athenahealth Releases First "PayerView" Ranking for Texas Health Insurers and Payers; Humana and Aetna Pay Texas Physicians the Fastest.

WATERTOWN, Mass. and HOUSTON -- athenahealth, Inc., the premier provider of web-based services, knowledge, and software for medical practices, today released its "PayerView" rankings for the state of Texas. The Texas PayerView rankings analyze claim performance data from more than 330 providers and 59 medical practices using athenahealth's athenaNet[R] database. Texas' health insurers and various payer organizations are ranked according to specific measures of financial and administrative performance and medical policy complexity in payment performance with physicians as these are experienced by the users of athenahealth's systems. Texas is the first PayerView state ranking athenahealth has released.

The Texas PayerView ranking was compiled using athenahealth claims data from the second quarter of 2006. The data includes an analysis of over 295,000 charge lines for the quarter, and includes government and private payer organizations with at least 1,500 charge lines of data for the quarter.

Highlights of the Texas PayerView rankings include:

* Medicare B-TX outperformed the state's private insurers on denials, denying only 5.6 percent of claims submitted.

* Medicaid-TX denied Texas physicians' claims 23 percent of the time, greater than any other insurer, and averaged 65 Days in Accounts Receivable (DAR), meaning that it took an average of 65 days to pay physicians for claims it did not dispute.

* Among national, private health insurers, Humana paid physicians the fastest, averaging only 28.5 DAR , followed by Aetna with 30.2 days.

* Private health insurer UniCare Life & Health Insurance Company (an operating affiliate of WellPoint, Inc.) shifted responsibility to the patient to pay the doctor more than any other payer on the ranking.

"Transparency continues to be one of the dominant themes in healthcare today, reinforced recently by the President's executive order requiring federal agencies to gather information about the quality and price of care and share that information with beneficiaries," said Todd Park, co-founder and chief development officer of athenahealth. "And yet, for the other major healthcare supply chain member, the insurer, there is virtually no actionable apples-to-apples data available to measure how well or poorly they perform one of their primary functions - paying for healthcare. The Texas PayerView ranking makes this various insurer and payer performance data publicly available and is an important step in bringing transparency to all stakeholders in healthcare."

In May of 2006, athenahealth and Physicians Practice[R], America's leading practice management journal for physicians, released the first annual national PayerView report highlighting the current rift between health insurers and physicians across the nation that was drawn from athenahealth's complete database of over 8,000 providers and more than 700 medical groups. Physicians Practice's senior editors worked with athenahealth analysts to identify appropriate performance measures, and devised a method of analyzing them.

Metrics for each category include:

* Financial Performance

* Days in Accounts Receivable (DAR) - On average, a measure of the length of time it takes a health plan to pay a claim. To determine DAR rankings, athenahealth began counting days from the date on which service was rendered to the patient to the date payment was received (the physician's standard definition).

* First Pass Pay Rate (FPP) - Percentage of claims that get paid in full the first time they are submitted. If a payer paid the claim without re-submission but only after 90 days, athenahealth did not count that as a first pass pay.

* Percent Patient Liability - Percentage of billed charges that insurers transfer to "patient responsibility" - i.e., to be paid directly by the patient. This metric reflects the burden placed on physicians to extract collections from patients due to increasing coinsurance obligations and the advent of consumer-directed or high-deductible plans. Insurers typically communicate that patients are responsible for paying part or all of a given doctor's bill weeks or even months after the doctor saw the patient. This makes these balances quite difficult for physicians to collect.

* Administrative Performance

* Denial Rate - This measure includes not just outright claim denials, but line items requiring any back-end rework by the physician. The more rework is required, the longer it takes to get paid and the more resources the physician has to spend to collect payment.

* Percent Phone Call - Percentage of claims requiring physician offices to call the health plan for clarification/corrective action when a claim has been submitted and the provider has received a response from the health insurer but is unclear on the response. For example, the payer may have used a certain code but did not provide a glossary for the code.

* Percent of Not on File (NOF) - Percentage of claims submitted by the physician that didn't make it into the insurer's claim processing systems for adjudication (i.e., were lost). Physicians are forced to resubmit these claims and go through the billing cycle all over again.

* Medical Policy Compliance

* Unclear Zero Pay - Percentage of claims that, although they comply with the national Medicare Correct Coding Initiative and would receive payment under the Medicare program, are in fact "paid" at zero dollars. The entire claim is written off due to the insurer's departure from these standard coding rules. The basis for these denials tends to be unclear, generally due to the complexity of a payer's rules. athenahealth considers these claims to be legitimate candidates for appeal.

The complete Texas PayerView rankings and methodology used are available at www.athenahealth.com/Texas. The website is designed to allow physician practices, medical societies, media, consumers and payers to compare the rankings and performance of specific insurers by region. Providers are encouraged to leverage the site in order to better evaluate their payer mix. athenahealth also hopes payers will use the site to guide quality improvement efforts.

For Texas PayerView rankings, athenahealth defines "payer" as a managed care organization, health insurer, military health plan, HMO, preferred provider organization, third party administrator, or Medicare or Medicaid plan, carrier or intermediary. The data presented in the ranking represents the experience that athenahealth has observed in transactions with these organizations by and on behalf of athenahealth physician clients who are engaged in submitting claims to these entities, and who in many cases are contracting with them on negotiated payment terms for the services that the physicians provide. The ranking does not present or ascribe causes for that experience. For example, depending on the role that a payer has assumed in connection with claims for payment, the PayerView ranking of the payer may be caused in whole or in part by the actions or processes of others, including other payers, with whom the payer in turn conducts business. athenahealth looks forward to working with any payer to identify and eliminate causes of adverse experience in any of the ranked categories.

About athenahealth, Inc.

athenahealth provides the only physician revenue and clinical cycle management offering that integrates web-based practice management and EMR software, continually updated payer knowledge, and back office processing specialists into a single service. The results are faster payment at lower cost, increased patient care, higher revenue retention and less hassle for the more than 8,000 providers using athenahealth nationwide. The company collects close to $2 billion on behalf of its clients annually. athenahealth is dedicated to helping providers make optimum use of their time, ultimately improving the quality of service delivered and the financial reward for it. For more information about athenahealth, visit our Web site at www.athenahealth.com or call 1-888-652-8200.