RCM Mastery with athenahealth: Secrets of Top-Performing Practices

RCM Mastery with athenaOne / anthenaHealth: Secrets of Top-Performing Practices

RCM Mastery with athenahealth: Secrets of Top-Performing Practices

The Power of RCM in Today’s Healthcare Practices.
As the CEO & Founder of GoHealthcare Practice Solutions, LLC, I’ve seen firsthand how Revenue Cycle Management (RCM) can make or break a medical practice. In today’s complex, fast-paced healthcare landscape, mastering RCM is no longer optional, it’s essential. With shrinking margins, increasing regulations, and patient financial responsibility at an all-time high, healthcare providers must adopt robust systems that optimize both front-end and back-end revenue processes.

One of the most powerful tools we deploy for our clients is athenahealth RCM, particularly athenaOne billing. Over the last five years, our expert team has partnered with practices to leverage athenahealth’s capabilities, streamline their revenue operations, and deliver measurable improvements in cash flow, claim resolution, and denial rates.

In this article, I’ll walk you through the secrets behind top-performing medical practices using athenahealth and how GoHealthcare Practice Solutions helps them stay ahead.

The Challenges of Revenue Cycle Management in 2025
Today’s practices face a host of challenges:

• Evolving payer rules and fee schedules
• Complex pre-authorization processes
• High patient deductibles and co-insurance
• Delayed reimbursements from both payers and patients
• Workforce shortages and training gaps

RCM isn’t just about sending out claims, it’s about managing the entire financial journey, from scheduling and verification to payment posting and appeals. Poorly managed RCM can lead to increased days in A/R, ballooning denials, and ultimately, lost revenue.

Why Top Practices Choose athenahealth
athenahealth is a cloud-based powerhouse that offers integrated solutions across clinical, financial, and operational workflows. Practices choose athenaOne billing because of its:

• Seamless claim scrubbing and submission
• Built-in payer rule updates
• Real-time insurance eligibility verification
• Integrated denial tracking
• User-friendly dashboards for KPI monitoring

At GoHealthcare Practice Solutions, we specialize in navigating and optimizing these tools. Our team has over 8 years of deep, hands-on experience with athenahealth (now athenaOne) across multiple specialties and practice sizes.

Secrets of High-Performing Practices Using athenahealth
High-performing practices that use athenahealth have a few things in common:

1. They Don’t Just Implement—They Optimize
These practices don’t treat athenahealth as plug-and-play. They customize it to align with their workflows, configure rules for claim edits, and set up tracking mechanisms for key metrics.
2. They Audit Constantly
Ongoing audits of claims, payments, and rejections help prevent revenue leakage. Automation makes it easier, but human oversight ensures nothing slips through the cracks.
3. They Train Staff Thoroughly
Top-performing teams know how to use athenahealth effectively. From front-desk staff to billing teams, everyone is trained and accountable.
4. They Use Partner Expertise
Working with a partner like GoHealthcare gives practices access to an RCM extension of their team—experts who live and breathe athenaOne billing daily.

Automation & AI in RCM
Automation and AI are transforming RCM. Within athenahealth, we implement features such as:

• Automated eligibility checks
• Intelligent claim edits based on payer behavior
• Denial prediction models
• Chatbots for patient balance reminders

These capabilities free up staff to focus on patient care and complex revenue issues, driving efficiency and reducing errors.

Patient Responsibility Management
With high-deductible plans on the rise, patient payments now represent nearly 35% of practice revenue.
Our team uses athenahealth to:

• Verify patient eligibility in real-time
• Generate accurate estimates before the visit
• Offer payment plans within the portal
• Send automated reminders via email or text

We help practices build trust while collecting more upfront.

Front-end Accuracy & Pre-authorization Processes
Revenue success starts before the visit.

Our strategy includes:

• Insurance verification 48 hours prior to appointments
• Authorization tracking logs built in athenahealth
• Training front-desk staff to collect required documentation
• Scripted communication templates for pre-service collections

By ensuring accuracy up front, we significantly reduce denials and delays downstream.

