Do you run an urgent care clinic? Are billing errors costing you money? Athenahealth helps urgent care clinics bill faster and better. Over 160,000 healthcare providers use Athenahealth systems nationwide. The platform processes more than 1 billion claims each year. Studies show practices save 20% on billing costs with Athenahealth. Urgent care visits increased by 34% in the last 5 years.
Athenahealth is a cloud-based medical billing and EHR system. The platform handles all billing tasks automatically for practices. It reduces claim denials by 35% compared to manual systems. Average claim processing time drops from 14 days to 3 days. The system works 24/7 without any downtime for updates. Over 92% of claims get accepted on the first submission. Practices see revenue increase by 15% in the first year.
This guide shows how to set up Athenahealth billing. We cover each step in the setup process clearly. You will learn best practices for urgent care billing. Setup takes 2-4 weeks for most clinics. Training staff requires only 5-10 hours of time. Most practices go live within 30 days of starting. The investment pays back within 6 months, typically.
Initial Setup Requirements
Getting started with Athenahealth requires some basic requirements. Gather all needed info before starting setup.
Practice Information Setup
Enter your clinic name and tax ID number. Add physical address and phone number details. Upload business license and incorporation documents. Provide DEA numbers for prescribing providers. Include a CLIA certificate for lab services. Set your billing address if different from your physical address.
Provider Credentialing Data
List all providers with their NPI numbers. Upload medical licenses for each provider. Include specialty board certifications and dates. Add malpractice insurance policy information. Provide DEA numbers for controlled substances. Upload hospital privileges if applicable.
Insurance Payer Configuration
Enter all insurance payers you accept. Add payer IDs and contract numbers. Upload fee schedules for each payer. Set up electronic claim submission connections. Configure eligibility verification settings automatically. Add prior authorization requirements by the payer.
Fee Schedule Configuration
Fee schedules control how much you bill. Proper setup ensures correct payment amounts. Different payers have different fee schedules.
Standard CPT Code Setup
Add all common urgent care CPT codes. Include E/M codes 99281 through 99285. Add procedure codes for minor surgeries. Include lab test codes you offer. Set up radiology codes for imaging. Add injection and vaccine codes used.
Insurance-Specific Fee Schedules
Create separate fee schedules per payer. Medicare rates differ from commercial insurance. Medicaid has the lowest reimbursement rates, usually. Workers’ comp rates are often the highest. Self-pay rates should be clearly defined. Update fee schedules annually at a minimum.
Modifier and Adjustment Rules
Set up common modifiers like 25 and 59. Configure bundle edits to prevent denials. Add automatic adjustments for contractual rates. Set up write-off rules for different payers. Configure prompt payment discount rules if applicable.
Claim Submission Workflow
Athenahealth automates most claim submission tasks. The system checks claims before submission automatically.
Real-Time Eligibility Verification
System checks insurance automatically at check-in. Real-time results show coverage and copay. Staff see deductible and out-of-pocket amounts. Prior authorization requirements display automatically. Inactive policies get flagged immediately. This prevents billing inactive insurance later.
Automated Claim Scrubbing
System checks all claims for errors. Missing information gets flagged before submission. Bundling issues are corrected automatically. Modifier requirements are added automatically. Claims only submit when completely clean. This increases first-pass acceptance rates significantly.
Electronic Claim Submission
Claims are submitted electronically the same day as service. No paper claims or manual entry needed. The system tracks submission and acknowledgment automatically. Denied claims get flagged for quick action. Remittance advice imports automatically for posting. Payment posts to patient accounts automatically.
Payment Posting and Reconciliation
Athenahealth automates most payment posting tasks. The system matches payments to claims automatically. This saves hours of manual work daily.
ERA Payment Processing
Electronic remittance advice downloads automatically from payers. System matches payments to claims instantly. Payment posts to correct patient accounts. Adjustments apply automatically per contract terms. Denial reasons are displayed for quick review. Staff only handle exceptions and denials.
Patient Payment Management
Patient payments are posted at the time of service. Credit card processing integrates with the system. Payment plans are set up easily for patients. Outstanding balances are tracked automatically by the system. Automated patient statements are mailed monthly. Online payment portal for patient convenience.
Bank Reconciliation
Daily bank deposits match posted payments. System flags any discrepancies for review. Month-end reconciliation reports are generated automatically. Insurance aging reports show outstanding claims. Collection accounts can be tracked separately. Financial reports are always available in real-time.
Staff Training and Go-Live
Proper training ensures a smooth transition to Athenahealth. Plan adequate time for staff to learn. Go-live support prevents major disruptions.
Pre-Go-Live Preparation
Complete all setup configurations first week. Test system with sample patients and claims. Train staff 2 weeks before the go-live date. Run parallel billing for one week. Clear all pending claims from the old system. Schedule go-live for a slow day or weekend.
Go-Live Support
Athenahealth provides on-site support for go-live. Support staff help for the first few days. Technical issues get resolved immediately by the team. Staff have a direct phone line to support. Extra hands help manage patient flow. System monitoring catches problems early before they escalate.
Post-Go-Live Optimization
Review system performance after the first month. Identify any workflow bottlenecks or issues. Adjust configurations based on real usage. Additional training for struggling staff members. Fine-tune fee schedules and payer setups. Monthly review meetings with the Athenahealth team.
Conclusion
Athenahealth’s billing setup streamlines urgent care operations significantly. The system automates most billing tasks and reduces errors. Proper setup and training ensure successful implementation. Most clinics see ROI within 6 months. Claims process faster with higher acceptance rates. Staff productivity increases by 40% on average. Patient satisfaction improves with faster check-in and checkout.
FAQs
How long does Athenahealth’s setup take?
Most urgent care clinics complete setup in 2-4 weeks. This includes all configuration and staff training. Some clinics go live faster with dedicated resources.
What is the cost of Athenahealth?
Pricing is percentage-based, typically 4-8% of collections. This covers all software and support services. No upfront licensing fees are required. Monthly costs vary based on practice size.
Does Athenahealth integrate with other systems?
Yes, it integrates with most lab and imaging systems. Common integrations include Quest, LabCorp, and radiology systems. API connections allow custom integrations, too.
How much staff training is required?
Basic training takes 5-10 hours per staff member. Front desk staff need 3 hours minimum. Billing staff require 5 hours of training. Providers need only 2 hours typically.
Can we run in parallel with the old system?
Yes, parallel processing is recommended for one week. This ensures no claims are lost. Staff can compare both systems during the transition. Most practices feel comfortable after a parallel period.
What support is available after go-live?
24/7 phone support plus dedicated account manager. The online help center has training videos. Live chat support is available during business hours. On-site support available if needed urgently.
How quickly do claims get paid?
Average payment time is 3-5 days for electronic claims. This is 70% faster than paper claims. Medicare pays within 14 days, usually. Commercial payers vary from 5 to 30 days.
Is there a mobile app for providers?
Yes, Athenahealth has mobile apps for iOS and Android. Providers can review charts and results remotely. Electronic prescribing works through a mobile app. Secure messaging with staff is included, too.
