Billing teams are still spending an extraordinary amount of time on claim statusing. Of the nearly 4.28 billion claim status inquiries made in 2023, more than a quarter of them were at least partially manual (1.5B).1 And of those conducted electronically, how many were done inefficiently, tediously logging into multiple payer portals?
However it’s accomplished, claim statusing is weighing down revenue cycle budgets more than ever. While the volume of inquiries has increased 19 percent over 2022, the cost to conduct them went up an incredible 71 percent, to $12.5 billion1. That’s 15 percent of total annual administrative spend.
$12.5B is an alarming enough number on its face, but the situation looks even more dire if you dig into the time, labor, and downstream costs that make up that total.
The time cost
On average, a claim takes 24 minutes1 to status manually, outpaced only by prior authorization in time cost. Those minutes add up to thousands of hours spent annually on tedious work, often not even resulting in an actionable denial or underpayment.
A solution that enables teams to only work the claims that need immediate attention keeps staff focused on higher-value follow-up and appeals.
The people cost
If up to half of your RCM positions are sitting vacant,2 you simply do not have enough staff to sit on hold with payers and manually refresh portals. That frustrating work can also affect employee morale, contributing to turnover and exacerbating an already strained labor market.
Taking an automated approach not only lightens the load for billing teams — it can increase their job satisfaction to perform the most meaningful and actionable work.
The downstream cost
Inefficient claim statusing can also have a detrimental impact on overall financial performance. Delaying appeals means more A/R days, and ultimately less cash on hand. Healthcare organizations deserve to get paid what they’re owed without employing an army to chase it down.
Clearly, an automated claim status solution can save organizations time and money by reducing the effort required for manual follow-ups. However, not all claim status solutions are created equal.
Identifying the right claim status partner
Before moving forward with an automated claim status solution, revenue cycle leaders should ask the following questions of a vendor. More on these in our next blog:
- How frequently will my claims be statused?
- What information will I receive?
- What are the success rates of your automations?
- How do you charge for your claim status?
Automating claim status may seem low priority, but it’s more like low-hanging fruit — a clear win to reduce the expense of manual and inefficient statusing, retain revenue cycle staff, and accelerate time to payment.
2 Healthcare Trends and Data Show Clinical Shortage ‘Tip of the Iceberg’
