User Guide — athenaOne Medical Coding (for ambulatory customers)

 

athenahealth will provide the supported procedure, evaluation and management and diagnosis coding along with the appropriate modifiers (“medical coding”) for your Visits as described in the athenaOne Medical Coding ambulatory Service Description document.

• All medical coding is performed and/or reviewed by a team member holding an AAPC or AHIMA certification prior to claims being submitted to payers.
• Medical Coding excludes any specialized or non-standard coding, including coding related to MIPS, CPT II codes, customer-specific directives or requirements, or payer contracts.
• athenahealth does not handle any fee schedule updates, and any CPT/HCPCS codes must be added by the practice for coders to be able to select an applicable code.

 

As set forth in your athenahealth services agreement, we will complete medical coding upon your Go-Live Date for Visits that you route to us for coding.

• Prior to sending a Visit to us for coding, you must ensure that all information related to each Visit is accurately and completely documented in athenaOne, as described in our onboarding training and any documentation subsequently provided to you for Medical Coding. This includes but is not limited to, entering and verifying all visit details related to registration and the actual visit. We rely on you to verify the accuracy and completeness of all information documented in athenaOne, and we assume for Medical Coding purposes that all information has been verified as accurate and complete.

• Once you have included all the necessary information and documents, you can send a Visit to us for coding by clicking Send to Coding on the Charge Entry screen in athenaOne.

• The athenaOne system will scan each missing slip for the following billing integrity condition:

  
  

  Manual Routing — Billing Integrity Conditions
  Encounter	Signed and closed

  
  

  • If an encounter has not been reviewed and signed off by the provider, a message will notify you that the missing slip has failed the billing integrity check.
    
    
  • The missing slip will then be linked under Unmet Criteria for Medical Coding on the Workflow Dashboard.
  • Use the Worklist: athenaOne Medical Coding page to resolve missing slips issues that need practice attention.
• Missing slips that pass the Billing Integrity Check are routed to athenaOne Medical Coding to complete medical coding.
• Coders may ask you questions or request further information through a Query; all Queries must be closed out before coding can be completed.

For detailed steps, see To send a missing slip to athenaOne Medical Coding in the Step-by-step instructions section below.

 

For ambulatory customers who have contracted with athenahealth for athenaOne Medical Coding services, eligible missing slips can be automatically pulled in for review instead of practice users manually sending each visit from the Charge Entry page. 

 

Automated routing of eligible missing slips to athenaOne Medical Coding is an opt-out feature for any department/provider that is contracted with Medical Coding.

• As of November 2024, athenaOne Medical Coding best practice configurations are enabled by default for all new ambulatory Medical Coding customers at Go Live to help them avoid delays in claim creation and time to bill, and use the Medical Coding service most effectively.

• To opt out for your entire organization or for specific department(s), contact your Customer Success Manager (CSM) or your Onboarding project team. For details, see athenaOne Medical Coding Settings (for ambulatory customers).

• Note: Automated routing is only compatible with standard appointment workflows. If your practice uses the Expedited Encounter or Appointment Workflow Bypass, your SM or Onboarding team will change this setting to No and you will need to use manual routing.

 

The athenaOne Medical Coding product scans each missing slip to determine billing readiness, and provides visibility on missing slips that fail to meet one or more Billing Integrity Criteria.

 

Missing slips are scanned for the following Billing Integrity conditions:

 

Condition	Criteria
Encounter	Signed and closed
Billing Tab	Review completed   Note: You can require Billing Tab review to be completed before the encounter is closed, so more missing slips can be automatically routed to athenaOne Medical Coding. See athenaOne Medical Coding best practice configurations for details.
Primary insurance package	Valid primary insurance package attached to the missing slip
Supervising Provider	Valid Supervising Provider attached to the missing slip   Note: ,Supervising Provider can be defaulted from the Provider Table, so more missing slips can be automatically routed to athenaOne Medical Coding. See athenaOne Medical Coding best practice configurations for details.
Patient Check-out	Completed   Note: You can choose to allow missing slips without Patient Checkout completed to be automatically routed to athenaOne Medical Coding. See athenaOne Medical Coding best practice configurations for details.

 

Once missing slips have met all the above conditions, a charge validation is also done to check for:

• Charges entered but not yet defined in the practice's Fee Schedule

• Charges entered without a Diagnosis code

Missing slips that meet all the above criteria will automatically be routed to athenaOne Medical Coding.

