Athenahealth Unveils Over 80 New AI Features for Revenue Cycle Management

Athenahealth is rolling out more than 80 new artificial intelligence (AI) features for revenue cycle management (RCM) operations on its AI-native athenaOne platform. The company, known for providing electronic health records (EHRs), RCM, and patient engagement solutions to small and independent provider practices, aims to reduce manual administrative work and improve outcomes with these enhancements.

“The current generation of AI can read, write, and understand at its own level, allowing us to dramatically improve the services we provide throughout the software stack,” said Paul Brient, athenahealth’s chief product and operations officer. This shift is significant for healthcare providers who are increasingly looking for ways to optimize their revenue cycles.

New and Expanded AI Features

The new RCM roadmap includes several key features:

• Automated Insurance Selection: AI algorithms help in selecting the best insurance options based on patient eligibility, coverage, and payment history.
• AI Copay: Automates copay calculations and processing, reducing errors and speeding up transactions.
• Voice AI: Voice agents handle prior authorization calls, completing them in under an hour.
• Express Coding: Accelerates coding processes with automated suggestions and validations.
• Expanded Payer Surveillance: Enhanced monitoring of payer activities to identify and address issues proactively.
• Expanded Anomaly Detection: Improved detection of billing irregularities and potential fraud.
• Expanded Denial Resolution Automation: Automated workflows for handling denials, reducing the time and effort required.

Early results from these features are promising. According to athenahealth, there has been a 30% increase in revenue recovery from coding-related denials and a 16% reduction in insurance-related denials. The AI-powered voice agents have also shown efficiency, completing prior authorization calls swiftly.

Real-World Impact

One of the early adopters of these new capabilities is Heart & Vascular Care, a Georgia-based practice serving around 55,000 patients. Larami Oliver, Vice President of RCM at Heart & Vascular Care, shared that the experience has been "very positive."

“The AI features fit into our existing workflows in a way that makes adoption easier,” said Oliver. “For a practice our size, this matters a lot.”

Under the Hood

The technical architecture behind these new features is robust and designed for scalability and efficiency:

• Data Integration: The platform integrates with various EHRs and payer systems to ensure seamless data flow.
• Machine Learning Models: Customized models are trained on large datasets to improve accuracy over time.
• Real-Time Processing: AI algorithms process data in real-time, providing immediate insights and actions.
• User Interface Enhancements: Intuitive interfaces help users interact with the system more effectively, reducing training requirements.

Brient emphasized that these features are part of a broader strategy to leverage AI for continuous improvement. “We are actively reducing the amount of work our customers have to do to get paid and increasing the success rate of their payments,” he said.

Key Takeaways

• AI Integration: Athenahealth’s new AI features are designed to integrate seamlessly into existing workflows, making adoption easier for healthcare providers.
• Efficiency Gains: Early results show significant improvements in revenue recovery and reduction in denials, highlighting the practical benefits of these AI enhancements.
• Scalability and Flexibility: The platform’s architecture supports scalable and flexible solutions, ensuring that it can adapt to evolving healthcare needs.

As healthcare organizations continue to navigate complex regulatory environments, such as Medicaid work requirements, tools like Athenahealth’s AI-powered RCM features will play a crucial role in optimizing operations and improving patient care.