Author Topic: software help  (Read 2577 times)

desheba

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software help
« on: September 21, 2014, 07:52:44 PM »
Good evening,

I need help from anyone that has used Athenanet/AthenaHealth.....I have a potential client that uses this system and I was wondering if anyone knows if you can use the EHR clinical side without using Athenanet's billing company?  Also, is there another system comparable to them?  The doc really likes the clinical side, but there are issues with the billing side.  I am trying to find out if the doc can separate herself from the billing side and only use them as a clearinghouse to send the bills electronically only?

If not able to separate from the Athenanet doing the billing, is there any type of manual or place I can find out how to things on my own without them?  You have to call Athenanet and setup a ticket every time you have a question and when I asked to tell me how to do it (ex: posting a insurance cc pymt that came to the office), they kinda talked over the answer and said it was something that should be sent back to the billing department to do.

Any ideas and/or suggestions will be greatly appreciated!

Thank you!

kristin

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Re: software help
« Reply #1 on: September 21, 2014, 10:03:41 PM »
It looks like you can learn to use the existing PM software through Athena, either through their training program(which may or may not cost something), or on your own, or you can purchase your own PM software to do the billing. Which will be potentially costly, and definitely time-consuming, if it does not integrate with Athena. 

I can't see being able to use just Athena's CH, if you are not using their PM system....unless they use an outside CH like Gateway, Emdeon, etc, that can be used with other software. But don't quote me on that. If their CH is just for their system, that is that, so far as I know. Someone else can correct me if I am wrong.

I have only seen the clinical side of Athena before, not the PM side, so I can't really say what is comparable. I do know that I wasn't impressed with the clinical side. If the doctor likes it, and doesn't want to switch, you may just have to bite the bullet and learn the PM side.

The thing to take into consideration, as far as I am concerned, is what is going to be more difficult/costly in the end? Learning to use Athena, which is already set up and in place, or trying to start over with a new PM software and CH? For me, I would much rather keep what is in place, and do the training, then to start over with something new.

desheba

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Re: software help
« Reply #2 on: September 22, 2014, 10:11:56 AM »
Thanks Kristin for your response.  I don't have an issue learning their pm side and working with it, the problem is that you can't use the clinical side without using Athena's billing service only from what the doctor has explained to me.  The doc says "the revenue from the billing is their charges for using the clinical side." I was really wondering if this is true and if anyone uses Athena's pm side without using Athena's billing services/company? 

Thanks!


RichardP

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Re: software help
« Reply #3 on: September 22, 2014, 03:22:13 PM »
The doc says "the revenue from the billing is their charges for using the clinical side." I was really wondering if this is true and if anyone uses Athena's pm side without using Athena's billing services/company?

We had a client who wanted to switch to AthenaHealth.  We researched it and were told what your doctor told you.  The only way you can use AthenaHealth is to let them do the billing (which is shipped overseas).  Additionally, the doctor must assign his benefits to AthenaHealth.  The insurance companies pay AthenaHealth, AthenaHealth takes their cut, and then sends the remainder on to the Doctor.  Both of those were deal-killers for our client, but particularly the fact that the doctor loses control of HIS money - because it must be signed over to AthenaHealth.

This was about three years ago, so I don't know what provisions are still in place now.

PMRNC

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Re: software help
« Reply #4 on: September 22, 2014, 05:20:20 PM »
I'm sorry but that is just CRAP. Ask the provider if he is ok accepting 100% Responsibility of all consequences of any negligence or BREACH. We can't STOP offshore companies but we sure can educate providers on the REAL life consequences and liability THEY take on by hiring offshore.
Linda Walker
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kristin

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Re: software help
« Reply #5 on: September 22, 2014, 06:58:17 PM »
I had no idea that this is what was going on with Athena....I have never heard of that before! Sounds like it is all or none with Athena.

So my new suggestion for dasheba is this...

If the doctor is considering you as her biller, there must be some reason or reasons she is unhappy with Athena's billing service, even if she likes the clinical side of the software. If you can come up with a proposal where you work with her to find a different EHR/PM to use, that is affordable, and you can explain to her that she will be better off using you in the long run to do the billing(find out what she doesn't like about Athena, and make that work to your advantage), I bet you can get her as a client. While there will be a bit of upheaval switching to a new software, and transferring data, and setting up with the CH, show her that in the end, it will be better for her.

You could go with Practice Fusion for the clinical side, which is free, but not without issues, and you would need to make sure you use a PM system like Kareo that is compatible. There are so many choices out there, but that is one idea.

desheba

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Re: software help
« Reply #6 on: September 22, 2014, 07:52:46 PM »
The doc says "the revenue from the billing is their charges for using the clinical side." I was really wondering if this is true and if anyone uses Athena's pm side without using Athena's billing services/company?

We had a client who wanted to switch to AthenaHealth.  We researched it and were told what your doctor told you.  The only way you can use AthenaHealth is to let them do the billing (which is shipped overseas).  Additionally, the doctor must assign his benefits to AthenaHealth.  The insurance companies pay AthenaHealth, AthenaHealth takes their cut, and then sends the remainder on to the Doctor.  Both of those were deal-killers for our client, but particularly the fact that the doctor loses control of HIS money - because it must be signed over to AthenaHealth.