 

Missing slips that fail to meet the criteria will appear in the Unmet Criteria for Medical Coding column on the Workflow Dashboard and on the athenaOne Medical Coding — Unmet Criteria worklist, where they can be reviewed and updated by your practice.

• Once your practice completes the actions needed, those missing slips will automatically be sent to athenaOne Medical Coding during the next hourly execution of the auto routing engine.

 

 

 

Note: Missing slips that have been updated on the Charge Entry page by the practice users must be manually sent to athenaOne Medical Coding.

• For detailed steps, see To manually send encounters to athenaOne Medical Coding after changes saved in Charge Entry in the Step-by-step instructions section below.

 

athenahealth examines patient health records for completeness and necessary supporting documentation to enable us to complete coding. athenahealth accesses patient health records and completes coding based on what is present in the record.

 

Charts requiring additional documentation or clarification are returned to your organization via a coder query process. Medical coding will not be completed until the requested information or documentation is received. It is your responsibility to respond to any queries.

 

For detailed steps, see To resolve queries sent by athenaOne Medical Coding in the Step-by-step instructions section below.

 

 

athenahealth creates claims and sends them directly to payers for adjudication after coding is completed; however, holds may prevent the claim from being sent to the payer or patient.

 

 

If a claim coded by athenaOne Medical Coding has a documentation or coding-related hold, we will move that claim to a worklist to be reviewed by us.

• You will work with us to address the documentation or coding-related hold.
• You will promptly respond to any requests made through athenaOne for additional information or documents.
• We will not be alerted to and will not respond to any hold for a claim not coded by us.

 

athenahealth may determine that your organization must resolve a claim in a coding-related hold, in which case the Medical Coding service routes the visit back to you for resolution.

• You can view claims in hold status via the Claims tab by selecting the Workflow Dashboard. Claims appearing in Athena Hold and CBO Hold will be worked by the coding service.
• For details on claim hold status indicators, see the Claim Status O-help topic.

 

The athenaOne® Medical Coding Performance Dashboard provides transparency into key performance indicators (KPIs) related to the athenaOne Medical Coding service, including:

• Service utilization rate
• Turnaround times
• Amount of work done by athenahealth's coding team independently
• Amount of work where the coding team needed your practice's assistance

 

1. On the Main Menu, click Support and then click Create Case or Call.
2. Select Additional Services, and then athenaOne Medical Coding.

 

1. Display the Claim Workflow Dashboard: On the Main Menu, click Claims and then click Workflow Dashboard.
2. In the Missing Slips column, click a linked total. The Missing Slips worklist appears in the Task Bar on the left.
3. In the Task Bar, click a linked missing slip. The Claim: Charge Entry page appears in the Workspace.
4. Make sure the following required Billing information is completed correctly:
   • Date of Service
   • Service Department/Place of service
   • Insurance
   • Rendering Provider
   • Supervising Provider
5. Scroll down to the Charges section. The athenahealth Medical Coding team will enter information in this section.
6. Note to Coder — Enter any information you would like a medical coder to review before coding this encounter.
7. Click Send to Coding.

8. The athenaOne system scans the missing slip for the following billing integrity condition:

   
   

   Manual Routing — Billing Integrity Conditions
   Encounter	Signed and closed

   
   

   • If the encounter has not been reviewed and signed off by the provider, a message will notify you that the missing slip has failed the billing integrity check.
     
     
   • The missing slip will then be linked under Unmet Criteria for Medical Coding on the Workflow Dashboard.
   • Use the Worklist: athenaOne Medical Coding page to resolve missing slips issues that need practice attention.
9. Missing slips that pass the Billing Integrity Check are routed to athenaOne Medical Coding to complete medical coding.
10. A banner appears at the top of the Claim: Charge Entry page, confirming the encounter was successfully sent to the athenaOne Medical Coding service.

 

1. Display the Worklist: athenaOne Medical Coding — Unmet Criteria page:
   • From the Workflow Dashboard, click any linked number in the Unmet Criteria for Medical Coding column for a specific department.
   • From the Non-Clinician Inbox, click the Unmet Criteria for Medical Coding link.
     

   The Unmet Criteria tab of the Worklist: athenaOne Medical Coding page appears.

    

   

   Tip: Click the image to see an expanded view

   
   

2. Filter for the encounters you want to see and sort the columns if needed.

3. Hover over a linked action in the Action Needed column to see the complete list of actions needed for that encounter.

4. Click the linked action in the Action Needed column to display the page where you can complete the missing step or provide the missing information.
   

