General Category > General Questions

software help

<< < (2/2)

kristin:
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:

--- Quote from: RichardP on September 22, 2014, 06:22:13 PM ---
--- Quote from: desheba on September 22, 2014, 01:11:56 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?
--- End quote ---

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.

--- End quote ---

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:
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:
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]

--- End quote ---

PMRNC:

--- 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!
--- End quote ---

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.

Navigation

[0] Message Index

[*] Previous page