Do you use Athenahealth for your primary care practice? Are you setting up billing for the first time? Research shows 45% of practices struggle with initial setup. The wrong setup costs clinics $85,000 annually in lost revenue. Many practices lose 20% revenue from config mistakes.
This guide covers every step for billing setup. We show what to do in the correct order. Learn how to avoid common setup mistakes. Get your practice billing working right fast. These steps work for all primary care clinics. Follow this checklist to start billing correctly today.
Practice and Provider Setup
Practice info must be accurate and complete. Provider credentials need proper setup first. This forms the foundation for all billing work.
Enter Practice Information
Add practice name, address, and phone number. Enter the tax ID number and NPI correctly. Include all practice locations being used. Set up billing address if a different location. Add practice hours and contact info. Verify all info matches insurance records. Wrong practice info causes automatic claim denials.
Configure Provider Profiles
Create a profile for each provider in practice. Enter provider NPI numbers and license info. Add specialty codes and taxonomy codes correctly. Include provider work schedules and locations. Set up the provider signature and credentials. Verify provider insurance enrollments are current.
Set Up Rendering Providers
Identify which providers will see patients. Link providers to correct practice locations. Set up provider availability and schedules. Configure provider billing rates and fees. Add provider modifiers if needed, always. Verify rendering provider credentials with payers.
Insurance and Payer Configuration
Insurance setup controls claim submission and processing. Each payer needs proper configuration in the system.
Add Insurance Companies
Enter all payer names and addresses correctly. Add payer IDs and contact information. Include claims submission addresses and phone numbers. Set up electronic payer IDs for EDI. Configure payer remittance addresses for payments. Add payer websites and portal logins.
Configure Clearinghouse Settings
Set up a clearinghouse connection for claims submission. Enter clearinghouse login credentials and IDs. Configure claim submission rules and edits. Set up electronic remittance advice downloads. Test the clearinghouse connection before going live. Verify all payers connected through the clearinghouse.
Set Up Fee Schedules
Create a fee schedule for each insurance plan. Enter allowed amounts for all CPT codes. Set up contracted rates with each payer. Include copay and deductible amounts by plan. Configure coinsurance percentages for services billed. Update fee schedules when contracts change.
Patient Demographics and Registration
Patient info must be complete and accurate. Missing info causes claim denials and delays.
Collect Patient Information
Enter the patient’s full name exactly as on the insurance card. Add date of birth and social security number. Include current address and contact phone numbers. Collect email address for patient portal access. Add emergency contact info for records. Verify info with the patient at each visit.
Verify Insurance Coverage
Scan the front and back of the insurance cards. Enter insurance ID numbers exactly as shown. Add group numbers and plan names correctly. Verify eligibility before each appointment scheduled. Check copay, deductible, and benefits info. Note if prior OK is needed for services.
Set Up Guarantor Information
Identify who is financially responsible for the account. Enter the guarantor’s name and contact details clearly. Add a relationship to the patient in the system. Include billing address if different from the patient’s. Set up payment preferences and methods.
Charge Capture and Coding
Proper coding ensures claims get paid correctly. Charge capture must happen for all services. This step directly affects practice revenue.
Configure CPT Code Library
Add all CPT codes used in practice. Include code descriptions and fee amounts. Set up modifiers used with codes. Link codes to appropriate diagnosis codes. Configure time-based codes for E/M visits. Add preventive care and screening codes. Keep the code library updated with annual changes.
Set Up Diagnosis Codes
Add common ICD-10 codes used in practice. Create a favorites list for quick access. Link diagnoses to common procedures performed. Set up code bundles for frequent combinations. Update ICD-10 codes when they change. Remove obsolete codes from active use.
Create Charge Templates
Build templates for common visit types. Include typical codes for each visit. Set up exam room charge capture workflows. Create templates for preventive visits by age. Add chronic care management templates, too. Configure annual wellness visit templates correctly.
Claims Submission and Tracking
Claims must be submitted correctly to get paid. Tracking ensures nothing falls through the cracks.
Enable Electronic Claims Submission
Turn on electronic claims for all payers. Configure claim scrubbing rules and edits. Set up automatic claim submission schedules. Enable real-time eligibility checking before submission. Configure claim status tracking and monitoring. Set up alerts for claim rejections.
Set Up Claim Scrubbing Rules
Enable edits for missing patient info. Check for invalid CPT and diagnosis codes. Verify modifiers are used correctly on claims. Catch duplicate claims before submission happens. Flag claims needing prior OK approval. Review high-dollar claims before submission always.
Configure Claim Status Monitoring
Set up automatic claim status checks. Monitor the aging of unpaid claims regularly. Flag claims over 30 days old. Set up alerts for denied claims. Track resubmission of corrected claims, too. Generate reports on claim status weekly. Regular monitoring improves collections and cash flow.
Payment Posting and Reconciliation
Payments must post correctly to patient accounts. Reconciliation ensures accuracy of posted amounts.
Set Up ERA Auto-Posting
Enable electronic remittance advice downloads daily. Configure auto-posting rules for clean payments. Set up tolerance levels for payment variances. Flag payments needing manual review always. Auto-post adjustments and contractual write-offs correctly. Verify ERA amounts match bank deposits.
Configure Payment Posting Rules
Set up payment posting by insurance plan. Configure write-off codes and adjustment reasons. Create posting rules for copays and deductibles. Set up posting for patient payments, too. Configure refund processing workflows and approvals. Document payment posting procedures for staff.
Reconcile Payments Daily
Match posted payments to bank deposits. Review ERA reports for posting accuracy. Check for unapplied payments needing research. Reconcile patient payment batches at day’s end. Investigate any posting discrepancies found immediately. Generate reconciliation reports for management review.
Reporting and Analytics
Reports show how practice billing performs. Analytics identify problems needing attention quickly.
Set Up Key Performance Reports
Configure denial rate reports by payer. Set up days in AR aging reports. Create clean claim rate tracking reports. Generate revenue by provider and location. Set up collection rate monitoring reports. Configure patient AR aging by balance. Schedule reports to run automatically weekly.
Monitor Practice Performance
Review denial trends and common reasons. Track claim submission and payment timelines. Monitor staff productivity and accuracy rates. Identify the top denial reasons for correction. Compare performance to industry benchmarks available. Set improvement goals based on report data.
Create Custom Dashboards
Build a dashboard showing key billing metrics. Include denial rates and clean claim percentages. Add days in AR and collection rates. Show revenue by provider and payer. Configure alerts for metric thresholds exceeded. Share dashboards with billing staff and management.
Conclusion
Athenahealth billing setup requires careful attention to detail. Practice and provider info must be accurate. Insurance and payer config affect claim success. Patient demographics and charge capture need accuracy. Claims submission and payment posting must work. Regular reporting monitors billing performance always. Following this checklist ensures proper billing setup.
FAQs
How long does Athenahealth billing setup take?
Setup typically takes 2-4 weeks for most practices. Larger practices may need 4-6 weeks total. Timeline depends on practice size and complexity.
Can I import existing patient data?
Yes, Athenahealth supports data import from most systems. Patient demographics and insurance info can transfer. Historical claims and payment data imports, too.
What reports should I run regularly?
Run denial rate reports weekly to track. Monitor days in AR aging monthly. Check clean claim rates each week. Review revenue reports by provider monthly.
How often should fee schedules be updated?
Update fee schedules when payer contracts change. Review and update at least annually. Medicare rates update every January. Commercial payer rates vary by contract terms.
What happens if the practice info is wrong?
Wrong practice info causes automatic claim denials. Insurance companies reject claims with mismatched data. Correcting info requires claim resubmission always.
