Will Billing Separate EMR Winners From Losers?

The other day, I was speaking with a sales exec from a medical billing company, who commented that his company interfaces with about 200 of the leading EMRs.  His comment got me thinking.

I believe we haven’t thought enough about billing when we consider what will drive consolidation in the EMR market. Whether vendors offer it through offering their own practice management system or an easy-to-work-with infrastructure, billing counts a great deal. And the EMRs that aren’t integrating seamlessly aren’t exactly in the driver’s seat in medical practices.

Vendors aren’t in the easiest position when it comes to being a good billing partner. They can offer a suite with practice management available as an add-on, but doctors may not want the whole thing. They can offer an EMR + PM suite that’s already integrated, but what if the practice doesn’t like one of the two?  Some vendors are partnering with companies that make third-party billing applications, but if the other party were to pull out abruptly that strategy could enrage customers.

Still, vendors that balance these factors right have a powerful advantage. After all, practices WANT to get Meaningful Use dollars, but they NEED to get paid. I know that billing would be one of the first things I’d consider if I was shopping for a medical office EMR.

What I’m really saying here is that while most of us agree that a big EMR firm consolidation is coming, we haven’t talked much about the role of strong billing support in an EMR’s market viability. I think we should. I’d love to know if you’ve seen medical office software that really has a strong billing approach, and what you like about it. Thoughts, anyone?

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.


  • Anne, your point is an extremely critical one, and you’re correct that billing is one of the cornerstones of providers maintaining cash flow for operations and IT investments, such as an EMR–and their choice of an EMR. As part of a revenue cycle organization, we often talk to CFOs who would love to make the leap to an EMR and achieve Meaningful Use dollars, but this kind of proactive use of funds requires a solid foundation of incoming revenue, much of which comes from billing. With the average U.S. hospital operating at less than a 3% margin, and with the independent physician practice quickly going the way of brick-and-mortar CD stores, I would say that not only is a top-shelf billing platform such as ePremis necessary (and that it integrates seamlessly with the chosen EMR), but that making sure your billing team’s skills and daily practices in collecting as much A/R as possible are just as important. This is definitely an “iceberg” concept, but I’m glad you brought it up in the context of HIT. Many people seem to forget (or want to forget) the cornerstone revenue cycle operations that make funding HIT investments and achieving stimulus money possible for many healthcare organizations.

  • Full disclosure – I am an EMR reseller.

    Having said that, you hit the nail on the head. So many times I have seen this scenario. Doctor sees EMR demo, doesn’t care about the billing side because he/she doesn’t do billing. Buys EMR and leaves the staff to figure out the billing side. It’s not an intentional thing, just I am buying what directly relates to me.

    The problem is that many EMR vendors also treat their billing platforms as an afterthought so the aren’t many products that are solid in both EMR and PM.

    That’s why you should outsource your billing!

  • Moving data from one system or from part of one to another always involves trade offs. This is especially true in a medical practice, which has various systems carrying out different, but related functions: scheduling, medical information, billing and collections. For example, there are these issues to look at:

    o Interface v Features. Do the features of a third system override using a single interface and database?

    o Redundancy. Does a third party system add unnecessary complexity, such as, having to make double entries for corrections to both systems?

    o Integration. In the case of billing and collections, how does it work, if at all, with the practices’ general accounting system, such as Quickbooks?

    o Administration. Does a third party system require setting up its own security system?

    o Vendor Responsibility. Is one vendor responsible for all systems or do users have to call separate vendors for each system?

  • The importance of a well-integrated billing system is often understated, so I was delighted to see Anne shed light on this subject. We often encounter customers who may be generally unsatisfied with their EMR, but remain reluctant to switch for fear of potential billing nightmares. Our company has been successful in developing PM options that allow us to remain a competitive player in the over-saturated market. Our approach not only offers customers the option of a complete and well-integrated PM system, but also gives them the ability to seamlessly keep their current PM system (through creation of custom interfaces). In the future, I believe we will see many more EMR/PM vendors adopting a similar strategy.

  • I am currently searching for my next EMR and this has become evident to me as one of the most important aspects of my search. As I have been looking I have realized most EMRs are able to be customized, meaning I can make them work how I want (to a certain degree) and/or I can adapt, but the billing portion is what really makes or breaks me.

    I would love to know what EMRs out there are considered tops from a billing perspective.

  • Finally some one hit on one of the most important factors in purchasing an emr that is fully integrated onto one platform (clinical and pms). Why have two software vendors and misc. hardware vendors. All in one suits any size medical practices. If you do not get paid using the expensive emr you have just invested why even look at that emr. In the end everybody is looking for efficiency with lower dollars overall.

    Correct me if I am wrong- Is that not the goal of all this investment and push by all sectors of HIT including government ?

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