BOSTON, Mass. — athenahealth, a leading provider of network-enabled software and services for healthcare organizations, announced new AI-powered practice and revenue cycle management (RCM) innovations designed to streamline administrative operations and improve payment efficiency across ambulatory practices. The latest AI-native athenaOne features aim to reduce manual work by more than half, transforming how practices manage billing, claims, and reimbursements.
“Curing complexity across the revenue cycle has always been core to athenahealth,” said Paul Brient, Chief Product and Operations Officer at athenahealth. “Rapid advances in AI, coupled with our decades of experience, are enabling us to make another transformative leap in reducing customer workload and improving revenue cycle outcomes. Our AI-native, cloud-based co-sourcing model will yield revenue cycle results that were unimaginable only a year ago—clean claim rates near 99%, billing within days, and assurance that practices receive every dollar they should—all while removing more than half of the manual work previously required.”
Built on athenahealth’s single-instance SaaS infrastructure, the new capabilities leverage the power of the company’s extensive payer integrations and continuous analysis of billions of claims. By applying these insights, the platform automates manual tasks, enhances claim accuracy, and accelerates reimbursement across the revenue cycle.
Among the new features is automated insurance selection, now available in athenaOne, which uses AI to select the correct coverage from an insurance card image. This has reduced insurance-related denials by 13 percent and claim holds by 35 percent. Patient liability estimation, currently in pre-Alpha development, will predict a patient’s out-of-pocket responsibility based on payer contracts and expected services, improving transparency and helping practices collect payments more efficiently. Waitlist scheduling, soon entering Alpha testing, will automatically identify open appointment slots caused by cancellations and notify patients via text, improving access to care and provider utilization. Express coding and real-time clinical documentation improvement, also in Alpha testing, will recommend procedure codes for billers and prompt clinicians to document diagnoses more comprehensively at the point of care.
AI payer portal agents and voice AI are being tested to automate searches for payer policy changes, prior authorization status, and claim updates, helping practices process documentation faster and more accurately. Automated denial advice, already available in the platform, uses AI models to generate real-time claim correction suggestions for coding-related denials, increasing payment recovery by more than 26 percent compared to manual efforts.
“Since our founding, athenahealth has focused on leveraging innovation to drive administrative work out of the business of medicine, so that practices can focus on their patients and get paid fairly for the care they’re providing to their communities,” said Bob Segert, Chairman and CEO of athenahealth. “Our cloud-based, AI-native architecture allows rapid deployment of new features, enabling us to revolutionize revenue cycle management and position practices for sustainable growth.”
Recognized for 19 consecutive years in Best in KLAS, athenahealth’s RCM platform continues to lead the industry, delivering measurable results with a 5.7 percent median initial denial rate compared to an industry average above 10 percent, a 98.4 percent clean claim rate, and a 78 percent patient pay yield.
