athenaOne for Specialties
Women's Health: Key Billing and Revenue Configuration
Women’s health practices face unique financial challenges—such as high denial rates (up to 28%) and complex, multi-stage billing for prenatal and episodic care. Financial performance is driven by overcoming these administrative hurdles and optimizing clinical efficiency.
Optimizing athenahealth for Women’s Health requires configuring workflows to manage extended episodes of care, preventive screenings, and OB/GYN-specific billing. Utilizing the platform's athenaOne for Women's Health solution streamlines complex encounters into automated, clean claims.
Key configuration and revenue cycle management (RCM) components
1. Specialty-Specific Coding & Charge Capture
- Favorites Lists: Configure and map your most common CPT (e.g., ultrasounds, annual exams, deliveries) and ICD-10 codes. Link these into your clinical templates and order sets to ensure automatic, accurate charge capture at the point of care.
- Obstetrical (OB) Workflow: Activate the specialized OB episode-of-care module to correctly group and bill the global maternity period. This links prenatal visits, lab orders, and delivery charges together for compliant, streamlined billing.
2. AI-Native Billing & Denial Prevention
- Automated Clearing: Use athenahealth Revenue Cycle Services to handle claim scrubbing and automated insurance selection. This leverages network-wide payer rules to catch errors and correct coding denials in real-time.
- Prior Authorization Automation: Turn on automated eligibility checks and authorization workflows to prevent claim holds and denials. This reduces manual phone calls and administrative burden.
3. Analytics & Dashboard Monitoring
- Insight Dashboards: Track crucial RCM performance indicators natively within the athenaOne Revenue Cycle Management system. Key metrics to monitor include:
- Charge Lag: Measure the days between service delivery and charge entry.
- Patient Pay Yield (PPY): Monitor and optimize patient collection rates for copays and deductibles.
4. Patient Engagement & Collections
- ·Automated Outreach: Reduce manual administrative tasks by setting up automated wellness outreach. Tailor reminders to patients for routine well-woman visits, mammograms, and other essential preventive services.
- Digital Payments: Empower patients to view and pay their bills online via the athenaOne for Women's Health patient portal to help lower your overall cost to collect.