About billing in athenahealth
athenaOne combines the EHR (athenaClinicals) with athenaCollector, athenahealth's practice management and revenue cycle service for billing, claims submission, authorization and denial management, and patient collections. athenahealth says more than 30,000 rules scrub claims before they are sent to payers, and its Rules Engine assigns each claim a status such as DROP, HOLD or MGRHOLD. Depending on the athenaCollector package, athenahealth or the practice posts payments and follows up on billed claims. athenaOne is used by solo and small practices, multi-site medical groups, urgent care centers, FQHCs and larger health systems.
Does SFA work with athenahealth?
Yes. We work inside your athenaOne account using user logins your practice creates for us. We have no official partnership or integration with athenahealth, and we do not touch queues athenahealth reserves for its own staff, such as CBOHOLD.
What billing work does SFA handle in athenahealth?
We clear HOLD and MGRHOLD claims by kick code, handle charge entry and coding review where needed, and work the follow-up your athenaCollector package leaves with the practice. If you are on a No Posting or No Follow-Up package, we also post payments and work BILLED and FOLLOWUP claims.
How does onboarding work?
It starts with a free practice audit, where we review your billing in athenahealth and walk you through where revenue may be slipping. If you move forward, we sign a Business Associate Agreement, your administrator creates user accounts for our team, and we review your payer list, fee schedules and open A/R. We also confirm which athenaCollector package you are on, because it decides which tasks belong to athenahealth and which belong to your practice.
Do we need to change our EHR?
No. We work inside your existing athenahealth setup, so there is no migration and your providers keep documenting the way they do today. Your athenaOne setup and athenahealth's own services stay in place; we fill in the work your package assigns to the practice.
What access does SFA need?
We need athenaOne user accounts with billing permissions for claim worklists, Claim Action, charge entry and, where your package requires it, payment posting. Your practice administrator sets the permissions and can deactivate the accounts whenever you choose.
How are claims handled?
athenaOne scrubs every new claim and puts errors into HOLD or MGRHOLD with a kick code. We work the Claim Worklists by kick reason, follow the Claim Notes, correct the claim and let the Rules Engine rescrub it. Claims are reviewed against applicable billing, coding and payer-specific rules (10,000+ in our workflow) before submission to help identify preventable errors.
How are payments posted?
On the standard athenaCollector service, athenahealth posts payments, and we review posted activity for short pays and missing remittances. On a No Posting package, we post insurance and patient payments on the Post Payment page and reconcile them to deposits.
How are denials worked?
Denials that athenahealth reviews sit in CBOHOLD and come back to the practice with advice when they need practice action. We act on that advice, fix coding or documentation issues with your providers, and file corrected claims or appeals before the payer's deadline.
How does SFA Intelligence fit in?
SFA Intelligence is our AI-assisted workflow, powered by the RCM Employee platform, which we license. It works alongside athenahealth, reading the claim and remittance data your practice authorizes, to run eligibility checks (270/271), check coding against NCCI edits, scrub claims, categorize denials by reason, flag timely-filing risk in A/R and reconcile 835 payments to spot underpayments. Your team keeps using athenahealth as usual, and our billers review and own every claim decision. There is no direct integration with athenahealth, only the access your practice grants.
What reporting will we get?
You get monthly reporting on collections, A/R aging, denials and clean claim rate, reviewed with your named account manager. We combine athenaOne's own reporting with our review of held claims by kick code, so you can see which errors come from the front desk and which come from coding. Figures are reconciled to what athenahealth shows, so your numbers and ours match.
What security controls apply?
We sign a BAA before any work begins, and our U.S.-based team is HIPAA trained. Staff systems use MFA, staff devices are encrypted, and we complete an annual HIPAA security risk assessment. Your practice creates our athenahealth accounts and can change or revoke them at any time.
What does implementation look like?
After the BAA is signed and accounts are active, we can typically begin within 24 hours of receiving system access. The first weeks focus on clearing held or rejected claims, confirming ERA enrollment with your main payers and building an A/R worklist by age and filing deadline. We also watch claims flagged ATHENADROP, which athenaOne marks when an unsubmitted claim is 15 days from the payer's filing deadline. Your named account manager is your single point of contact throughout.
Billing tips for athenahealth practices
Work holds by kick code
The Claim Worklists show each held claim once, under its current kick reason. Assigning by kick code (AUTH, CPT, DIAGNOSIS and so on) lets one person fix the same error type in a batch and spot the upstream cause.
Know your package before you post
athenahealth posts payments for standard athenaCollector clients, while No Posting clients post their own on the Post Payment page. Posting in the wrong place, or twice, is a common cleanup job after staff turnover.
Treat ATHENADROP as a deadline alarm
ATHENADROP means an unsubmitted claim is 15 days from the payer's filing limit. Those claims need same-day attention, before they turn into FWRFILINGLIMIT write-offs.
Sources
- athenaOne User Guide: Billing Overview
- athenaOne User Guide: How to Correct Claims in Hold Queues
- athenahealth: athenaCollector, athenaCommunicator, athenaClinicals
- athenahealth: Enhanced Claim Resolution
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