Athenahealth deploys more than 80 new artificial intelligence capabilities for revenue cycle management (RCM) operations on the AI-native athenaOne platform.
Athenahealth provides electronic health record (EHR) software, RCM, and patient engagement solutions for small and independent healthcare providers. The new RCM roadmap aims to reduce manual administrative tasks and improve outcomes across the entire outpatient revenue cycle, the company said.
“The most interesting thing about the current generation of AI is that it can read, write, and understand at its own AI level,” Paul Brient, chief product and operations officer at athenahealth, told Fierce Healthcare. “This allows us to dramatically improve the services we provide across our software stack.”
New and expanded AI-native capabilities include automatic insurance selection, AI copays, voice AI, express coding, enhanced payer monitoring, enhanced anomaly detection, enhanced denial resolution automation, and more.
According to the company, early results from the features within the platform show a 30% increase in coding-related denials and a 16% decrease in insurance-related denials. Additionally, the company says its AI-powered voice agents complete pre-authentication calls within an hour.
“We are actively reducing the amount of work our customers have to do to get paid,” says Bryent. “And we are increasing their payment success rate.”
One of the early adopters of the new capabilities is Georgia-based Heart & Vascular Care.
Lalami Oliver, RCM’s vice president of heart and vascular care, told Fierce Healthcare that the organization’s experience to date has been “very positive” and that the features fit into existing workflows “in a way that facilitates implementation.”
“For a practice field our size, that’s really important,” Oliver said.
Oliver said Heart & Vascular Care serves about 55,000 patients in the state.
“We found great value in the areas we tested it, and Athena Health listened to our feedback and helped us make adjustments,” Oliver said. “That responsiveness helped instill confidence throughout the team.”
Aside from automated insurance selection and copay accuracy, Oliver said ambient listening tools have also been successful in RCM operations.
“While often discussed as a documentation solution for providers, it can also support revenue cycle performance by creating more comprehensive notes, which improve visit understanding, coding support, and follow-up,” Oliver said.
These new tools have reduced billing discrepancies and improved operational efficiency, accuracy and staff experience, Oliver said.
“Having the right insurance information in the right place from the start reduces rework and ensures claims are filed correctly,” says Oliver. “On the patient side, improved copayment accuracy and smoother front-end processes improve the experience as patients experience shorter wait times and are less likely to face unexpected follow-up balances.”
Bryent said using AI will allow athenahealth to continue to remove friction from RCM operations.
“Our company was founded on the idea that we can take the friction out of that side of the revenue cycle and help customers get the payments they are owed,” Bryent said. “And AI allows us to take that to the next level.”
