2014 Ambulatory RCM Services
Uncovering Truths When Services Are Outsourced

WORTH KNOWING

STRONG CLAIMS PROCESSING FROM NEXTGEN, ATHENAHEALTH, AND ECLINICALWORKS DRIVES SATISFACTION.

RCM customers see NextGen as a trusted business partner due to highly effective, well-managed claims processing. athenahealth and eClinicalWorks respondents also reported timely, accurate, and effective claims processing.Some Cerner and Kareo customers reported inconsistencies resulting in increased A/R days and lower levels of trust.

ECLINICALWORKS OFFERS STRONG DENIALS MANAGEMENT AND FOLLOW THROUGH.

Only eClinicalWorks customers noted a relatively easy denials process. athenahealth, Cerner, Kareo, and NextGen customers reported challenges resulting in additional work: athenahealth and NextGen customers want more proactive status updates; Kareo customers want more vendor follow-through; and Cerner customers want better denials visibility.

PROVIDERS CONFIDENT IN NEXTGEN’S AND ECLINICALWORKS’ RCM PRICING MODELS.

NextGen’s and eClinicalWorks’ delivery is highly consistent, and few providers question the sustainability of their percentage-based cost structures. Kareo and athenahealth customers are generally optimistic, yet billing delays have some questioning Kareo’s model, and rate increases have left a few questioning athenahealth’s. About half of respondents feel Cerner’s pricing is sustainable—others are concerned over inconsistent delivery.

ATHENAHEALTH DELIVERS MOST CONSISTENTLY ACROSS AMBULATORY SUITE.

Only athenahealth matches good RCM performance with strong ambulatory EMR/PM functionality and support. NextGen’s and eClinicalWorks’ RCM verticals perform well, but EMR/PM customers want more vendor guidance and support. Cerner’s EMR outperforms their RCM services; however, Millennium PM is not yet rated due to a relatively small customer base. Conversely, Kareo’s PM system outperforms their RCM services, but their EHR is not yet rated due to a relatively small customer base.

BOTTOM LINE ON VENDORS: TRUSTED BUSINESS PARTNER

 Do you consider your RCM service vendor to be a trusted business partner? Percentage answering yes.

ATHENAHEALTH: 90%

Strong ambulatory portfolio. Highly consistent RCM performance and efficient claims processing. Three-quarters say cost structure sustainable—cost increases have a few concerned. Very good vendor transparency and reporting. Denials and rejections require additional customer work. Good provider-facing support, and limited feedback suggests very good patient-facing support. Good mix of smaller and larger practices.

KAREO: 67%

RCM relatively new area—mostly smaller practices (one or two physicians). Inconsistent claims-processing delivery: two-thirds satisfied, one-third frustrated. 80% of customers feel cost structure is sustainable. Transparency and reporting strong. Poor follow-up on denials and rejections. Provider-facing support lacks follow through; poor patient-facing support. RCM part of an inconsistent portfolio: PM customers pleased; EMR offering relatively new. 

NEXTGEN: 100%

RCM services relative strength in ambulatory suite. Highly consistent delivery and effective claims processing engender customer trust. Nearly all feel cost structure is sustainable. Good vendor transparency, though reporting interface could be improved. Communication around denials and rejections can improve. Good provider-facing support; customers state patient calls often go unanswered or involve long wait times. Good mix of smaller and larger practices.

PRELIMINARY DATA

CERNER: 78%

RCM relatively new area. Inconsistent 78% claims processing. Five of nine feel Cerner’s cost structure is sustainable. Vendor transparency and reporting need improvement—data requires extra manipulation. Little insight into denials and rejections status. Generally good support and communication. Lower-rated ambulatory portfolio; improving EMR experience. Few using integrated Millennium PM. Mostly smaller practices in sample.

ECLINICALWORKS: 100%

RCM relatively new area. Consistent, high performer in all RCM categories.Strong claims processing and very good provider-facing support; limited feedback suggests very good patient-facing support. Nearly all feel cost structure is sustainable. Good transparency and strong reporting tools. Strong denials and rejections management. Good ambulatory portfolio; EMR/PM functionality is strong. Customers want better vendor attentiveness and support. Mostly smaller practices in sample.

OTHER VENDORS

GREENWAY

New area for Greenway. KLAS spoke with four Greenway customers using PrimeRCM. Initial responses extremely varied in regard to claims processing: two very pleased; two very dissatisfied.