Athenahealth Fee Schedule Optimization: How to Review, Adjust, and Boost Revenue (Lesson 1)

Maintaining a profitable and compliant fee schedule is a must for every athenaOne practice. Outdated CPT codes, inaccurate allowable amounts, or stagnant charge rates can lead to lost revenue and claim denials. In this guide, we walk through how to review and optimize your athenahealth fee schedule.

What Is a Fee Schedule?

A fee schedule is a table of CPT (procedure) codes and their corresponding fees charged by a practice under a contract with a particular insurance package or allowable category. You can manually create fee schedules or provide athenahealth a spreadsheet of procedure codes and fees for importing.

💡 For athenaOne practices – We recommend reviewing your fee schedule at least once a year to ensure you're charging appropriately and not missing revenue opportunities.

Why Should I Update My Fee Schedule Annually?

• Remove expired CPT codes that may cause claim rejections.

• Add new CPT codes or update descriptions for billing accuracy.

• Ensure all charges exceed allowed amounts to avoid underpayment.

How Do I Know IF My Fee Schedule Needs Optimization?

1.Compare with Official Code Changes

• Compare the latest code updates at CMS.gov or AMA to get the new code changes, then match to your fee schedule.

• You can also use:

  • Validate Codes tool in the Claim Edit screen.

  • Or go to Claims > Code and Knowledge Base to search by code.

2. Run the Payment Mismatch Tracking Report

This report compares your allowed amounts to your actual charges. If you have your allowable schedules (contracted rates) loaded in athenahealth already, this report will show below, at, or above expected amount. If you do not have any contracted rates loaded, you will only see unknown -- which can still be helpful.

Steps to Run the Report:

1. Navigate to Reports > Payment Mismatch Tracking.

2. Set Start/End Dates (e.g., YTD) and filter by Payment Post Date. Keep all other fields unchecked,

3. Choose XML output for full functionality.

4. Use the hyperlinks on the left to open tabs for:

   • “Below Expected”

   • “At Expected”

   • “Above Expected”

   • “Unknown”

5. Download the lists as .csv files.

6. Review the “charge” vs. “allowed amount” columns.

   • If your charges match or are below the allowed amount, consider an update.

⚠️ We recommend ensuring your charge amounts are always above the allowed reimbursement rates.

Need Help With Fee Schedule Optimization?

Our athenahealth consultants can analyze your payment mismatch trends and help update your fee schedules strategically.
📞 Contact us today to make sure you’re not leaving money on the table.