According to the New York Times, disease-classification systems originated in 17th-century London to help doctors prevent the bubonic plague from spreading to populations that didn’t speak English.
French physician and statistician Jacques Bertillon (1890s) introduced the first medical coding system when he developed the Bertillon Classification of Causes of Death. In the 20th century, the codes encompassed not only causes of death but also incidence of diseases.
These days, medical coding translates the content of a patient’s health records into a universal standard medical code so it can be billed properly. Let’s take a closer look at the landscape to see how things stand, and identify the medical billing and coding trends you should look for in 2018.
The medical billing and coding landscape
The New York Times writes of the current medical and coding billing system:
“That system, with its lines of alphanumeric codes and arcane medical abbreviations, has given birth to a gigantic new industry of consultants, armies of back-room experts whom medical providers and insurance companies deploy against each other in an endless war over which medical procedures were undertaken and how much to pay for them. Caught in the crossfire are Americans like Wanda Wickizer, left with huge bills and indecipherable explanations in languages they cannot possibly understand.”
Between 2015 and 2020, Deloitte predicts worldwide spending on healthcare will increase anywhere from 2.4 to 7.5%. Despite this extra spending, many healthcare delivery organizations are facing increased operational costs, which are eating into their returns.
One source of increased operational costs is the ever-expanding complexity of medical billing. The same Times piece cites in-office earwax removal and vaccinations as examples; there exist unique codes for the method used as well as each injection. On top of that, not every payer uses the same coding system.
Administrative costs account for a full quarter of U.S. hospital spending; for comparison, those costs sit at 16% and 12% in England and Canada, respectively.
Hospital administration cost infographic (Source)
While medical billing and coding are ever-changing, there is general movement toward efficiency. Here are three medical billing and coding trends you should be watching in the coming year; they’ll only get more important as 2018 gets underway.
Three trends to look for in 2018
1. Computer Assisted Coding (CAC)
1. Uses natural language processing (NLP) to read and interpret text-based clinical documentation from patient charts.
2. Identifies potentially relevant ICD-10-CM diagnoses, ICD-10-PCS and CPT procedures, and present on admission (POA) indicators to provide suggested codes and corresponding documentation for coders or CDI specialists to review and approve.
CAC software is proliferating, particularly for coding inpatient claims. According to a report available through Research and Markets, the global market for computer-assisted coding software is projected to reach $4.75 billion by 2022.
Slide from a 2014 presentation on NLP in healthcare (Source)
According to CareCloud, coding specialists are afraid that the CAC built into EHRs could replace their jobs within a decade. This concern, however, is likely overblown. CAC is a huge help to human coders. According to one study, CAC increased coder productivity by over 20% and reduced coding time by 22% relative to their peers who didn’t use CAC, all without reducing accuracy.
A Cleveland Clinic study found that CAC had a lower precision rate when used without the assistance of a credentialed coder. As Sandra L. Brewton (RHIT, CCS, CHCA, CPC, AHIMA-Approved ICD-10-CM/PCS Trainer) writes:
“It cannot be overemphasized that the use of computer-assisted coding alone does not replace certified coders. The software is limited and does not have the ability to apply guidelines or make decisions about code application and the circumstances of each admission. It does not have the ability to ‘choose’ a principal diagnosis or a principal procedure, and in many cases, does not have the ability to build ICD-10-PCS procedure codes.”
2. EHR alignment
Poor record keeping—from not capturing the chart data you need to code correctly to capturing the data but making it hard for a coder to find later—can lead to a variety of problems for reimbursement. Already, most providers spend too much time searching for the right diagnostic codes for their patients rather than looking at and listening to them.
If your EHR and medical billing software are integrated, especially if your medical billing offers CAC, the process can go much faster. For example, your software can offer coding suggestions at the point of documentation, making codes more accurate from the get-go.
When your EHR has integrated CAC, it can automatically populate patient demographic data into a bill instead of wasting time by requiring staff to re-enter it and introducing the opportunity for errors. Fewer errors increases your first-pass claim acceptance rate, can improve data abstraction, and offer more robust reporting than standalone EHR and billing and coding software.
This reporting can include a robust set of financial data, such as units billed per visit, days sales outstanding (DSO) to accounts receivable, net revenue per visit (NRV), staff productivity, referral numbers, appointment cancels, and no-shows.
In 2016 ONC called for white papers on how the blockchain can improve healthcare. Researchers submitted more than 70 papers, and ONC awarded 15 papers covering everything from precision medicine clinical trials and research to a decentralized blockchain-based record management prototype for EHRs.
“Blockchain is booming in clinical trials right now; it is a big favorite of the pharmaceutical sector,” Maria Palombini, director of emerging communities and initiatives development at the IEEE Standards Association, said. Palombini predicts that blockchain has especially intriguing promise in EHRs.
In September, HealthcareITNews published “Why blockchain could transform the very nature of EHRs.” And Bruce Broussard, CEO of Humana, described blockchain as the next big healthcare technology innovation.
There are three primary reasons EHRs should consider adopting blockchain data storage:
- It can offer better privacy protections
- It can make information exchange easier and more efficient
- It can increase patient control over their data
Palombini detailed one sample application scenario:
“Everything you have in your health record gets put into the blockchain. Then the patient is managing their health record. How many times have you gone to the doctor and they ask, ‘What medicine are you taking? What is your wearable telling you?’ Why are you spending 15 minutes of your time with your doctor re-reciting something you think is written down in his chart from the last time you were there? Especially if you go to a new doctor, you want him to be able to have your health record.”
With blockchain, it could be as simple as a patient giving their doctor a token to access their records. “Using blockchain technology to reconfigure EHRs makes sense,” Elizabeth G. Litten, partner and HIPAA privacy and security officer at Fox Rothschild, recently wrote.
Dave Watson, chief operating officer at SSI Group (an RCM and analytics company), sees tremendous potential for the blockchain to improve revenue cycle management and claims processing.
By recording tests, results, medical billing, and payments in an immutable ledger, the blockchain could reduce fraud and even save money by decreasing the time and labor currently used to track that information through various systems.
On Medium, strategy, design, and development consultancy Sidebench wrote that the three areas where the blockchain could impact healthcare with the clearest path forward to providing significant ROI through cost savings are developing better health exchanges, protecting patients and practitioners through supply chain accountability, and reducing fraud in billing and claims.
Palombini’s “Holy Grail” is when patients own and control their own complete health histories, from hospital stays to outpatient visits to data from wearables. Blockchain is a tool that could help get us there. But it’s not the only way.
Getting ready for 2018
For smart providers, 2018 will be all about integrations. If possible, you want your medical billing software, CAC, and EHR to all integrate seamlessly. If they can take advantage of blockchain? All the better. To learn more about your software options , check out Capterra’s medical billing software, CAC, and EHR directories.
Looking for Medical Billing software? Check out Capterra's list of the best Medical Billing software solutions.