Practice Management - Billing Rules Engine - Increased Practice Revenue
They advertise
http://www.athenahealth.com/our-services/athenaCollector.php
Satisfied Customers: March '08 "After 11 years, we have built a network of over 12,000 active providers that all contribute – whether they know it or not – to the continually updated payer rules that make athenahealth’s Rules Engine a robust machine combating denied claims for all of our clients." The contract renewal rate is roughly 97%.
Corporate Profile: http://www.athenahealth.com/about-us/fact-sheet.php
* * * MONTHLY NEWSLETTERS http://www.athenahealth.com/news-and-events/athenaPulse.php
Are they profitable yet?
When I used to compete against athenahealth, I really liked their business model. Pay a small percentage or ASP monthly fee to basically do your own billing, or pay a higher % to get more follow up in a traditional billing service way. or pay the highest % to have them handle everything. All with the ability to jump from one program to the next with 90 days given notice. It sounded very flexible, which is great because who knows what tomorrow brings in a physician practice.
The last practice I ran across made it very clear that they wished to do their own billing, and maybe it was just the sales rep, but full collections was the only offering by athenahealth. A change in company philosophy or a greedy salesperson - I do not know.
I talk to clients who swear by them and ones who swear at them so...depends on who you talk to.
Yes, they are now profitable: http://finance.yahoo.com/q/ks?s=ATHN
Any more specifics ?
Those who "swear by them" say?
Those who "swear at them" say ?
The ones that are happy feel that the application is very easy to use, and that their recievables have improved dramatically since going to athenahealth.
Others have relayed that athenahealth only goes after the easy money, so if you are partcipating with many payers especially in managed care that you are better off finding a local independant billing service that is reputable and really understands your payer mix from working with other local practices.
Additionally, I have been told that athenahealth comes in with a lowball price, such as 4% - 6% and then after a year and you have handed control over to them, it jumps fto 7% - 9%, with them taking their percentage for money that they never collected, such as co-pays.
Their EMR is a different story altogether...
I usually do not hear such drastic swings in opinions concerning one company.
I think their business model will rule the day - although I agree, the bait and switch tactics descriibed above will eventually back fire on them. I wish these companies would just offer a fair service for a fair price and quit misleading us.
They need to abandon their in-house EMR efforts though and get hold of a half decent EMR. The one they are developing is ghastly. Time to fire your developers and start over - kinda like what Misys did. The PM is solid, although I would argue that the EMR is what really drives revenue. If your EMR is bloated and cumbersome, your income will be affected a lot more than by an equally cumbersome PM. Think about it. Doctor efficiency and time is worth a great deal more than $15/hr staff time. I'm not saying this generalization is true if the PM is defective, only if I have to choose between a smokin EMR or a smokin PM, the EMR wins hands down.
Disclaimer: I am the founder of e-MDs. Highest rated by doctors. All posts are opinion only
Will check to see what their customer relationship response is to the fees being increased after the first year.
Maybe they no longer do this and will state it in their contract. 97% re-signing rate is very high and suggests
the majority of offices are sold on their billing and accounts receivable services.
I’ve been a user of athena’s billing services for a couple years now, since 2005 when I came to EMRupdate looking for advice, and an investor in the company as soon as I my broker could buy shares. My wife’s practice also uses them but for both billing and EMR, and they could not be happier.
I am not sure what “Sales guy” is referring to in his comments about rates increasing. Niether my wife, or my rate has never increased, and none of my colleagues who use their services have increased either (some of their contracts go back 6 years). I do find myself paying them more now than when I first contracted them, but that is only because I am getting paid more. 3.75% of 800k is a lot more than 3.75% of 600k.
On the EMR side everything is not perfect, but the approach they have taken is very smart. I sat in on my wife’s practice’s emr selection, they looked at NextGen, ECW, Centricity and Athena . After viewing the demo’s and performing site visits with the competitors she decided to go with Athena. It’s been live for a few months now and Athena has blown away all of her (and my) expectations.
On day one her practice was paperless, not because she wanted it to be(which she did) but because Athena made it so. With them you outsource your paper. The 100 or so fax’s she received a day are sent directly to them. They have nurse practitioners who look at each and every one of those inbound faxes, attach it to the patient, tie it to the order, and queue it up for her staff to take action. That's just one of the services they provide that no other EMR vendor takes on.
