7 Ways Athena Users Can Increase Collections
Why Athena Users Need to Take Control
If You Aren’t Actively Involved in Your Athena Billing, You are Losing Money
Athena software is a favorite among many pediatricians, but if you aren’t taking extra steps in following up behind Athena’s billing team, you are definitely leaving money behind. You likely have things that have gone to patient responsibility that payers should be paying, you are probably seeing your AR over 90 days slowly grow, and your team’s Holds are growing.
Following up on the Athena billing team can be difficult and frustrating, but at Altus we have an entire team dedicated exclusively to Athena clients. We have created an entire process for our team to follow up on the billing and in this article, we’re sharing it with you so that you can ensure Athena is collecting everything they should for you.
See the seven steps you can take to grow your collections with Athena below.
7 Steps to Increase Athena Collections
Step 1: Work HOLD and MGRHOLD Lists
This is the billing follow-up Athena told you about as a new client. Every office likely has this as part of their workflow, but be sure to check in and validate that it is getting worked in a timely manner.
Step 2: Address Athena-Assigned Holds
Work Athena’s Holds under the CBOHOLD and ATHENAHOLD Listings
These are the holds Athena assigns themselves, but they are often not worked until claims have aged 45
to 60 days. Start follow-up at 30 days and work these before Athena has a chance to get to them so you can get paid faster.
Step 3: Ensure Accurate Claim Scrubbing
Claims should be scrubbed before being sent
Athena’s technology will allow for different coding based on different payers, but if it hasn’t already been set up or if another rule supersedes the coding rule, it is lost and the procedure can be denied in error.
We see many errors with state Medicaid rules and when commercial payer coding requirements change.
We also have a number of examples where the NDC was misused. A current coding example is with COVID-19 vaccines. The “coding advice” tool recommends $0 charges for several commercial plans, even though the practices now use private stock.
Step 4: Conduct Thorough Coding Reviews
Review notes as needed.
Athena offers an enhanced coding package, but in our experience, it is not sufficient when trying to identify coding issues. We see many problems with how screening tools and vaccine extra components (90461s) are coded.
Step 5: Verify Posted Payment Accuracy
There are ongoing concerns with payment posting accuracy. When done incorrectly, we open a case to get it fixed, as Athena does not allow clients to fix these errors themselves.
Step 6: Initiate Proactive Claim Follow-Up
Start your own aggressive follow-up on claims 30 days after the date of service.
Though Athena will work on these, they often are not reviewing them until it is close to timely filing limits. We have seen numerous occasions where Athena is unable to follow up on a claim because they have locked themselves out of a payer’s system and then assigned the claim to the office. Athena will also transfer many claims to patient responsibility without review.
Step 7: Review All Denials and Appeals
Athena will appeal a claim with a standard Athena letter, but it does not follow the payer’s appeal process. Athena will also accept denials they shouldn’t and write off the claims or procedures. At times, Athena will get very far behind in payment posting and will not see some denials until very close to timely filing.
If You Aren’t Actively Involved in Your Athena Billing, You are Losing Money
If you are an Athena client and you are not providing extensive follow-up on their work, you are probably leaving money behind, and you likely don’t know where to start to recover that revenue.
Athena claims to do the billing and that is a service you are paying for, but adding your own follow-up will ensure you don’t have things written off that shouldn’t pay. The Altus process outlined above will give you a structure to continuously review all claims in Athena, from claim submission to final payment.
Contact a Pediatric Medical Billing Consultant
If you have questions about this or any other ways to follow up on the work Athena is doing for your pediatric practice, schedule a meeting with our pediatric billing team and we can go over your collections.