Photo: Courtesy athenahealth
EHR software company athenahealth has announced the launch of AI-native updates to its revenue cycle management that will embed agentic AI directly into the athenaOne platform.
This is part of the core infrastructure, athenahealth said. It is doing the updates at no extra cost, going from an era of “bolt-on” add-ons to value-embedded AI at scale.
WHY THIS MATTERS
Athenahealth serves 160,000 practicing ambulatory physicians. AthenaOne processes 315 million claims annually, representing $45 billion.
Ambulatory practices, as are all providers, are challenged by reimbursement and administrative work.
The RCM innovations are aimed at eliminating manual work and getting providers paid faster.
Athenahealth said its AI-powered billing solutions result in 70% fewer manual tasks, 98.4% cleaner claims, faster payments (a 78% patient pay yield) and a 5.7% median denial rate compared to the 10%-plus industry average.
Payer-portal agents, voice AI and two-way patient messaging are built in.
“Rapid advances in AI, coupled with our decades of experience and data, 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.”
The new AI capabilities are built upon athenahealth’s SaaS infrastructure. The direct integrations are with the largest payers.
AI in the RCM continuously learns from analyzing billions of claims, payer policy updates and denial resolutions. It then applies these insights across the revenue cycle,
AthenaOne features utilizing these new AI capabilities include automated insurance selection, patient liability estimation, waitlist scheduling, express coding with real-time clinical documentation Improvement, automated denial advice, and AI payer portal agents and voice AI.
Currently in alpha testing, AI agents search payer websites for policy changes to modify or develop rules to prevent rejections and denials.
THE LARGER TREND
In 2022, private-equity firms Hellman & Friedman and Bain Capital agreed to buy athenahealth for $17 billion, according to Reuters.
In 2024, athenahealth introduced new electronic health record products aimed at specialists. By combining critical electronic health record and practice management capabilities with tailored workflows, the cloud-based company said it was aiming to reduce burnout and improve the EHR experience in specialty care.
Athenahealth has been operating since 1997.
Email the writer: SMorse@himss.org