I don’t want to go into too much detail, but because of the services they provide with their EMR. I am convinced that she will never miss anything in regards to patient care-- again, because Athena makes it so.
I haven’t bit the bullet and purchased it yet, I'll be adding it later this year.
The implementation team was top notch, they sat with each member of the clinical staff and customized the solution so that it fit what they wanted perfectly.
I have to thank whoever puts this forum together, I don't post often, I think its been since 2006 but read every week. It's great to see everyone's great insight.
"Damn it Jim, I'm a doctor, not a billing specialist!"
Dr. Care: I have to thank whoever puts this forum together, I don't post often, I think its been since 2006 but read every week. It's great to see everyone's great insight.
I showed your comment to our publisher, Nick Harrington, and it put a smile on his face! Thanks for your readership, Dr. Care, and I hope you will post more often in the future!
Robert Gleeman, Medical Journalist for EMR Update.com Email: robert@emrupdate.com Tel: 1-650-968-6359 Skype and ooVoo user name: robertgleeman EMR progress is a matter of fact. EMR Update supports your right to know.
I am curious.....How many of you using athenahealth take advantage of the seamless interface they have with Transworld Systems.
GreenFlag Profit Recovery byTransworld Systems is a Web Based Fixed Fee collection service that serves over 20000 medical professionals nationwide. Our Fixed Fee Averages $10.00 per account!
We are an MGMA Adminserve Partner http://www.mgma.com/pm/default.aspx?id=10010.
We also enjoy HFMA Peer Reveiwed Status http://www.hfma.org/vendors/peer_review/
View our website at http://web.transworldsystems.com/houston/ or our Online Video at http://www.impactmovie.com/transworld
Dr. Care: I’ve been a user of athena’s billing services for a couple years now, since 2005 when I came to EMRupdate looking for advice, and an investor in the company as soon as I my broker could buy shares. My wife’s practice also uses them but for both billing and EMR, and they could not be happier. I am not sure what “Sales guy” is referring to in his comments about rates increasing. Niether my wife, or my rate has never increased, and none of my colleagues who use their services have increased either (some of their contracts go back 6 years). I do find myself paying them more now than when I first contracted them, but that is only because I am getting paid more. 3.75% of 800k is a lot more than 3.75% of 600k. On the EMR side everything is not perfect, but the approach they have taken is very smart. I sat in on my wife’s practice’s emr selection, they looked at NextGen, ECW, Centricity and Athena . After viewing the demo’s and performing site visits with the competitors she decided to go with Athena. It’s been live for a few months now and Athena has blown away all of her (and my) expectations. On day one her practice was paperless, not because she wanted it to be(which she did) but because Athena made it so. With them you outsource your paper. The 100 or so fax’s she received a day are sent directly to them. They have nurse practitioners who look at each and every one of those inbound faxes, attach it to the patient, tie it to the order, and queue it up for her staff to take action. That's just one of the services they provide that no other EMR vendor takes on. I don’t want to go into too much detail, but because of the services they provide with their EMR. I am convinced that she will never miss anything in regards to patient care-- again, because Athena makes it so. I haven’t bit the bullet and purchased it yet, I'll be adding it later this year. The implementation team was top notch, they sat with each member of the clinical staff and customized the solution so that it fit what they wanted perfectly. I have to thank whoever puts this forum together, I don't post often, I think its been since 2006 but read every week. It's great to see everyone's great insight.
Dr. Care,
Thank you for sharing your real world experience with athenahealth with us. It sounds like your experience has been overwhelmingly positive, over a period of years which is good to hear.
For the record, I was not trying to imply that athenahealth was notorious for always, 100% of the time, increasing their rates and lowering their service as time goes on, but I have heard this complaint from a few customers, and third parties who do business with athenahealth.
As mentioned, I have also heard many stories such as yours where the practice is very happy, and I could not tell you why such a drastic change in opinions. I also realize that sometimes practices (it isn't always just the salespeople) only give half the story when it comes to why a vendor did or did not do something to / for a customer. A rate increase by any RCM vendor may be justified because:
- A change in payer mix (making each claim worth less, and so a % increase may be justified because the labor is the same.
