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Tighter Budgets, More Choices Affecting the Landscape for Ambulatory Clearinghouse Services

As a tough economy puts greater focus on the revenue cycle process, many physician practices are re-evaluating their clearinghouse partners. OREM, UT, July 09, 2009 /24-7PressRelease/ — As a tough economy puts greater focus on the revenue cycle process, many physician practices are re-evaluating their clearinghouse partners. A new report from market research firm KLAS finds that nearly a third of practices are not committed to their clearinghouse, and in many instances, newer, smaller vendors are taking business away from traditional giants like Emdeon and RelayHealth.

In "Managing the Claim and Getting Paid: Ambulatory Clearinghouse Services", KLAS collected data from more than 500 physician practices to rate the performance of over a dozen clearinghouse vendors. The report highlights an increasingly crowded market in which cost-conscious and service-challenged providers are laying aside traditional vendor loyalties in favor of new solutions – leaving many vendors scrambling to differentiate themselves.

"Getting claims submissions paid the first time is an important base line measurement for a clearinghouse," said Mark Wagner, KLAS research director and author of the clearinghouse report. "But it was surprising to learn that efficiency in first time claims alone does not always differentiate the performance of clearinghouse vendors. Much more important is how responsive the service is when things break."

According to the report, Emdeon and Navicure clients both average 89 percent of claims receiving payment on first submission. However, Emdeon’s indirect clearinghouse service received the lowest overall client satisfaction score while Navicure was near the top in overall performance, despite the fact that both had the same first time claims submission payment efficiency. Navicure’s high performance rating was largely attributed to the fact that the company provides constant client interaction and takes care of customer issues in an efficient, consistent manner.

The KLAS study also noted a strong correlation between client satisfaction with a clearinghouse service and the practice management (PM) solution to which the clearinghouse is tied at a client site. For instance, providers who used the Emdeon service in concert with PM products from eClinicalWorks, Henry Schein and McKesson all scored Emdeon better than the 71 (out of 100) average the company received in the KLAS study overall. However, providers who used Emdeon with the Sage PM product gave the clearinghouse a lower performance rating of 64.5.

In contrast, the price of a clearinghouse service appears to have little correlation to customer satisfaction. While ROI is always a factor, particularly during a tough economy, providers rarely expressed dissatisfaction with the price of a clearinghouse, if they felt the level of service they received was worth the cost. Some of the top-ranked vendors in the KLAS study, such as Navicure and ZirMed, are seen as premium services that charge premium prices, while the two clearinghouse vendors whose services are free to providers, Availity and Office Ally, are ranked in the middle and upper-middle of the field.

Among the 15 vendor solutions rated in the KLAS clearinghouse services report, RealMed was the top-rated vendor with an overall performance score of 93.3 out of 100, while Navicure (91.4) and ZirMed (91.4) tied for second place. Other vendor solutions rated in the report are Allscripts, Availity, Capario (MedAdvant), The Consult, Emdeon (Direct), Emdeon (Indirect), Gateway EDI, GE, Ingenix, Office Ally, Practice Insight (Indirect) and RelayHealth (Indirect).

To learn more about the clearinghouse services market, as well as the strengths and weaknesses of participating vendors, the report "Managing the Claim and Getting Paid: Ambulatory Clearinghouse Services" is available to healthcare providers online for a significant discount off the standard retail price. To purchase the full report, healthcare providers and vendors can visit http://www.KLASresearch.com.

About KLAS
KLAS is a research firm specializing in monitoring and reporting the performance of healthcare vendors. KLAS’ mission is to improve delivery, by independently measuring vendor performance for the benefit of our healthcare provider partners, consultants, investors and vendors. Working together with executives from more than 4,500 hospitals and over 2,500 clinics, KLAS delivers timely reports, trends and statistics, which provide a solid overview of vendor performance in the industry. KLAS measures the performance of software, professional services and medical equipment vendors. For more information, go to http://www.KLASresearch.com, email [email protected] or call 1-800-920-4109 to speak with a KLAS representative.


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