1. What is Insights?
Insights is the user interface (UI) for Athelas’ Revenue Cycle Management (RCM) product. The landing page looks like this:
The goal of Athelas RCM is to automate medical billing processes to reduce denials, boost collections, and free up considerable amounts of time for medical staff to spend with patients, rather than doing paperwork.
2. Why should I use Insights?
Medical billing in the US Healthcare system is an extremely complex undertaking, highly prone to human error and costly when done incorrectly. This is because insurance companies will not pay out incorrectly-filed claims.
Because of this dynamic, the national average denial rate hovers around 11% annually.
Insights’ proprietary rules engines attack this problem head-on, applying both global and custom rules to each claim, depending on the practice and payer involved. Medical practices that use Insights see their denials rate drop dramatically, leading to thousands and sometimes millions of dollars recovered, as you can see in these examples from current customers’ sites:
3. How do I navigate the platform?
The speediest way to navigate Insights is by holding Command + K on a Mac, or Ctrl + K on a PC. This will bring up a universal search modal. From here, you can type in anything you need–a patient’s name, an encounter ID, or even just search for PR Settings.
In this example, you can see the first several navigation options with the keyword testing.
Alternatively, you can navigate using the left-hand side panel that lists Insights pages, organized into categorical dropdown menus, as shown in this screenshot.
4. How do I get help when I’m stuck?
Many problems you encounter in Insights can be solved on your own. We have resources to guide you through Insights and explain what’s happening at various steps along the way.
- The first place to check when you get stuck on a page or process is in our help center, linked here. It is also linked in the
informationicon in the header bar on Insights.
We recommend searching for basic keywords or phrases in the search bar, rather than scrolling through all these individual guides.
For example, if you want to find out what patients see when you email them a statement, you could type statement in the search bar to see if an article exists that may help.
Turns out, there is one!
Of course, feel free to reach out to your Athelas representative for assistance at any time.
🚩 Common Feature Flags
1. Why is there a negative balance on this encounter or claim?
Here is an illustrative example of a situation in which negative balance would appear.
- A claim for $200 is submitted for a single procedure
- The payer decides to pay $100 for this procedure
- This $100 remit gets posted and goes toward the balance
- Then, the payer updates their decision to pay $120 instead. They send a second remit, but they don't claw back the first. Now there's a balance of -$20
- For net new remittances, our system would have Paused here for manual review, rather than automatically posting and creating a negative balance. However for older remits, some of these double postings slipped through from our old system
- Now, the practice has to do some manual work to decide which remit to post and which to negate, or wait for the payer to claw back one of the remits, before the balance is pushed to PR
- Usually the payer has already clawed the money back, they just don't indicate it on the remittance. As of 8/28/24, only the Athelas Ops team has the ability to reconcile conflicting remits, but in the coming weeks, sites will be able to do it in Insights.
This screenshot shows that secondary insurance overpaid by $49.13. It would be up to the Ops team to verify whether this payment has been rescinded by the payer yet, before balancing
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