Do you use Athenahealth for radiology billing daily? Are you struggling with claim denials and rejections? Studies show imaging centers lose 15-20% revenue from billing errors. Athenahealth processes over 120 million claims each year successfully. About 75% of radiology claims contain at least one error. Proper software use can reduce denials by 60% or more. Understanding system features helps practices get paid faster.
Athenahealth is a cloud-based medical billing software system. The platform offers special features for imaging and radiology centers. Many practices do not use all available tools effectively. Research shows that only 40% of users maximize software capabilities. Training gaps cause the most common billing errors in the system. Imaging centers using best practices see 30% better collection rates. Learning system shortcuts improves billing efficiency and accuracy significantly.
This guide covers essential Athenahealth billing tips for imaging centers. We show how to use key features correctly. Learn system shortcuts that save time every day. Improve your claim acceptance rates starting now. These tips work for centers of all sizes. Follow these guidelines to maximize your software investment value.
Setting Up Imaging-Specific Charge Capture
Proper charge capture setup prevents missed charges and denials. Athenahealth offers imaging-specific tools and templates. Configure settings correctly from the start for success.
Creating Custom Charge Templates
Build templates for common imaging procedures performed daily. Include CPT codes, modifiers, and diagnosis codes together. Save templates with descriptive names for easy finding. Use templates to speed up the charge entry process. Update templates when codes or fees change.
Configuring Procedure Code Libraries
Organize radiology codes by modality type and body area. Add commonly used codes to the favorites list. Include technical and professional component codes separately. Set default modifiers for each procedure code. Link diagnosis codes to appropriate procedure codes. Remove outdated or rarely used codes from the library.
Setting Up Fee Schedules
Enter contracted rates for each insurance payer accurately. Update fee schedules when contracts renew or change. Set different rates for facility and non-facility services. Include global, technical, and professional component fees separately. Use the bulk upload feature for large fee schedule updates.
Optimizing Claim Submission Workflow
Efficient claim submission reduces delays and improves cash flow. Athenahealth automation features streamline the billing process a lot.
Automated Eligibility Verification
Enable real-time eligibility checking for all appointments scheduled. Set alerts for patients with inactive or invalid coverage. Verify benefits before the patient arrives for imaging service. Check the auth requirements during the verification process automatically. Update patient insurance info right away when changes occur.
Electronic Claim Scrubbing
Turn on automated claim scrubbing before submission always. Review scrubbing rules and edit checks regularly. Address all flags and warnings before releasing claims. Set up custom rules for imaging-specific requirements. Monitor scrubbing reports to identify recurring error patterns.
Batch Claim Processing
Submit claims in daily batches for faster processing. Review batch reports before final submission to payers. Hold claims with errors for correction and resubmission. Track claim status using the batch number for reference. Set up automatic batch submission schedules overnight.
Managing Radiology-Specific Modifiers
Modifiers affect payment amounts for imaging services a lot. Athenahealth helps apply the correct modifiers to radiology claims.
Technical vs Professional Component Modifiers
| Modifier | Component Type | When to Use | Payment Impact |
| TC | Technical only | Equipment and staff | 60-70% of the total |
| 26 | Professional only | Doctor interpretation | 30-40% of the total |
| None | Global service | Both components | 100% of fee |
Bilateral Procedure Modifiers
Modifier 50 indicates a bilateral procedure was performed today. Some payers prefer RT and LT modifiers instead. Check payer preferences before submitting bilateral imaging claims. Enter the modifier on the first procedure line only. Payment is typically 150% of the single procedure rate.
Multiple Procedure Modifiers
Modifier 51 shows multiple procedures performed in the same session. First procedure pays at 100% of the fee schedule. Subsequent procedures pay at reduced percentage rates. Order procedures by fee amount from highest to lowest. Athenahealth can apply modifier 51 automatically sometimes.
Utilizing Denial Management Tools
Athenahealth provides powerful denial management and tracking features. Using these tools improves collection rates and cash flow.
