A recent report from Research Nester highlights Managed Outsource Solutions as one of the key players in the United States (U.S.) medical coding market. Outsource Strategies International (OSI), a Managed Outsource Solutions service, is a leading physician billing company with more than 15 years of experience in the industry. Their services include, but are not limited to medical billing and coding, dental billing services, patient scheduling, insurance verifications and authorizations, AR management and more. The company provides the services of skilled and experienced medical billers and certified coders, who are proficient at handling claims related to Medicare, Medicaid, Aetna, Workers’ Compensation, Oxford, Humana, BCBS, No Fault, United, GHI and others.

The Research Nester report predicts that the United States (U.S.) medical coding market that recorded a value of USD 4050.4 million in the year 2019, is further expected to cross market revenue of USD 8157.9 million by the end of 2028. The market is predicted to grow at a CAGR of 8.8% during the forecast period, 2020-2028.

The report highlights the medical coding transcription process, which is divided into a six-tier hierarchy – retrieving patient information, pre-coding, assigning codes, quality audit, customer feedback and implementing challenges.

Retrieving patient information involves collecting demographic/insurance information and performing insurance verification, which is an important service for practices to reduce denials, minimize delayed payments and improve patient care and satisfaction. OSI follows a customized, HIPAA-compliant billing process ranging from claim entry to denial follow-up and appeals.

Key factors that are predicted to boost the market growth are –

  • increasing advancements in software and technology in the healthcare sector
  • growing utilization of data analytics
  • advent in data enrichment tools such as mobile health or mHealth and electronic health records (EHRs)
  • rising implementation of IT in the healthcare sector for real-time data monitoring in order to effectively manage the patient records
  • growing demand for streamlining of hospital billing procedures
  • increasing occurrence of healthcare fraud in the United States
  • frequent updates and revision of the classification systems along with the increasing adoption of proper coding and billing procedures in hospitals’ and diagnostic centers’ revenue generation cycles
  • the development of stringent regulations to counter cybercrime and fraud
  • the rising demand for streamlining of the hospital bills and medical records of patients on account of the rapidly increasing number of medical tests, treatments, and procedures in the upcoming years

However, factors that restrain the market growth are data security and privacy concerns such as the rising number of ransomware attacks and data breaches, and impact of COVID-19. It is also anticipated that with the rising number of COVID-19 patients and the increasing number of patients visiting hospitals for treatment, the demand for medical coding in the nation would grow at a significant pace in the days to come.

Outsourcing Plays a Key Role

This market report highlights that the United States (U.S.) medical coding market is further projected to cross USD 4500 million by the end of 2021. Backed by the increasing concern for data security, healthcare organizations are increasingly outsourcing numerous tasks to offshore companies, which is anticipated to create opportunities for market growth. Reliable medical coding firms handle all the medical billing tasks for both private and public sectors. For instance, Outsource Strategies International (OSI) provides medical coding outsourcing solutions for clinics, physician groups and hospitals, and all medical specialties.

The report segments the market by patient type, end-user, service mode, classification and solution.

By patient type, the market is divided into inpatient and outpatient. Of these segments, the inpatient segment encompasses acute and long-term care hospitals, hospices, skilled nursing facilities, and home healthcare services. The outpatient segment in the market is further anticipated to grow with the highest CAGR of 9.8% during the forecast period.

End-users of this market are – hospitals, diagnostics centers and others. Owing to the rising number of hospitals in the nation, the hospitals segment is projected to grab the largest market share of 80.29% by the end of 2028. By service mode, the market is segmented into in-house and outsourced. Among these segments, the outsourced segment registered the largest market share of 77.50% in the year 2019, and is projected to grow with the highest CAGR of 9.3% during the forecast period.

By classification, the market is segmented into international classification of diseases (ICD), healthcare common procedure code system (HCPCS), current procedural terminology (CPT), international classification of functioning, disability & health (ICF), and diagnostic-related groups (DRGs). With respect to diagnostic centers, the international classification of diseases (ICD) segment is projected to register the largest share of 67.85% of the market in 2021.

By solution, the market includes professional fee coding, facility coding, emergency department medical coding, HCC risk adjustment coding and other coding solutions. Of these segments, facility coding solutions with respect to diagnostic centers is projected to grab the largest market share of 56.64% in the year 2022. Other prominent players mentioned in the report are 3M, Conifer Health Solutions, LLC, Coding Network, Maxim Healthcare Group, Aviacode Inc. and I-conic Solutions.