Tabs:

Find the patient tab (Search tab)

 Search the patients’ last name or the I.D of the patient.

 There’s a “Quick view” where you can see the patient’s’ summary information like demographics, insurance,
outstanding balance, upcoming appointments.
 If I wanted to see the chart of the patient, I’ll click the clinical tab (chart) and it will lead me to the medical
record of the patient.
o First thing that I do is checking the NOTE if there’s something important written in there like if the pt
is eligible or not.

MOSTLY EMR’S are the same. They have:

 Allergy, vaccine, medication tab – Both Historical/Present

 Problem tab – It shows the pt acute or chronic illnesses, shortly the patient’s Active or historical problem in
heath. Plus, the potential dx.
 Result tab – Lab result they did to the patient. (Imaging here)
 Visit Tab – It shows the patients follow up, and when you click the follow up it will show you a lot like reason
of visit, Assessment, and plan but for a quick view, click the “Full encounter summary” and it’ll show you the
everything in detailed but was summarized.

Patient Case

- Different patients’ appointment from the past to the future schedules.

Message box

- Where anyone can message you or if you wanted to message someone for instance the doctor and or maybe the
Athena itself (Welcome greet and so on).

Check in patient: Mostly Telehealth “this is today”

 Homepage
- A patient will appear in there and there’s an icon “check in”, click it.
- check in page – make sure everything is updated, demographics insurance.
- “Done with the checking”, click it if you’re done.
- Click “SAVE”.

In-take (done by the nurse)

 Go to in-take
 Things doing here are, changing clinics pt preferred or you recommended., reasons for visit
 “Done with in take and go to exam”, when you’re done.

Exam

 Visits and cases

 HPI, ROS, P.E, A/P
Billing (Check out and charge entry)

- We able to review and create the claim quickly.

- ICD codes will be selected by the clinicians during the A/P

- If the clinician does the procedure in the office, you’ll see the correct CPT code.

- It shows you if it’s closed.

Additional
MY TASK IN ATHENA:

Reason:

On my average day of work, I start the day by checking my emails. This

way, I can check the information that I requested from different facilities,
download it, then put in the specific folder dates and to EMR and we get
everything organized at the start of the day.
1. It’s my task to use the Athena EMR system to enter and verify patient demographic information, insurance details,
and other relevant data. This accurate information is crucial for successful claims submission.

- Whenever I’m looking for a missing information or I need some information of the patient and need to put it in our
system to bill it, I go to the E-Medical Record where there’s a search engine… If it’s an existing patient basically in our
system there’s already a claim number provided. If its new, there are more information that I can search for like
Patient ID, DOB, SSN, Ins. #, Phone number… that can match the patient’s I’m looking for.

Then by clicking the matched patient there’s a quick view where you can see the patient’s’ summary information like
demographics, insurance, outstanding balance, upcoming appointments. There I can get the information that I
needed.

2. Then, Coding and Charge Capture: I assign appropriate medical codes (such as CPT, ICD-10, and HCPCS codes) to
documented patient services and procedures. The Athena EMR system assists in accurate code selection and ensures
compliance with coding guidelines.

3. and Claim Creation and Submission: Using the Athena EMR system, one of my tasks is to generate electronic claims
based on the coded patient encounters. These claims are then submitted to insurance companies for reimbursement.
The system helps streamline the claim submission process and allows for efficient tracking.

4. Claims Tracking and Follow-Up: I can monitor the status of submitted claims within the Athena EMR system. We
track claims to ensure they are processed and paid by insurance carriers in a timely manner. If claims are denied or
delayed, billers initiate follow-up actions to resolve issues and resubmit if necessary.

5. Once insurance payments are received, we use the Athena EMR system to post and reconcile payments accurately
against the corresponding claims. This task helps maintain accurate financial records and identifies discrepancies.
Payment-Posting.

