Outside healthcare, fax is a curiosity. Inside it, fax is still how a great deal of work gets done. Referrals go out by fax, results come back by fax, payers send decisions by fax and pharmacies ask questions by fax. New staff are often surprised. Experienced staff know that the fax line is one of the few channels that reaches every other organization a practice deals with.
This article explains what fax does in healthcare today, why it has lasted, what federal policy is changing, and what that means for a practice planning the next few years. For a general introduction to the technology, see what is electronic fax.
What fax does in a medical practice
In a medical office, fax is the common carrier for documents moving between organizations that do not share a system. A practice's EHR can exchange data easily with systems built to talk to it. It cannot assume the same of a small specialty office across town, a regional lab, a long term care facility, a payer's utilization review team and an attorney's office requesting records. Fax works with all of them because every one of them has a fax number.
The most common traffic falls into a few groups:
- referrals and consult notes between providers;
- orders, results and reports between practices, labs and imaging centers;
- prior authorization requests, supporting documents and decisions between practices and payers;
- refill requests and clarifications between pharmacies and prescribers; and
- records requests and responses involving patients, other providers, insurers and legal representatives.
Why fax has lasted
Fax persists in healthcare for practical reasons rather than nostalgia.
- Universal reach. Every counterpart has a fax number. Not every counterpart has a compatible electronic connection, and setting one up for each relationship is not realistic for a small practice.
- A document, not data. Much of what moves between organizations is a signed form, a letter or a report. Fax carries the document as it is, signatures included.
- Familiar evidence. A transmission confirmation is widely accepted as proof that a document was sent, which matters for referrals and authorizations with deadlines.
- Accepted by rules and contracts. Many forms, payer processes and regulations name fax as an accepted channel, so moving away from it is not one organization's decision.
Patients' own records requests show the point. Under the HIPAA right of access, a practice must provide records in the form and format the individual requests if it is readily producible, and can be asked to transmit a copy directly to a person the individual designates. The rule is in 45 CFR 164.524. In practice, the designated person is often another provider, and the channel both sides have in common is often fax.
What federal policy is changing
The clearest change is in prior authorization. The Centers for Medicare and Medicaid Services published its final rule on Advancing Interoperability and Improving Prior Authorization Processes (CMS-0057-F) in February 2024. Among other provisions, it requires impacted payers to support prior authorization through application programming interfaces, and it finalizes a requirement for those payers to make a decision within 7 calendar days for standard requests and 72 hours for expedited requests. Its requirements phase in with compliance dates in 2026 and 2027.
The rule's own discussion shows why fax will not disappear quickly. Commenters told CMS that adoption of electronic prior authorization by providers would be gradual, and raised the burden of converting prior authorizations submitted via phone or fax into electronic format. The rule applies to specific categories of payers, and many practices work with payers outside its scope. For the foreseeable future, a practice should expect electronic channels and fax to run side by side.
What healthcare fax is not
A few common assumptions are worth correcting:
- It is not inherently insecure, or inherently secure. A fax machine in a hallway exposes documents to anyone walking past. A well run online fax service with access control and transmission records can be safer than the machine it replaces. The safeguards around the channel decide the risk.
- It is not a substitute for interoperability. Fax moves a document. It does not make that document structured data in the receiving system. Practices still re-key or attach faxed information, which is where much of its cost lies.
- It is not ending on a date. No federal rule sets a date after which healthcare stops using fax. Planning for that date is planning for something that has not been scheduled.
What this means for a practice
The realistic goal for most practices is not to stop faxing. It is to take fax off paper, so that the channel everyone else still uses is handled inside the practice's own digital workflow. That means faxes that arrive in the right inbox instead of a tray, documents that are filed instead of piled, transmission records that settle disputes, and staff time spent on the patient instead of the machine.
Referrals and authorizations are usually where that change pays off first, because each one is a request with a deadline. Our article on referrals and prior authorizations by fax covers how to track them. For the cost side of the decision, see the hidden costs of paper fax in a medical office.
Where LABUSA eFaaS fits
LABUSA eFaaS lets a practice send and receive faxes through email and a hosted fax service, with no fax machine or fax server in the office. Incoming faxes are converted into digital documents and delivered to designated recipients, outgoing faxes are sent from email, and every transmission leaves a queryable record. Where your documents fall under HIPAA, the obligation to meet it stays with your practice, and eFaaS supplies encrypted transmission and storage, named accounts and access control, and retention you configure.
See how it fits a medical office on our medical practices page, read how eFaaS works, try LABUSA eFaaS free for 30 days, or request a workflow consultation. You can also contact our team.