    

   Action Needed	athenaOne page/ Action
   Add Primary Insurance	Claim: Charge Entry page — Update the Primary Insurance, then Save Changes. Click Send to Coding.
   Add Supervising Provider	Claim: Charge Entry page — Select the Supervising Provider, then Save Changes. Click Send to Coding.
   Complete Billing Tab Review	Claim: Billing tab on the Checkout page — Verify billing information, then click Save & Enter Charges.
   Complete Patient Checkout	Checkout page — Click Done with Checkout.
   Ensure Provider has Signed and Closed the Encounter	Follow up with the Provider for encounter sign off.
   Go to Charge Entry and Click Send to Coding	Claim: Charge Entry page — Click Send to Coding.
   Manually Route Missing Slip	Claim: Charge Entry page — Click Send to Coding.
   Review and Update Fee Schedule	Claim: Charge Entry page — Review the Charges section, then click Fee Schedule and update the required procedure codes.
   Review and Update Procedures with Missing Diagnosis Codes	Claim: Charge Entry page — Review the Charges section, update the required procedure codes, then Save Changes. Click Send to Coding.

    

5. Once you complete the actions needed, those missing slips will automatically be sent to athenaOne Medical Coding during the next hourly execution of the auto routing engine.

   • Note: Missing slips that have been updated on the Charge Entry page by the practice users must be manually sent to athenaOne Medical Coding.
     
6. On the page where you're completing the action needed, you'll see the Unmet Criteria task bar on the left. Click Return to Worklist: Unmet Criteria if you want to go back to the worklist.
7. From the Worklist: athenaOne Medical Coding page, click Go to Workflow Dashboard in the top right if you want to return to the Workflow Dashboard.

 

For ambulatory customers who have contracted with athenahealth for athenaOne Medical Coding services, if your organization has automated routing enabled, the Send to Coding button on the Charge Entry page will be disabled by default because the system will handle routing automatically whenever possible.

 

However, if you make changes on the Charge Entry page for an encounter and then click Save Changes, automated routing to athenaOne Medical Coding will be disabled and you will need to manually send that encounter to coding.

 

An alert appears at the top of the page:

 

Tip: Click the image to see an expanded view

 

1. Click Send to Coding .

2. The athenaOne system will check the billing integrity criteria and notify you if any criteria is not met.

3. Missing slips that fail to meet the criteria will appear in the Unmet Criteria for Medical Coding column on the Workflow Dashboard and on the athenaOne Medical Coding — Unmet Criteria worklist, where they can be reviewed and updated by your practice.

4. In the worklist, you can filter on Action Needed: Manually Route Missing Slip to identify the missing slips that need to be manually sent to Coding.

 

1. Display the Worklist: athenaOne Medical Coding — Practice Input Needed page:
   • From the Workflow Dashboard, click any linked number in the Practice Input Needed for Medical Coding column for a specific department.
   • From the Non-Clinician Inbox, click the Practice Input Needed for Medical Coding link.
     

   The Practice Input Needed tab of the Worklist: athenaOne Medical Coding page appears.

    

   

   Tip: Click the image to see an expanded view

   
   

2. Filter for the encounters you want to see and sort the columns if needed.

3. Click the linked text in the Action Needed column to view the Query Details window.
   

   

   Tip: Click the image to see an expanded view

   
   

4. Complete the actions needed to resolve the query.
   •  If the query is asking you to update documentation or provide more information, you can click the Patient ID link in this Query Details page to go to the appointment Checkout page.
   • If the query is asking you to update your practice's Fee Schedule, you can click the Fee Schedule Page link at the top right of the worklist page to go directly to that page. Fee Schedule updates are one of the leading reasons why queries are raised today.

5. Respond to the coder by typing a reply in the text box in the Open Queries section, then click Send .

   • The encounter is automatically reassigned to athenaOne Medical Coding team.

   • Once you’ve responded to a query, it will move from Open Queries to Resolved Queries in the Queries Detail window.

   • You can always go back and review previous Queries, or click Add more details to add more information if needed.

   • Note: A reply is required before athenaOne Medical Coding can continue working on the visit bill.

6. Click Close to close the Query Details window and return to the Worklist: athenaOne Medical Coding — Practice Input Needed page.

7. From the Worklist: athenaOne Medical Coding page, click Go to Workflow Dashboard in the top right if you want to return to the Workflow Dashboard.

 

 

1. On the Main Menu, click Support and then click Create Case or Call.
2. Select Additional Services, and then athenaOne Medical Coding.

 

(Refer to the FAQs listed in the Resources section above)