Medical Billing is much more complicated than it seems. According to a survey conducted by CMS (Centers for Medical and Medicaid Services), healthcare expenditure and cost will reach a staggering amount of $5.7 trillion by 2026. The US healthcare industry is huge as it completely relies on public and private insurers, and they must strictly abide by the HIPAA rules and regulations. However, keeping an eye on the latest medical billing and coding trends in 2021, healthcare professionals need to streamline their medical billing processes and obtain a full refund for their medical services. Even in 2021, as digital transformations are sweeping through the healthcare industry, many medical practices are grappling with the complexities of medical billing and coding services in the US.
This article will examine the latest medical billing and coding trends to help healthcare professionals cope with daily medical billing challenges.
Medical Billing Industry and its Dynamics
Peter G. Foundation has reported that the US has the highest per capita medical spending among rich countries, approximately $11,100. As compared with other comparable economies, they were only able to spend half of this amount. However, the administrative expenses are about $940, which is still at a high percentage. Experts argue that these high costs are due to the complexity of the US healthcare system, and this seems like a fair estimate.
From a Medical Billing Perspective
The United States of America has an overwhelmingly increasing aging population and is vulnerable to chronic diseases. Therefore having comprehensive health insurance is a necessity. Private insurance companies have dominated the healthcare industry, followed by Medicaid and other tax-funded government insurance programs that serve the needs of such aging specific groups. As a result, medical billing systems must support different funding sources and follow different claim procedures to collect payments for healthcare services. However, facing denied medical claims and uncollected payments is a reality that medical billers face daily. Medical billing and revenue cycle management processes can get much complex and complicated, making small healthcare professionals and practitioners choose not to accept any medical insurance. Large healthcare organizations and institutions with higher medical billing claims usually outsource their medical billing services to third-party firms.
Outsourcing Your Medical Billing and Coding Services
The medical billing outsourcing market is huge and growing rapidly. According to reports from Grand View Research, it is expected that the medical billing outsourcing market will reach $25.3 billion by 2028 with a CAGR of 12.3%. Top medical billing companies are trying to offer more specialized services to take full charge of the revenue cycle management (RCM) of medical practice and reduce unresolved medical claims and revenue leakage due to medical billing and coding errors. Medical billing firms must ensure 100% error-free information in patient registration, insurance validation, claim submission, and payment denial to achieve this goal. It requires automating medical billing and coding tasks, from a time-consuming process that every medical practice has to go through, regardless of its size or specialty.
Medical Billing Coding System in the US
The medical billing coding system in the US includes tens of thousands of different medical codes that cover everything from medical supplies, medications to complex surgical procedures and treatment plans. Medical coding is usually a coded language consisting of five-digit lexemes that allow for a seamless communication process between a healthcare provider and insurance carriers, or even patients paying for their services directly. There are primarily four different medical coding sets.
CPT (Current Procedural Terminology) Codes
CPT is a level 1 set of codes introduced by the American Medical Association (AMA) back in 1966. CPT codes usually cover anesthesia services, Evaluation & Management (E/M), radiology, surgery, laboratory, pathology, medical services, and procedures. CPT codes are broken down into three categories:
– Describing common procedures
– Experimental Services
– Performance tracking codes
HCPCS (Healthcare Common Procedural Coding System) Codes
HCPCS codes are the second level of the medical coding system. AMA created them at the request of CMS. HCPCS codes reflect such medical services and procedures offered by the Medicare and Medicaid programs, which are not included in the CPT range.
ICD – 10 – PCS Codes
ICD – 10 – PCS codes are reserved for the use of hospitals only to report inpatient medical services and procedures
ICD – 10 CM Codes
ICD – 10 – CM codes are diagnosis medical codes used to establish medical necessity and justify further medical-related services.
Medical codes are very important in medical billing, as they provide an accurate framework for the successful medical billing of a healthcare provider. A certified medical coder can only do medical coding. As per the AAPC survey, an average salary of a medical coder in 2021 is approximately $54,890. Medical coders also use specialized coding software instead of reading or searching through medical codebooks. However, the job of a medical coder demands other necessary skills and expertise too. Besides being well-versed in the medical billing and coding field, a medical coder also needs to know human anatomy, medical billing procedures, and supplies. But most importantly, a medical coder needs to keep track of the latest changes or updates in the medical coding system. With the Covid-19 pandemic, there have been many recent changes in the US medical coding system.
The Recent Changes brought by the Covid-19 Pandemic
The COVID-19 pandemic did bring a lot of new medical-related diagnoses and procedures. The AMA had to make significant changes to Evaluation and Management (E/M) procedures, while CMS finalized changes to Medicare physician fees. The ongoing shift to telemedicine in outpatient care created additional challenges for medical institutions regarding billing payers.
Many healthcare providers were desperate to keep up with these new changes and considered automated medical billing coding as a possible solution or the only alternative to complex medical billing procedures. However, the need to automate medical billing can become a major trend in medical billing. Even though medical coding is an integral part of medical billing, the process is much more complex and involves many specific steps. The need of the hour is to outsource your complicated medical billing and coding procedures from a reliable and trustworthy medical billing firm.