Choosing EHR / EMR Vendor - Importance of Claims Processing Stability

I got an email this morning from someone that complained about an issue that never comes up during the EMR selection process. Here's what he wrote, 'current practice management solution has switched who it uses for claims processing many times because of contract issues. '

When you research your system, you generally don't ask these questions. At the best, you (of your biller) may ask who is the Clearing house, just to make sure it is a good reputable company.

The EMR industry is under so much pressure that all kinds of things are happening. Vendors are cutting costs, cutting services and you will notice 'shortcuts' that can affect you. Here are some situations that can have prompted this -

  • A complete system is quite often built with partnerships. One such partnership is with a Clearinghouse to process your claims. Vendors strike deals and negotiate pricing. In doing so, sometimes promises are made that EMR companies cannot keep in terms of volume sales. When that happens, clearinghouse wants to raise prices, renegotiates contracts that can have direct repercussions on client pricing.
  • A worse case scenario is one where your vendors switch partners. If they bring in a less than desirable partner for claims processing, your cash flow can be severely affected. Just as there are 'Free EMR' companies, there are 'Free Clearinghouses'. Even paid EMR vendors sometimes use Free Clearinghouses because of pricing pressures.

Two quick questions can resolve that.

  1. Who is the clearinghouse partner? Make sure it is someone like Gateway EDI, or similar company that is stable and has been around, and has a good reputation.
  2. How long has the EMR company been in partnership with them? Is this the only clearinghouse they use, or do they partner with others also? If so, who are the others?

In short, unfortunately, this is one more thing you must have on your list to ask your EMR vendor.