This was about three years ago, so I don't know what provisions are still in place now.

Richard, everything you said is exactly what is going on...I sent a long email to explain how I did not think any billing company should have full control of her receivables.  I was awe struck at how they work.  The doc has over $50,000 in claims that have been sent back to her to process when Athena, the billing company, should follow up.  They only make one call on a claim and then send it to the provider for them to resolve.  Why pay for that??  They are asking the provider for proof of eobs or checks when they receive everything at their lockbox not hers.  She has no clue what has been paid and how much they are paying because you can't tell if a payment has been posted to an account or not.  I offered to help as a "special project" until she can decide to move from athena to a different system.  But I think she is trying to avoid paying me and Athena for the same work.  I feel bad for her because I think she is getting ripped off in so many ways!

I just wanted to make sure there are no other options with Athena first, before I really push her to move to a new system.  When I gave her my proposal for the project, I did mention that she could try Eclinical or Kareo. I hope she changes to something better soon, even if I am not the biller!

Thanks for the comments!

kristin

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Re: software help
« Reply #7 on: September 22, 2014, 09:26:55 PM »
Wait...WHAT? $50,000 in claims have been sent back to her so she can follow-up on them, when that is THEIR job? What is it that they do as a billing service? Data entry only? That alone should make your case that she needs to dump them, and go with you. I have no idea what should be in her AR based on her practice, but $50,000 worth of claims sitting around for her to "fix" is crazy. Not to mention the other stuff you said about them getting the payments at their end, and questioning her as to where they are, and the lack of accountability for what is paid and what is not.

I don't know if she is new to practicing or not, but turning over your billing to people who don't know what they are doing, or don't care, is the quickest way to fail. You have an opportunity to fix that...take it!

RichardP

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Re: software help
« Reply #8 on: September 22, 2014, 10:57:35 PM »
I'm guessing the $50,000 is what patients owe after the insurance has paid.

Think like a businessman.  This is a perfect way to skim the easy money.  The doctor has to type the CPT and DX codes into the EMR (no data entry costs for AthenaHealth).  Those codes are processed with software algorithms and an automatic request for more documentation is returned to the doctor if necessary.  When all codes "pass" the software algorithm they are forwarded to the Insurance Carrier.  Payment is forwarded automatically to AthenaHealth.  The software calculates Athena's percentage (6-7% when we checked), subtracts it from the payment, and forwards the remainder to the doctor's account.  The software generates a bill to the patient.  If they don't pay in a timely fashion, the software generates a call to the phone number of record.  If that doesn't result in full payment, the doctor is notified of how much the patient owes him - and he gets to collect.

Almost no human intervention at all in AthenaHealth's system - by design.  From here:

http://www.getfilings.com/sec-filings/111020/ATHENAHEALTH-INC_8-K/b88654exv99w2.htm

Page Numbers are at bottom left of page.  Scroll down until you see "3" for Page 3.  This starts with the last paragraph at bottom of Page 3 and continues to Page 4.  I obtained this in the process of checking out AthenaHealth for our client.  I'm sure there is a more recent document available if you want to search for it.

Quote

Athenahealth continually works to minimize human intervention across our service offerings. During Q3 2011, the athenaCollector team made significant headway in reducing manual work related to the denial management process. Leveraging the athenaRules engine, the team designed a sophisticated routing process to ensure that denied claims are forwarded to the appropriate specialist. This allows a significant portion of volume to be routed offshore to our business process outsourcing (BPO) partners, an important step in standardizing and ultimately automating denials work. This same routing engine will soon forward certain claims to a document creation engine. When completed, certain claim denials will result in an appeal being generated and returned to the payer with no manual intervention. We expect that the fully automated appeals process will improve average client DAR and reduce operating costs for athenahealth.
 
Improving average client DAR remains a key point of focus for athenahealth. At 39.7 in Q3 2011, it remains higher than we’d like it to be. One of the drivers for higher average client DAR this year was actually the automated month-end close reconciliation process that we rolled out late last year. While automatically reconciling clients’ bank statements to balances posted in athenaNet eliminates work for clients and enhances the integrity of our operations, it slightly delays clients’ financial reporting and adds approximately 0.5 days to average client DAR. Furthermore, we are finding that some clients are getting behind in working items in their hold buckets, meaning that they are not addressing claim issues that we flag for them in a timely manner. Thanks to our cloud-based architecture, we are monitoring this closely and the athenaCollector team is pursuing a number of initiatives aimed at improving average client DAR. We expect that these efforts will begin to have an impact on this metric during fiscal year 2012.  [End Quote]

PMRNC

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Re: software help
« Reply #9 on: September 23, 2014, 07:10:07 AM »
Quote
But I think she is trying to avoid paying me and Athena for the same work.  I feel bad for her because I think she is getting ripped off in so many ways!

Kristen is right, this is a great opportunity.. You could kindly and gently tell her to review her contract with them, if they are not doing what they were contracted to do she has the opportunity to get out of it due to contract breach.  Then I would work up a proposal, get a signed BAA, and see if you can access the system audit trail to show her what they are doing (or not doing). Run an incomplete and/or pending claim report as well. I'd make sure your proposal was centered around letting her have control over things she doesn't NOW as well as the additional INCLUDED services you can provide for her that she's not getting currently.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com