For healthcare providers, the revenue cycle management (RCM) process involves various complex steps – from patient scheduling and enrolment to insurance verification, coding and submission of claims to payers, and claims follow-up and payment collections. This is why many providers now consider medical billing outsourcing a practical option. Like many other industries, medical billing will be driven by various trends and innovations. Here are the key changes that physicians and their medical billing service providers should be prepared for:

  • Continued growth: According to a new report from Market Research Future, the medical billing service market is poised to grow at a CAGR of 6.5% during forecast period 2017-2023. The key factors driving this growth are increasing healthcare expenditure, increasing internet use, greater need for risk and compliance management, and increasing use of Information Technology in healthcare. Providers are also driven to outsource medical billing tasks to reduce recruitment and infrastructural costs and increase revenue.
  • Blockchain: Blockchain is a secure technology that creates authentic data records that can be shared between networked database systems. The technology records digital events in a way that does not allow for the data to be changed or recognized until it reaches the recipient. Blockchain ensures data integrity in healthcare by protecting the data managed by healthcare organizations, which includes Patient health information (PHI), electronic health records (EHRs), data collected from IoT devices (Internet of Things) or monitoring systems, and medical billing and claims information. With blockchain, all of this data is protected in an immutable register and readily available.
  • Computer assisted coding (CAC): Market Insights Reports predicts that the CAC market will at a CAGR of 11.3% from 2019 to 2025. CAC allows medical codes to be automatically generated from clinical documentation. It uses natural language processing (NLP) to identify important ICD and CPT Coding terminology and expressions. CAC supports medical coders by enhancing their productivity and accuracy. CAC can help healthcare organizations improve compliance with increasingly complex payer and quality reporting requirements, and streamline the medical billing processes.
  • Automated medical billing: Paper claims have become a thing of the past. Today, medical billing is handled on web or cloud-based software. Medical billing software allows medical billers to efficiently streamline billing activities, from claim submissions to managing insurance and patients’ billing and payments. Automated medical billing reduces risk of error in insurance claims processing by flagging potential errors in advance. This allows billers to resolve issues proactively and minimize payment delays and denial. Web-based systems can be accessed by billers and healthcare providers from anywhere, which explains why outsourced medical billing services are so popular. However, using technology to send and receive insurance claims is not error proof. It is important for the medical billers to be proficient in using advanced medical billing technology. This will save time and money for all parties involved. As their role evolves, medical billers must also master the art of medical billing collections and know how to correct claim denials in the clearinghouse and quickly get them resubmitted to collect on all outstanding patient accounts (
  • ICD-11: With about 55,000 codes for injuries, diseases and causes of death, ICD-11 has several new chapters and will have an impact on coding for all specialties. ICD-11 is completely electronic and designed to support electronic health records (EHRs). ICD 11 will have a content model with 13 parameters to address the issue of duplication and confusion of codes in the medical bill. It will allow non-medical entities like insurance companies and the common public to get a better understanding of the medical bill. The update will help payers to better categorize the condition of the entity and speed up claims processing and medical reimbursement ( Medical billing companies can start familiarizing their coding and clinical documentation staff with ICD-11 concepts to prepare for implementation over the coming years.
  • Virtual medical care: As Deloitte puts it, virtual health is a reality of the present. Combining digital and telecommunication technologies, telemedicine bridges the gap between patients, physicians, and other caregivers. It allows providers to coordinate patient care in a more efficient manner. Virtual health services could provide a significant return on investment as the health care sector moves from the fee-for-service model to value-based care and compensation. However, billing a virtual patient visit is not the same as billing an in-person visit and rules for billing telemedicine can vary among government and private third-party payers. To ensure proper reimbursement for virtual medical care, medical billers need to know: which codes and modifiers are applicable, the telemedicine guidelines for each payer, and whether the patient’s insurance covers telemedicine.

The year 2018 saw patients evolving as consumers of healthcare. With patients as consumers, the medical practice is now considered a business. Partnering with an experienced medical billing outsourcing company is the best way to leverage future trends and drive RCM success.