Denial Management & Reduction Tactics
Denials are a top cause of revenue loss. With athenaOne, we:

• Set up custom denial categories for precise reporting
• Route rejections to designated billing teams in real-time
• Track top 5 denial reasons by payer
• Set 48-hour turnaround goals for appeal submissions

Our team reduces initial denial rates to below 5%, with resolution rates above 90%.

Dashboards, KPIs, and Benchmarking Success
athenahealth provides dashboards that help us monitor key performance indicators (KPIs) such as:

• Clean claim rate
• First-pass resolution rate (FPRR)
• Average days in A/R
• Net collection rate
• Patient collections rate

Using these tools, we benchmark performance monthly and hold teams accountable with data-driven goals.

Our Expert Billing and Coding Strategies at GoHealthcare Practice Solutions
GoHealthcare Practice Solutions isn’t just another practice management company. Our process includes:

• Full athenaOne optimization audits
• A/R takeovers for aging claims
• Denial trends analytics with root cause corrections
• Weekly performance reviews
• Custom SOPs tailored to each client’s workflow

We act as an extension of your team, dedicated to improving collections, reducing denials, and driving operational efficiency.

Real Client Results:
Here are some recent results from our clients using athenahealth:

• Orthopedic practice in NJ: Reduced A/R over 90 days from 32% to 12% within 6 months.
• Multi-specialty clinic in TX: Increased patient collections by 22% through portal-based payment reminders.
• Cardiology group in CA: Achieved 98% FPRR by optimizing front-end claim edits.

These outcomes are achieved through consistent collaboration, system optimization, and expert oversight.

How We Reduce Denials and Days in A/R
Our formula:

• Root cause analysis of top denial reasons
• Daily rejection reviews in athenaOne
• Weekly appeal tracking meetings
• Real-time claim status updates
• Regular payer-specific training for staff

The result? Denials drop. A/R days shrink. Collections go up.

Staff Training and RCM Workflow Redesign
We believe people + process = performance. That’s why we:

• Train front-desk, billers, and coders on athena workflows
• Re-map processes to reduce manual entry
• Standardize documentation to minimize claim errors
• Align team KPIs with financial goals

When every stakeholder is aligned, the system performs better.

Top 10 RCM KPIs with Target Benchmarks

1. KPI Target Benchmark
2. Clean Claim Rate≥95%
3. First Pass Resolution Rate (FPRR)≥90%
4. Average Days in A/R< 35 days
5. Denial Rate< 5%
6. Net Collection Rate≥95%
7. Patient Collection Rate≥80%
8. No Response Rate< 10%
9. Days to Pay< 21 days
10. % of A/R > 90 Days< 10%

Authorization Compliance Rate100%
We help practices track and hit these benchmarks using athenahealth’s built-in tools.
athenaOne Optimization Tips from RCM Experts.

Here are some insider tips from our experts:

1. Use custom rules for charge edits to match payer nuances.
2. Automate recurring charges for predictable services.
3. Enable real-time eligibility alerts in scheduler view.
4. Use the task bucket system to streamline denial workflows.
5. Tag charges with custom attributes for performance tracking.
6. Review clearinghouse rejections daily and adjust scrubbing rules accordingly.
7. Optimize patient statements for clarity and response rates

With the right setup, athenaOne becomes your most powerful financial tool.
Achieving Financial Health in Medical Practices

RCM mastery isn’t a dream, it’s a decision.
At GoHealthcare Practice Solutions, we empower practices to unlock the full potential of athenahealth RCM through expert guidance, customized strategies, and relentless execution. We’ve helped clients across the country turn financial chaos into clarity.

If your practice is ready to elevate performance, reduce denials, and get paid faster, let’s talk.
Schedule a free consultation or revenue cycle audit today.

Let our team of athenaOne billing experts show you what’s possible.

Disclaimer: We are not contracted by, affiliated with, or endorsed by AthenaHealth in any capacity. We do not receive compensation, sponsorship, or any form of payment from AthenaHealth. All references to AthenaHealth are made for informational purposes only and do not imply any official connection.