6. Patient Billing and Statements: I generate patient statements for any remaining balances after insurance payments.
They can utilize the Athena EMR system to send statements, process patient payments, and set up payment plans.
7. When claims are denied, I review denial reasons and work on appeals or corrective actions. This process involves
communication with insurance companies to rectify issues and resubmit claims. We see our task through this
workflow dashboard where u can see column of work queue for claim errors, appointment issues or insurance
eligibility problems. We use this dashboard to create claims that need additional attention. Click on the department
that needs an attention and list of different payers will appear and one’s I click one person its summary will appear
and identify the potential denials before they occur. “As much as possible we prevent denials so there’s no backlogs”.

However, if there’s no potential denial written we can do billing in one or same page like any updates to patient
demographics, insurance, billing codes (There’s a column there where to put or update procedure (CPT codes), units,
dx (ICD), charges (adjustment/Transfer balance), Adding attachments.

If there’s potential denial written like (This procedure requires authorization and the payer does not have valid
authorization information on file). We’ll format the claim send it to the payer and follow up until its paid. Go to
Authorization “add new”, fill out necessary information then save.

Verify Authorization Status: First, confirm whether the procedure actually requires authorization as per the payer's
guidelines. This may involve checking the payer's policies, contacting the provider, or reviewing the patient's
insurance plan documents.

Contact the Payer: If the procedure does indeed require authorization and the payer does not have valid
information, I will initiate contact with the insurance company. Inquire about the specific authorization requirements,
the process for obtaining any necessary forms or documentation. Then..

When Initiating Authorization Process: we’ll work with the healthcare provider to gather the necessary clinical
documentation, MR, and other supporting information required for the authorization. They will then submit this
information to the payer for review and approval.

Then Appeal or Request Retroactive Authorization: In some cases, we may need to appeal the denial of
authorization or request. This involves providing additional information or documentation to demonstrate the medical
necessity of the procedure.

Throughout the process we biller will maintain open communication with the healthcare provider and the patient.
Keep them informed about the authorization status, any documentation required, and the progress of the appeal.

If the authorization issue cannot be resolved immediately, We may place a temporary hold on billing the patient for
the procedure until the authorization is obtained. This helps prevent the patient from receiving an inaccurate or
unexpected bill.

After all the process, Document Everything: Detailed documentation of all communication, authorization requests,
appeals, and other actions taken is crucial. This documentation serves as a record of the steps taken to address the
authorization issue and can be useful for reference in case of disputes or inquiries.

If Necessary, Follow Up and Escalate: If the initial attempts to obtain authorization are unsuccessful, the medical
biller may escalate the matter within the insurance company or explore other avenues to resolve the issue, such as
involving the provider's credentialing department or reaching out to regulatory agencies if needed.

Ultimately, the goal is to ensure that the necessary authorization is obtained so that the procedure can be billed and
processed correctly with the insurance company, reducing potential financial burden on the patient, and facilitating
proper reimbursement for the healthcare provider.

8. Reports and Analytics: Medical billers may generate reports and analytics using the Athena EMR system to track
key performance indicators (KPIs), revenue trends, claim submission success rates, and other metrics that provide
insights into the financial health of the practice.

9. Compliance and Regulations: The Athena EMR system often incorporates built-in compliance features, helping
medical billers adhere to industry regulations, coding guidelines, and documentation requirements.

10. Communication: The Athena EMR system enables secure communication and collaboration among different
departments, including billing, coding, and clinical staff, ensuring accurate billing and comprehensive patient care.
In summary, the tasks of a medical biller in an Athena EMR environment encompass various aspects of revenue cycle
management, from coding and claim submission to payment posting and denial resolution..

And I make sure before my shift ends, I did emails. Its one of my task to send email to different facilities or
departments. Like I said earlier that I start my day by checking emails for the information that I requested and I
ended it with emails requesting for specific information like patients information or missing CPT or ICD and so on to
reduce backlogs or delay of services.