Instead of charging a flat monthly fee per user or per provider, athenahealth takes a cut of the money your practice actually collects. This unique model aligns their incentives with yours — but it also means your cost can vary significantly month to month.
Services rendered to patients. Diagnoses coded, procedures documented in athenaOne EHR.
athenahealth's RCM team submits claims to insurance payers electronically within 24 hours.
Insurance payers remit payment. athenahealth posts ERAs, manages denials, and pursues patient balances.
athenahealth applies 4-7% to net collections deposited to your bank account.
The athenahealth fee applies to your net collections — not your charges, not your gross receipts. Net collections are defined as payments actually received from:
Important: Net collections are typically 70-85% of gross charges for a well-run practice. If you charge $100,000/month but adjust for contracts and bad debt, your net collections may be $75,000 — and the athenahealth percentage applies to that $75,000 figure.
| Factor | Impact on Rate | Typical Effect |
|---|---|---|
| Number of providers | Higher count = lower rate | ↓ 0.5–1.5% for 10+ providers |
| Monthly collections volume | Higher volume = lower rate | ↓ 0.25–1% for $200k+/month |
| Contract length | Longer term = lower rate | ↓ 0.25–0.5% for 3-year |
| Specialty complexity | Complex billing = slight premium | ↑ 0.25–0.5% for subspecialties |
| Payer mix | Government-heavy payers = possible adjustment | Varies |
| Modules selected | Full suite vs. EHR only | RCM included drives higher % |
| Negotiation leverage | Competition in your market | ↓ 0.5–1% with competitive quotes |
The collections model can be advantageous or costly depending on your practice size, specialty, and growth trajectory. Here's how to think about whether it works for you.
Obtain quotes from NextGen, Kareo, or AdvancedMD before negotiating with athenahealth. Use these as leverage to push below 5%.
athenahealth will discount 0.25–0.5% for 3-year commitments versus year-to-year agreements.
If you have satellite offices, negotiate a single enterprise agreement for all locations combined to reach volume thresholds.
Request a clause tying fees to collections improvement — if athenahealth doesn't improve your collections rate, your percentage should decrease.
athenahealth sales reps have quarterly quotas. Negotiations in late March, June, September, or December often yield better terms.