4 Medical Billing Trends You Can’t Afford to Sleep On

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Rigid, complicated coding rules, debates about fee structures, attempts to reward for outcomes, and heated negotiations are just some of the constant struggles in the medical billing world.  

medical billing trends

Those are the constants, but to get a better picture of the trends impacting the medical billing world, I spoke with Cara Buckhaulter, Billing Services Operations Manager at NueMD and Daniel Kivatinos, CEO of drchrono.

Here are the four medical billing trends they pointed out as issues to watch going forward:

1. ICD-10

Last October the International Statistical Classification of Diseases and Related Health Problems tenth update (ICD-10) went into effect.

According to Workgroup for Electronic Data Interchange (WEDI), the ICD-10 migration was “by most accounts highly successful despite its enormity of scope and effort.”

It contains 71,924 procedure codes and 69,823 diagnosis codes. An August 2015 WEDI study showed that less than half of doctors were prepared for the ICD-10 conversion. Only a fifth of them had started or completed internal testing.

WEDI has some great lessons for providers and EHR vendors from the ICD-10 implementation. They recommend proactive updates to EHRs from vendors and early and proactive communication to vendors from providers. Some providers didn’t realize their EHRs needed to be updated. Others’ systems didn’t get updated until late in 2015. Similarly, vendors should run tests themselves instead of expecting their EHR vendor to test the software.

Basically, if you sit around and wait for your software vendor to make sure you’re ready, you’re going to have a bad time.

The other big trend related to ICD-10 is that having to learn new codes for ICD-10 will depress coder productivity, according to Advanced Data Systems Corporation (ADSC). Using a code lookup tool can help decrease the learning curve, but practices will likely still need to hire new coders, mostly consultants or “second jobbers.”  

According to CareCloud:

Coding specialists fear coding software integrated into EHRs or practice management systems may replace their jobs within the next ten years. We believe the outlook is bright for billers and coders. ICD-10 means more accurate medical billing and coding, which translates to more jobs with higher salaries as more providers make the inevitable switch. The change will present new opportunities for coders as problems solvers, i.e., some insurers may not update their systems on time, leading to A/R issues and cash flow problems, and;

Medical billers and coders need to deal with unexpected challenges and repercussions that IT isn’t equipped to handle.

And the numbers aren’t too shabby, either: the US Bureau of Labor Statistics reflects that employment for medical transcriptionists is expected to increase by 11% in the coming years, and medical records and health information technicians will grow by 20% through 2018.

In addition, “ICD-10 will most likely reveal the inefficiency of many practices’ workflow,” wrote Helen DeCelles-Zwerneman for the Capterra Medical Blog last year. “So health IT professionals were seeking out new ways of helping doctors and coders. The end goal was better data gathering and analysis and, ultimately, better patient care.”

2. EHR

Electronic Health Record software (EHR) adoption rates are extremely high; more than 75% of hospitals nationwide use EHR systems. But not all of them have billing integrated.

Expect all EHR systems in the future to have integrated billing. “Today what’s driving physicians to go digital is tracking medical claims,” Kivatinos said. “Doctors now are looking to get paid in a streamlined way. If you see several patients in a day you don’t want to sit around entering forms to get paid.”

CareCloud agrees, “The administrative burden is overwhelming for physicians, who more than ever are turning to medical billing companies for help.”

All five of our five most popular EHR systems have integrated billing.

Two of the top five vendors offer software features that help with revenue cycle management and medical billing. Practice Fusion offers medical billing and Allscripts offers financial solutions.

The other three offer human help. CureMD offers billing services. ClinicalWorks launched revenue cycle management in 2012. And McKesson offers Revenue Cycle Services.

3. ACOs

If you’re looking for the drama in medical billing, look no further than Accountable Care Organizations (ACO). Revcycleintelligence.com defines ACOs as “Groups of doctors, hospitals, and healthcare providers helping provide Medicare beneficiaries with top-notch coordinated fee-for-service care.”

