This site is not affiliated with athenahealth, Inc. All pricing sourced independently from public sources. Verify current pricing at athenahealth.com.
athenahealth ROI: Do Higher Collections Offset the Cost?
The fundamental promise of athenahealth's collections model is alignment: they only earn more when you collect more. But the real question is whether the collections improvement athenahealth delivers exceeds what you pay. The answer depends entirely on your starting point.
If you improve collections...
athenahealth claims 98% first-pass acceptance vs 70–80% industry average. Practices see 5–15% collections improvement when starting from a low baseline.
And you replace your billing team...
In-house billing for a 10-provider practice typically costs $15,000–$40,000/month in staff. athenahealth replaces this with the collections percentage.
ROI depends on your baseline
A practice at 80% collections gains most. A practice at 95% gains little. Use our scenarios below to model your specific situation.
ROI Scenarios: 10-Provider Practice ($500K/month gross)
Each scenario assumes the same gross billing volume and practice size — only the starting collections rate and existing billing cost differ. athenahealth fee assumes 5% collections rate.
Practice with poor billing (80% collections)
+$75,350/mo net gainPractice with average billing (88% collections)
+$22,350/mo net gainPractice with good billing (94% collections)
$5,150/mo net lossEstimates assume in-house billing replacement costs as shown. Productivity transition losses not included. Net ROI = (collections improvement + billing savings) − athenahealth fee.
Break-Even Analysis
The break-even point for athenahealth's collections fee compared to in-house billing depends on your current collections rate and billing cost:
| Current Collections Rate | Athena Improvement Needed to Break Even | Verdict |
|---|---|---|
| 75–80% | 3–5% improvement (achievable) | Strong ROI case |
| 82–88% | 2–3% improvement (achievable for many) | Good ROI case with billing savings |
| 90–94% | 1–2% improvement (marginal) | Dependent on billing cost savings |
| 95%+ | <1% improvement (very hard) | Likely no ROI — flat rate may be better |
What to Measure Before Deciding
Your current net collections rate
Divide total cash collected by total charges (adjusted for contractual write-offs). Industry average is 85–90%. If you're already at 95%, athenahealth has little room to improve you.
Your current billing cost
Add up billing staff salaries, benefits, clearinghouse fees, postage, and outsourced billing fees. This is what athenahealth's fee replaces. If this is already low, the case for switching weakens.
Your denial rate
Track what percentage of claims are denied on first submission. Above 15% is a red flag — athenahealth's 98% first-pass rate would be transformative. Below 5% suggests you already have efficient billing.
Days in AR
How long does it take to collect on average? Industry benchmark is 30–40 days. Above 60 days indicates billing inefficiency. athenahealth typically improves days-in-AR for practices with existing inefficiencies.
Frequently Asked Questions
Does athenahealth improve collections?
athenahealth claims an average first-pass claim acceptance rate of 98% compared to the industry average of 70–80%. Practices switching from inefficient billing often see 5–15% improvement in net collections. However, this improvement is practice-specific — those already running efficient billing operations at 95%+ collections see minimal improvement. athenahealth publishes case studies but independent validation varies.
What is athenahealth's ROI for a typical practice?
ROI depends on your starting collections rate. A practice at 85% collections spending $50,000/month on billing that improves to 93% with athenahealth collects an additional $32,000/month (8% of $400,000 gross). At a 5% athenahealth fee on $332,000 net collections, the cost is $16,600/month. Net ROI: +$15,400/month vs previous billing cost. This scenario represents a clear win. But a practice already at 93% would see no improvement and pay the percentage on top of current performance.
How long until you break even on athenahealth implementation?
Break-even on implementation costs ($1,000–$8,000) is typically 1–3 months if athenahealth improves collections. But you must also account for the 4–6 week productivity drop during transition. Total payback period for switching to athenahealth from an inefficient system is typically 2–4 months. For practices with efficient billing, there may be no break-even point — it costs more indefinitely.