case factor.
  • Practice specialty and billing complexity: Every specialty is unique when it comes to billing; some are more straightforward, while others require more time and attention. Specialties that are more intricate will naturally cost more than simpler ones.
  • Claims volume: The volume of claims can also impact the overall cost of athenahealth's medical billing service. A large volume of claims will likely be lower than a small volume.
  • Value of claims: Finally, the overall value of the claims a practice submits can affect the price. If your practice is submitting a lot of high-value claims, you can expect to pay a lower percentage. On the other hand, if you only submit a handful of lower-value claims, your percentage cost will likely be higher.

Athenahealth is the only medical billing service in our review that has no contract requirements and builds a clause into its contract that allows practices to back out of the medical billing service at any time.

Software

Included in the percentage price athenahealth charges is full access to its healthcare IT suite, including its electronic medical records (EMR) software – athenaClinicals – and its practice management platform – athenaCollector.

AthenaClinicals features a relatively easy-to-navigate, modern user interface that neatly organizes a practice's clinical tasks and patient documentation. Practices can customize the central dashboard to best support their workflows, and there's a patient portal for keeping patients engaged in their healthcare around the clock. To learn more about athenaClinicals, see our full review of the EMR software here.

AthenaCollector functions as a practice management system and a medical billing application. With it you can schedule appointments and verify patient insurance eligibility. The software also includes a reporting system that allows you to monitor the progress of athenahealth's billing teams. A robust reporting library includes all the data contained on the EMR and practice management software, which is automatically pulled into pre-generated reports on the software dashboard. These reports can be pre-scheduled for regular delivery or pulled on demand. Practices can also use athenahealth's custom reporting tool to create their own reports and format them to their own liking.

Athenahealth Support

You can reach an athenahealth support representative by phone or email. This service also provides multiple online resources, including FAQs and videos. You have access to an account management team that will contact you regularly to talk about ways to improve your practice's financial efficiency. However, there is no live chat support available for immediate answers to your questions.

This medical billing solution works with you directly. Before you agree to use the service, representatives will fly to your medical office to discuss your options face to face. They are also willing to come back if you need additional guidance. If they feel that athenaCollector cannot meet the needs of your practice, they will let you know without wasting any more of your time. This personal communication and honest evaluation is a valuable service that you will not find in every medical billing service.

Acquisition by Veritas Capital

If you're considering partnering with athenahealth, it's worth noting that the company was acquired in February 2019 by Veritas Capital for $5.7 billion, and new executive leadership took over management. While it's unclear how this has affected services, if at all, athenahealth is under new management than it has been in the past. The sale was mired in shareholder lawsuits surrounding the company's valuation; however, the legal arguments appear to not have touched on medical billing operations or the healthcare IT products.

Limitations

Athenahealth does not manage charge entry and coding, meaning practices are still responsible for handling those operations in-house or for outsourcing that portion of the billing process to a different third party. Most of the other billing services we reviewed do offer charge entry or coding, which are critical elements of the billing process.

In addition, athenahealth only performs denial management on most claim types. Some claims will be referred back to the practice for denial management, though it was unclear at the time this review was written which types of rejected claims athenahealth would not revise and resubmit. That could be a problem for practices looking to outsource their entire billing department because if the appropriate in-house staff is not on hand to manage these denials, those claims may not be paid.

Finally, athenahealth was unwilling to provide a ballpark price estimate for its services. While medical billing service pricing fluctuates depending on the specifics of each practice, other medical billing services were able to provide us with an estimated range of what they charge their typical clients. Athenahealth opted instead to only explain the factors that go into determining its pricing, which can be viewed above.

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athenaCollector

athenaCollector

The Best Medical Billing Service Providers of 2019

The Verdict

AthenaCollector, athenahealth's practice management software and medical billing service, boasts a high first-pass claims rate and is geared toward larger practices, though the company does service small, independent providers as well.

Adam C. Uzialko
Adam C. Uzialko
Adam C. Uzialko, a New Jersey native, graduated from Rutgers University in 2014 with a degree in political science and journalism and media studies. He reviews healthcare information technology, call centers, document management software and employee monitoring software. In addition to his full-time position at Business News Daily and Business.com, Adam freelances for several outlets. An indispensable ally of the feline race, Adam is owned by four lovely cats.