Athenahealth is rolling out more than 80 new artificial intelligence features for revenue cycle management (RCM) operations on its AI-native athenaOne platform.
Athenahealth provides electronic health records (EHRs) software, RCM and patient engagement solutions to small and independent provider practices. The new RCM roadmap aims to reduce manual administrative work across ambulatory revenue cycles and improve outcomes, the company said.
“The thing that is most exciting about the current generation of AI is that it can read and write and understand at its own AI level,” Paul Brient, athenahealth chief product and operations officer, told Fierce Healthcare. “And that really allows us throughout the software stack to dramatically improve the services that we provide.”
New and expanded AI-native capabilities include automated insurance selection, AI copay, voice AI, express coding, expanded payer surveillance, expanded anomaly detection, expanded denial resolution automation and more.
Early results from features live within the platform show a 30% increase in revenue recovery from coding-related denials and a 16% reduction in insurance-related denials, according to the company. Additionally, the company says its AI-powered voice agents are completing prior authorization calls in under an hour.
“We are actively reducing the amount of work that our customers have to do to get paid,” Brient said. “And we are increasing the success rate of their payments.”
One of the early adopters of the new capabilities is Georgia-based Heart & Vascular Care.
The organization’s experiences thus far have been “very positive,” with capabilities fitting into existing workflows “in a way that makes adoption easier,” Heart & Vascular Care Vice President of RCM Larami Oliver told Fierce Healthcare.
“That matters a lot for a practice our size,” Oliver said.
Heart & Vascular Care serves around 55,000 patients around the state, according to Oliver.
“We’ve seen strong value in the areas we’ve tested, and athenahealth has been collaborative in hearing feedback and making adjustments,” Oliver said. “That responsiveness has helped build confidence across our team.”
Aside from automated insurance selection and copay accuracy, Oliver said ambient listening tools have also been successful for RCM operations.
“While they’re often discussed as a provider documentation solution, they can also support revenue cycle performance by creating more comprehensive notes, which improves visit understanding, coding support and follow-up,” Oliver said.
With these new tools, Oliver said reduced billing discord has helped the practice improve efficiency, accuracy and staff experience.
“When we can get the right insurance information in the right place the first time, it reduces rework and helps claims go out correctly,” Oliver said. “On the patient side, better copay accuracy and smoother front-end processes improve the experience because patients spend less time waiting and are less likely to face unexpected follow-up balances.”
Brient said using AI allows athenahealth to continue to remove friction from RCM operations.
“Our company was founded on this notion that we can take friction out of the revenue cycle side and help our customers get paid what they're owed,” Brient said. “And AI just allows us to take that to the next level.”