Nobody likes being on hold with payers. Those hours add up fast—weeks of your life that could be better spent elsewhere. The good news? There are electronic tools and payer portal tricks that can help slash those phone hours. Here’s how to get started.
Embrace Electronic Transactions
Electronic transactions are the low-hanging fruit in the world of medical billing. If you're not using them, you're doing it wrong. Electronic Data Interchange (EDI) transactions like the 276/277 (claim status inquiry and response) and the 270/271 (eligibility inquiry and response) can save you significant time. Why wait on hold to check claim status when you can automate the process?
The Codes That Matter
Those 276/277 transactions aren't just for show—they can cut into those excruciating hold times. Set up your practice management system to automatically send claim status inquiries for claims over a certain age, say 14 days. Focus on those denial codes like CO 197 (Precertification/authorization/notification absent) that can often be resolved electronically. Automating these inquiries means your team spends less time dialing and more time resolving.
Automating Payer Portals
Payer portals can be a double-edged sword. They promise convenience but often deliver frustration. However, mastering these portals can eliminate a ton of phone time.
Pre-Auth and Eligibility Checks
Pre-authorization and eligibility verification are notorious time-sinks. But many payers now offer automated tools for these. Set up scripts or use automation software to batch-check eligibility and pre-auth statuses. Say goodbye to waiting for a rep just to confirm eligibility on a straightforward case.
Bulk Action Tools
Some portals offer bulk action tools—take advantage of them. Use these to upload multiple claims at once or download remittance advice in bulk. This is especially useful for practices with high claim volumes. If your portal doesn’t have these tools, push your payer reps for updates. They drive efficiencies that are worth fighting for.
Predictive Analytics and Dashboard Alerts
How often do you find out about an issue only after it’s too late? Retrospective action is costly. Predictive analytics tools can flag potential denial trends before they become a mountain of work.
Real-Time Alerts
Dashboards with real-time alert capabilities can reduce the need to check statuses multiple times. Set alerts for claims that hit certain criteria—like claims over $5,000 pending for more than 30 days. This proactive approach keeps you from playing catch-up.
Trend Analysis
Analyze your data to find out which payers and which types of claims have the highest denial rates. If Payer A regularly denies 30% of your claims due to CO 109 (Claim not covered by this payer/contractor, you must send the claim to the correct payer/contractor), you know where to focus your efforts before the next billing cycle.
Network with Other Billers
Sometimes it's not what you know, but who you know. Networking with other billing professionals can yield unexpected benefits.
Sharing Tips and Tricks
Join forums or local billing groups to trade tips on payer-specific quirks and portal navigation hacks. It’s amazing what you can learn about a payer’s “hidden features” or workarounds that aren’t in any manual but can save hours of frustration.
Peer Recommendations
Collectively pressuring payers for portal enhancements can be more effective than going it alone. Peer recommendations carry weight, especially when multiple voices report the same issue. Got a particular payer with a portal stuck in the Stone Age? Rally your network to push for updates.
Addressing Credentialing Delays
Credentialing issues can lead to countless unnecessary calls. If a provider isn’t credentialed properly, it creates a domino effect of problems—denials, rejections, and more.
Automated Credentialing Status
Some third-party tools offer credentialing status automation. These can alert you to upcoming expirations or issues with applications. The less you have to manually track, the less time you spend on hold with credentialing departments.
Expedited Credentialing Services
Consider using expedited credentialing services if you're frequently dealing with new providers. The upfront cost might be worth the back-end time savings when onboarding new staff.
Final Thoughts
Reducing phone time with payers isn’t just about comfort—it's a strategic move that affects your practice's bottom line. By leveraging electronic tools and mastering payer portals, you can significantly cut down on wasted hours and improve your team's productivity. The next step? Implement these strategies, monitor their impact, and constantly look for new ways to automate. The time saved can then be focused on what truly matters—improving patient care and boosting your practice’s efficiency.
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