Athenahealth Features That Will Make Your Life Easier: Part 2- Claim Custom Rules

Claim Custom Rules :

This instance of the “Athenahealth Features That Will Make Your Life Easier” will highlight athena’s “My Custom Rule Parameters.” Anytime you see the words “My” and “Custom” in the same header then you know it’s got to be good!  

There are six tables within this section of the Billing Admin settings – Procedures that Require Modifiers, Procedures that Require Coding Review, Non-Billable Procedures, Procedures that Require Authorization/Referral, Invalid Modifiers, and Invalid Diagnosis Codes. Each table allows Revenue Cycle leads at a practice to set claims on HOLD or MGRHOLD based on the criteria that the practice requires.

For example, let’s say you just noticed that a payer hasn’t been reimbursing you at the correct rate for a specific procedure and you want to immediately stop submitting any additional claims to that payer until you have additional conversations with the payer. No need to comb through your Missing Slips each day or monitor your billers to ensure they are manually holding claims one by one. You can use the “Procedures that Require Coding Review” table to place a HOLD on claims specifically for that payer.

Did you know this athena feature existed? If not, let's chat! We'd love to help you implement these at your practice to be more efficient!