Tracking Denial Reasons
Review denial reports weekly for all unpaid claims. Categorize denials by reason code and payer type. Identify the top denial reasons affecting your practice. Track denial trends over time using system reports. Share denial data with the billing staff in meetings. Set goals for reducing specific denial types monthly.
Creating Work Queues
Set up work queues for different denial types. Assign staff members to specific queue responsibilities. Prioritize high-dollar denials for quick attention and action. Use filters to organize denials by age. Set reminders for timely filing limit deadlines. Monitor queue completion rates and processing times.
Automated Appeal Letters
Use Athenahealth templates for common appeal situations. Customize letters with patient and claim-specific details. Attach supporting docs to appeals electronically when possible. Track appeal submissions and response deadlines carefully. Monitor appeal success rates by payer and type.
Leveraging Reporting and Analytics
Athenahealth offers robust reporting tools for practice management. Regular report review identifies billing problems and opportunities.
Key Performance Indicator Reports
Monitor days in accounts receivable daily or weekly. Track collection rate percentage by payer and overall. Review claim denial rate and top denial reasons. Measure clean claim rate on first submission attempts. Analyze charge lag time from service to billing. Compare performance against industry benchmarks regularly provided.
Revenue Cycle Reports
Run aging reports weekly to identify old balances. Review adjustment reports for write-off patterns and amounts. Monitor payment variance between expected and actual amounts. Track the auth compliance rates for imaging services provided. Analyze procedure volume and revenue trends by modality.
Custom Report Building
Create custom reports for specific practice needs. Filter data by date range, payer, or procedure. Export reports to Excel for deeper analysis offline. Schedule automatic report generation and email delivery. Share reports with management team members regularly. Use custom reports to answer specific business questions.
Best Practices for Staff Training
Proper staff training maximizes Athenahealth system benefits and efficiency. Regular education prevents errors and improves billing accuracy.
Initial System Training
Provide comprehensive onboarding training for all new staff. Cover imaging-specific billing rules and requirements thoroughly. Practice with test patients before live billing begins. Assign mentors to guide new users initially. Test knowledge with practical scenarios and examples. Document training completion for all team members.
Ongoing Education Programs
Schedule monthly training sessions on system updates. Review common errors and prevention strategies together. Share best practices among all team members. Provide access to Athenahealth online training resources. Attend webinars on new features and enhancements. Encourage staff to pursue coding certification courses.
Performance Monitoring
Track individual staff productivity and accuracy metrics. Review error rates by staff member monthly. Provide targeted coaching for repeated mistake patterns. Recognize high performers to encourage continued excellence. Create improvement plans for struggling team members. Monitor progress against goals set in reviews.
Conclusion
Athenahealth offers powerful tools for imaging and radiology billing. Proper charge capture setup prevents missed revenue opportunities. Optimized workflows reduce claim rejections and payment delays. Understanding modifiers ensures correct payment amounts received. Denial management tools improve collection rates when used well. Regular reporting identifies problems and tracks performance improvements.
FAQs
How do I set up imaging templates in Athenahealth?
Go to charge capture settings. Create a new template there. Add CPT codes and modifiers together. Save with a descriptive name for easy finding.
What is the best way to reduce claim denials?
Enable real-time eligibility checking always. Use automated claim scrubbing before submission. Review denial reports weekly for patterns. Train staff on common denial reasons monthly.
How often should I update fee schedules?
Review and update fee schedules quarterly at a minimum. Update right away when insurance contracts renew. Check rates match contracted amounts with payers.
Can Athenahealth apply modifiers automatically?
Yes, set default modifiers in procedure setup. The system can apply the technical component modifier automatically. Review auto-applied modifiers before final submission.
What reports should I review regularly?
Check days in AR weekly at a minimum. Review denial reports and aging reports often. Monitor the clean claim rate on the first submission. Run revenue cycle reports monthly for trends.
