Long gone are the days when spending hours on hold with payers was just part of a biller’s job. Or at least, it should be. The reliance on phone calls for payer follow-up is an archaic practice that no longer fits with the demands of modern medical billing. It’s time the industry pivots to a digital-first approach.
The Reality of Phone-Based Follow-Up
Let's face it: phone-based follow-up is inefficient. Billers sitting with the phone cradled to their ear, waiting eternally for an agent to pick up, can better use their time elsewhere. For context, the average hold time when contacting a major insurer can stretch past 30 minutes — and that’s just to get a representative on the line. Multiply that by the dozens of calls a billing department handles weekly, and the hours wasted tally quickly. Not to mention the human cost: frustration, burnout, and the inevitable mistakes that occur when people are rushed or stressed.
But beyond the time wasted, phone calls are a black box. There's no audit trail, no immediate verification of what's been discussed, and limited ability to reference back to previous conversations. Contrast this with digital communications, where every interaction is recorded, timestamped, and easily recalled.
The Power of Digital Communication
Switching to digital isn't just about cutting down hold times. It's about gaining control and transparency over the entire follow-up process. Payer portals, secure email, and electronic data interchange (EDI) offer billers the ability to submit inquiries, receive responses, and track claim statuses without ever picking up the phone.
EDI, for example, allows for the automatic submission and receipt of information. For a claim denial, a real-time EDI transaction can provide additional details on the denial reason code, such as CO-45 (Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement) — much faster than waiting on a call.
And sure, payer portals have their quirks. Some are clunky and counterintuitive, but even the least user-friendly portal beats a static phone call. Billers gain access to a wealth of information at their fingertips, from claim statuses to eligibility checks, empowering them to resolve issues more efficiently.
Addressing Payer Resistance
One might argue that some payers are slow to adopt digital communication tools. True. But this is changing, and practices need to be ahead of the curve, not lagging behind. As payers recognize the cost savings and efficiency of digital interactions, more are moving in this direction. It’s either adapt or be left on hold — literally.
The push towards digital also puts pressure on payers to improve their platforms. Feedback loops between practices and payers can lead to better systems. When practices demand more robust digital tools, payers must respond. As these tools evolve, they can dramatically reduce the workload on billing teams.
Training and Transition
A shift to digital-first follow-up isn't without challenges. Training staff on new systems and processes takes time and resources. However, the return on investment is clear. Digital interactions provide more detailed, easily accessible information, fostering a more agile billing environment.
Consider starting with a hybrid approach — using digital tools for high-volume payers while maintaining phone contact for those that lag behind. Gradually, as more payers come online with reliable digital options, the transition will become smoother.
And let's not forget another critical detail: the impact on patient satisfaction. Quicker claim resolutions lead to less patient frustration over billing errors and faster settlements, which is always a win.
The Future of Biller Roles
As digital follow-up becomes the norm, the role of billers will naturally evolve. Freed from the shackles of endless phone queue purgatory, billers can focus on higher-value tasks such as analyzing denial patterns or developing strategies to reduce aging A/R. This shift not only enhances productivity but also contributes to career satisfaction among billing professionals.
In a world where automation and AI tools like Arrow are increasingly prevalent, transitioning to digital allows billers to work smarter, not harder. The automation of routine tasks, coupled with digital follow-up, positions practices to handle more claims with fewer resources.
A Necessary Evolution
The death of the phone call in payer follow-up isn't just inevitable — it's necessary. As practices strive for efficiency, accuracy, and financial health, dragging feet on this transition is not an option. Digital is faster, clearer, and offers a level of accountability that phone calls simply cannot match.
For those practices still clinging to the old ways, it’s time to embrace the shift. The future of payer interactions is digital, and the sooner billing teams adapt, the sooner they'll reap the benefits. In the end, the choice is clear: evolve or risk falling behind in a competitive and unforgiving industry.
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