ACOs are meant to reduce costs and increase quality of care. An ACO rewards members with higher reimbursements for improving the quality and reducing the cost of care. It also punishes member providers with lower reimbursements for failing to meet target quality and cost metrics.

Membership is optional, and growing. “We continue to see an increase in the number of commercial payer ACOs,” Buckhaulter said.

The Massachusetts Medicaid program is mulling over whether it should invest $1.5 billion in accountable care.

According to revcycleintelligence.com, “By developing more accountable care organizations for its 1.8 million beneficiaries, MassHealth hopes to address many of the pressing behavioral health, community care, and long-term care problems plaguing the system.”

There’s evidence ACOs are saving money. A study from the Journal of the American Medical Association showed that ACOs participating in the CMS Pioneer ACO Model saved over $384 million ($300 in annual savings per beneficiary) within their first two years of implementation. However, those savings may diminish as ACOs pluck the “low-hanging fruit” of costs savings.

Critics of ACOs point out that the setup rewards members based on improvement, not absolute gains, which effectively punishes members who join when they’re already efficient.

“Some of these ACOs are partnering with EMR and Practice Management software vendors who have established an interface with the ACO to provide the statistical data required,” Buckhaulter said. “This reduces the burden of the practice in gathering data and providing it on a regular basis to the ACO. It does, however, often mean that by joining the ACO the staff will be required to learn new medical software.”

Drchrono and Practice Fusion partner with ACOs. “Practice management software is an amazing way to track medical claims and submit them to insurers,” Kivatinos said.

Drchrono is also connected to every insurance company. The software triggers billing events to submit a claim to an insurance company immediately. You’ll get a rejection immediately, so you can resubmit almost in real time.

4. Telehealth Services Reimbursement

As I pointed out in 23 Mind-Blowing EHR Stats for 2016, the global video telemedicine market is predicted to grow to $1,624.4 million by the end of 2020. << Tweet This! Walgreens and telehealth provider MDLive last year began a virtual care collaboration in 25 states.

For this reason telemedicine was number three on my list of the top-five EHR trends for 2016.

“As telehealth services continue to expand and providers look for tools that allow them to monitor their patients outside of the typical office setting, the medical community must also continue to put pressure on payers and lawmakers to mandate coverage of these services,” Buckhaulter said. “Currently, 26 states have telehealth parity laws that require private payers to reimburse providers for the telehealth services they perform. These parity laws prevent payers from withholding reimbursement for telehealth services based on the patient’s location, allowing the patient to attend telehealth sessions from their home or office without having to travel to a ‘qualified originating site,’ which remains a requirement for Medicare reimbursement.”

“The reimbursement amounts for telehealth services vary depending on a state’s legislation,” Buckhaulter said. “Many states with reimbursement mandates allow payers to determine the reimbursement rate for telehealth services. It is imperative that providers and their billing staff are aware of the telehealth coverage in their state and by their payers. Billers must be diligent to ensure that their providers are being paid accurately for the telehealth services they provide.”

Relatedly, “Medical providers are increasingly demanding the ability to use a mobile device for charting, billing and communication in a HIPAA-secure method,” Buckhaulter said. “This will particularly be required as telehealth services expand.”

According to Recode, telemedicine is the biggest area for growth in EMR tech. To help future-proof your EMR software, consider a company that’s taking strides in helping providers offer medical services remotely.

Conclusion

Do you agree these four medical billing trends are the ones to watch? Let me know in the comments. And for more medical billing tips, check out 10 ways to improve your practice’s medical billing collections in 2016.

Looking for Medical Billing software? Check out Capterra's list of the best Medical Billing software solutions.

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About the Author

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Cathy Reisenwitz

Cathy Reisenwitz is a former Capterra analyst.

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Well written. these 4 things are the pillar of medical billing. we always keep ourself update for this

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