- The practice no longer wished to enter the preliminary CPTs and ICD-9s and demographics into the system which would certainly justify a increase in % charged because now athenahealth is doing all of data entry.
- A physician or physician(s) leave the practice, or declining reimbursement rates meaning and billing service / RCM vendor makes an adjustment in % rate.
As long as these types of adjustments are in the agreement, and the salesperson walks the physician / administrator through what will happen when / if changes are made at the practice such as the above, then both parties should be fine.
I am not sure how large your practice is, or what specialties are covered, Dr. Care, but that 3.75% seems very competitive, so kudos to you for negotiating such a low rate with a company you are obviously so pleased with.
Thank you for taking time to post ! What type of medicine do you practice ? How many patients seen a day to get that low rate ?
Would appreciate specific info and testimonial of their billing and accounts receivable servcies. Regarding billing and accounts recievable, do you enter any data, or do they do it all ? How much work, and what type of work is involved on your part ?
Do they follow-up on outstanding A/R ?
Do you have much insurance aging beyond 120 days ? My billing company has lots of it for both patient and insurance aging. Some of it goes back 2 years.
How aggressive are they at collecting monies from the patients?
How about attention to details when a patient has multiple responsible parties? Such as one visit is an auto accident, another is a workmans comp case, another is a health insurance visit, another is a second auto accident case. Do the billers keep everything straight as to the responsible party for each specific visit ? My billing service can't keep this straight.
When needing to contact them regarding an issue, how available are they?
Although my ego would like me to say my practice is out of the ordinary, it’s a very typical solo-doc ortho practice 25-30 encounters a day. My rate is actually higher than the other ortho’s I know using the system (but I think that’s because they do more surgery than I do I only spend 1 day in the operating room/week).
It’s pretty straight forward. My staff uses their web based software to register, schedule, checking/out our patients. Then my staff enters the charges. I don’t interact with the software too much unless I am running reports, but my office manager and receptionist seems to really enjoy it. My office manager says her three favorite things about the software are the eligibility checks, that it prevents denials from happening in the first place, and that with a glance it allows her to monitor/do everything she needs to do in order to make sure I am getting paid. As a physician, the last reason very happy.
As far as the breakdown of the work, my practice does what makes sense for a practice to do. We deal with anything having to do with patients (coding, getting the right insurance, sending patients to collections etc…) they deal with the insurance companies and all the paper. I do my own credentialing, and they make sure the service is always working. My checks/eob's go directly to them, they post the payments deposit the checks (same day).
From a performance standpoint, I just ran some reports (I am a big number cruncher and their reports are amazing). I am doing very well considering my specialty and payer mix:
% of claims paid right correctly on first submission: 93%
DAR: 34 (including self-pay, workman’s comp, and secondary claims)
Revenue Realization rate after 30 days: 87%
After 60 days: 97%
After 90 days: 98.6%
After 6 months: 99.7%
Annually I write off less than 1% to bad-debt and don’t have anything really over 90 days in ar (see revenue realization above)
They aren’t a collections agency, but I use transworld, they have been great for my practice. It’s integrated with the solution so at a click I can all the patients eligible to collections to them to take care of. Transworld does a good job, I get the angry patient every now and again, but not as often as I expected.
As for keeping everything straight for auto/workman’s comp/insurance. They have never had one mistake in that area. When the patient comes in, my staff says this is for workman’s comp and then Athena does what they do for workman’s comp. For secondary claims, if one is listed on the patient, after the primary claim comes back, they automatically send out the secondary. I say automatically because it is automatic, I don’t even think a human touches it.
I have had to call into support to find out how to use the new features/reports they keep adding and they answer the phone quickly and I get my answer while I am on the phone with them. If there ever is anything bigger, they give me a date they’ll have it resolved and it’s resolved. I can actually see monitor what they are doing to fix my issue from the software application.
Way Cool.....
so how large of a in ouse billing staff do you have and where is their main focus if athena is taking care of so much of the bills
I appreciate the positive feedback about Transworld Systems. I actually like your viewing us as not as a collection agency but we are a licensed collections agency with 100 plus offices nationwide.
We market ourselves as an alternative to traditional bad debt agencies who use harsh tactics and charge high percentages.
I am happy to see you are also benefiting from our fully integrated athena interface.