User Guide — Co-Sourcing

 

athenahealth is in partnership with you. When your practice does better, so do we. Our innovative combination of software and services enables you to:

• Increase collections
• Receive faster payment
• Gain complete visibility into your practice, so you'll know the history and status of every single claim

Your practice will join a growing network of thousands of physicians who share — and contribute to — the largest real-time database of payer rules and regulations in the country. And you'll have a partner who manages your business issues, so that you can focus on patient care.

 

With athenahealth, billing errors are caught and corrected before they become problems. We have the largest real-time database of payer rules in the country, so we're able to immediately spot claims with incorrect codes, incomplete information, and other inaccuracies. Claims are scrubbed and sent out clean. Denials go down, cash flow goes up.

 

In addition, we provide full transparency into your practice. You'll never wonder where a claim is again. You can track and access information on any claim, from its starting point to its payment date. Reporting is simplified. Finger-pointing is eliminated, and control is enhanced. And you'll learn why, with close to $2 billion dollars in physician revenue under management, athenahealth has quickly become the country's largest revenue cycle management company for office-based physician practices.

 

 

With co-sourcing, your practice is responsible for credentialing your providers (see Credentialing Co-Sourced). Your staff must work with payers to provide the documentation that they require to issue provider numbers. athenahealth will confirm during what we call "provider enrollment" that your provider numbers in athenaOne are correct and that they are linked to your group and submitter numbers. athenahealth will also confirm the address to which the payer sends payment and remittance advice (if it's on paper) for that physician.

 

Your practice is responsible for establishing and maintaining contracts with payers. Credentialing is confidential information between a provider and payer. It is against industry policy for a payer to release this information to anyone outside the provider's office. Payers use this information to confirm that partners such as athenahealth have been authorized to discuss claims on behalf of the provider. For this reason, athenahealth will ask you at certain times to contact the payer and verify or update specific information.

 

Accurate enrollment directly affects the quality, accuracy, and efficiency of the work that athenahealth performs for your practice: eligibility transactions, claims, and electronic remittance all depend on correct enrollment to help ensure that your practice is paid promptly and correctly.

 

 

Your data consists of all the patient demographic and insurance information, schedules, user and provider data, claims, EOB images, attachment images, and payments stored in athenaOne. Our data consists of our rules (even the ones you told us about), master insurance list, denial codes, and other information that we use across our entire population of clients.

 

Data copies

You can get your data any time you want. It is possible to extract most of your data right through the reporting functions of athenaOne. If you cannot get what you need that way, athenahealth can write you a custom report. Most reports take from 5 to 10 hours to perfect. You can also ask our support center to ship you a disk (or set of disks) in about a week with your data on it. We will charge you $250 per set, unless you have notified us that you intend to terminate the relationship, in which case the final set is complementary (just to prove we don't have any hard feelings).

 

 

Co-sourcing requires that we have a good relationship with each other. Successful relationships are based on solid foundations and require regular attention. We want your relationship with athenahealth to be rewarding, and we promise to work in good faith toward that goal. We have designed our client support organization to have two tiers, our Client Support Center and Customer Success Management.

 

Client Support Center

Our Client Support Center (CSC) is available to your practice for help with athenaOne functionality and workflow questions. You can contact the CSC by selecting Support > Create Case or Call in the Main Menu.

 

The CSC operating hours are Monday – Friday, 7:30 a.m. – 9:00 p.m. ET, with 24/7 emergency support.

 

Payer enrollment

We ask that you not change your pay-to or remittance enrollment with payers. Please forward any such paperwork to us. Sometimes we need you to sign something or fill out a form so that we can do our part of the job. We expect that you will turn those types of requests around quickly.

You are responsible for establishing and maintaining contracts with payers.

 

User authorization

We will assume that if an action is approved in athenaOne by one of your users that you approve of it as well.

 

Mutual confidentiality

athenahealth will keep your information confidential, and you will keep athenahealth information confidential, unless the other party says it's OK to disclose it or the government asks for it. athenahealth will use deidentified data generated from your database to enhance our services.

 

Payment

You will pay us on time. That means you set us up with automatic electronic debit authority on your operating bank account (not the lockbox deposit account). We will send you an itemized invoice every month by email (or regular mail at your request) and then wait seven days before debiting your account.

 

No withholding of payment or service

If you have an issue with our service, you will not withhold payment, you will work with us to resolve it. athenahealth promises that if we have an issue with you, we won't withhold services. If you commit a serious breach that affects the ability of athenahealth to provide services to its other customers, athenahealth may suspend your access immediately.

 

Taxes, fees, and surcharges

Some states and local governments charge sales or excise taxes, or place other surcharges or fees on our services. These items are your responsibility to pay. When athenahealth passes these on to you, you will pay them promptly along with your service fee.

 

Additional services

Not everything is included in the service fee. There is a short list of additional fees (interfaces, custom reports, extra training, new provider setup, custom consulting projects, etc.).

 

Client Satisfaction Survey

athenahealth conducts two client satisfaction surveys: one survey for buyers and the other survey for end users.

• Buyers survey — Twice per calendar year, buyers of athenahealth services receive an email from the Senior Vice President of Customer Success asking them to rate, on a scale from 0-10, their likelihood of recommending athenahealth to a trusted friend or colleague.
• End users survey — Once per calendar year, end users of athenahealth services receive a prompt upon login to athenaOne asking them to rate, on a scale from 0-10, their likelihood of recommending athenahealth to a trusted friend or colleague.

athenahealth uses data from both satisfaction surveys to gauge how we are performing and to plan our future efforts. Your feedback matters to us, and it is important that we hear from you through this channel.

 

Reasonable promotion

You will let us use your practice's name occasionally in press releases and marketing materials.

 

We hope to continually earn your business.