ATHENAHEALTH, INC 
By WATERTOWN, Mass., May 25, 2011 (BUSINESS WIRE) -- athenahealth, Inc. (NASDAQ: ATHN), a leading provider of cloud-basedpractice management, electronic health record (EHR), and patient communication services to medical groups, and Physicians Practice(R), America's leading practice management journal for physicians, today released the sixth annual PayerView(R)Rankings. The Rankings are designed to look at payers' performance based on a number of criteria that, when combined, provide an overall ranking that quantifies the "ease of doing business with the payer." Results this year indicate that the majority of health insurers made incremental progress over last year in paying physicians, doing so on average, one day faster while denying 5% fewer claims.
This year Aetna moved up the rankings to claim top performance spots across several of the PayerView segments. Aetna was the #1 payer in the Major Payer segment, which includes Humana, Champus/Tricare, Cigna, HCSC, Medicare B, UnitedHealth Group, and Wellpoint. Aetna also ranked first in the National Commercial Payer segment, which includes Humana, Cigna, and UnitedHealthcare.
The complete 2011 PayerView Rankings and corresponding trends, evaluating 132 national, regional, and government payers can be found at www.athenahealth.com/PayerView. This year's index tracks performance data from more than 27,000 providers representing more than 47 million charge lines and $9 billion dollars in services billed in 41 states for the full year 2010. The data is derived from athenahealth's web-based medical billing and practice management platform, athenaCollector(R), and ranks health insurers in areas of financial performance, administrative performance, and transaction efficacy. All data used for the rankings come from the actual claims performance data of athenahealth providers and reflect athenahealth's direct experience in dealing with individual payers nationwide.
Among the key findings and trends revealed:
- National payers out-performed government payers; Aetna ranked top in first pass resolve rate (96.8%) and Humana had the lowest DAR (22.5 days) of the eight payers included in the Major Payer segment.
- After achieving #1 in Eligibility Accuracy in the 2010 results, Medicare performance significantly declined in 2011. athenahealth data suggests that coordination of benefits information contained in Medicare's eligibility transaction does not correlate with Medicare's backend adjudication systems.
- BlueCross BlueShield plans led payers in the transfer of responsibility to patients (according to PayerView, patient liability amounts are increasing across the industry).
- ERA Transparency - a metric new to PayerView this year - reveals that while the industry at large has had a difficult time transitioning to the standard ERA code set, in some instances causing providers to rely on paper remittance, the State Medicaids have had the most difficult time adopting the standard (average ERA Transparency rate of 76.7% compared to Medicare's rate of 97.1%).
Payers' progress across several key metrics validates athenahealth's ongoing efforts on behalf of its national physician network to use PayerView to uncover process gaps that exist between payers and medical providers. The rankings also highlight the pressures on the private and government sectors to improve complex administrative processes and reduce cost waste across the health care delivery supply chain. These efforts become even more urgent when set against the expansion of highly stressed state Medicaid programs (worst performers according to PayerView) under reform legislation.
"PayerView has developed into something that allows physicians to regain leverage with payers because they now have as robust of a data set as the payers have," said Jonathan Bush, Chairman and CEO of athenahealth. "We're pleased to see that PayerView has become a motivational tool, used proactively by payers to identify and then mend their process breakdowns and improve their performance on a host of administrative issues that have long been sore points for practicing physicians."
"Payers used to only react to these rankings, as opposed to engaging and collaborating year-round in PayerView's mission of closing costly administrative breakdowns and getting doctors paid sooner for service rendered," says Bob Keaveney, Editorial Director of Physicians Practice, which reports on the annual PayerView Rankings for its 200,000 readers. "Six years in, this has morphed into an iterative process used to advantage by both sides - payers and physicians. It's an uncensored, completely transparent gauge of strides made and strides yet to be made. This year's data show that the government and private sectors in health care are capable of employing tactical, practical things like electronic transactions to drive efficiencies."
About Physicians Practice
Physicians Practice creates content to help physicians strengthen their practice operations to improve patient care through its award-winning journal, popular Web site, audio conferences, newsletters, and live seminars. Physicians Practice(R), America's Leading Practice Management resource, has received numerous awards, including: Publication of the Year, Best Publication Redesign, and Best Regular Column for "The Bigger Picture" from the American Society of Healthcare Publication Editors (ASHPE); Publication Redesign from the American Society of Business Publication Editors (ASBPE); and recognition as one of Baltimore's Future 50 companies from SmartCEO magazine. For more information about Physicians Practice, visit our web site at www.PhysiciansPractice.com.
About athenahealth
athenahealth, Inc. is a leading provider of cloud-based business services for physician practices. athenahealth's service offerings are based on proprietary web-native practice management and electronic health record (EHR) software, a continuously updated payer knowledge-base, integrated back-office service operations, and automated and live patient communication services. For more information, please visit http://www.athenahealth.com/ or call (888) 652-8200.
This press release contains forward-looking statements, which are made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995, including statements regarding the anticipated benefits and potential for meaningful useof athenahealth's service offerings, the nature of prospective markets for those offerings, and the development an accountable care organization. These statements are neither promises nor guarantees, and are subject to a variety of risks and uncertainties, many of which are beyond our control, which could cause actual results to differ materially from those contemplated in these forward-looking statements. In particular, the risks and uncertainties include, among other things: the risk that our service offerings will not operate in the manner that we expect, due to design flaws, security breaches, or otherwise; potential interruptions or delays in our internet-based service offerings; our reliance upon third parties, such as computer hardware, software, data-hosting, and internet infrastructure providers, which reliance may result in failures or disruptions in our service offerings; errors or omissions included in our payer and clinical intelligence rules engine and database; and the evolving and complex government regulatory compliance environment in which we and our clients operate. Existing and prospective investors are cautioned not to place undue reliance on these forward-looking statements, which speak only as of the date hereof. athenahealth undertakes no obligation to update or revise the information contained in this press release, whether as a result of new information, future events or circumstances, or otherwise. For additional disclosure regarding these and other risks faced by athenahealth, please see the disclosure contained in our public filings with the Securities and Exchange Commission, available on the Investors section of our website at http://www.athenahealth.com and on the SEC's website at http://www.sec.gov.
SOURCE: athenahealth, Inc.
athenahealth, Inc.
John Hallock (Media), 617-402-1428 Director, Corporate Communicationsmedia@athenahealth.com or Jennifer Heizer (Investors), 617-402-1322 Director, Investor Relationsinvestorrelations@athenahealth.com- Payers Lift Denial Burdens Off Physicians, But Shift More Patient Collection Tasks to Practices
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