The Future of Medical Billing: Trends and Predictions

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We can observe improvements in the quality of medical services, new methods of treatments, and advancing technology. These provide essential support to human life. But let’s consider the technicalities behind the scenes. While the medical industry is quite complex, monetization adds even more difficulties. Here comes the role of Medical Billing. We shall dive into the medical billing process and the trends surrounding it.

What Is Medical Billing?

Generating and submitting medical claims to an insurance company for reimbursement of medical services rendered by a healthcare provider is called medical billing.

Does the definition sound complex? Well, let’s break it down. It is common knowledge that medical procedures can accumulate huge bills. Subsequently, health insurance is a way to provide emergency funding in times of need. But who has the patience or knowledge to file these claims and receive the reimbursement? A Medical Billing and Coding Professional handles this job.

Medical Billing: An Introduction 

Health is a crucial aspect of our lives. The healthcare industry is constantly evolving. It also contributes to the world economy. Therefore, awareness allows healthcare professionals, medical billers, insurance companies, and patients to make informed decisions and strategize ways to provide efficient services. We shall focus on medical billing while understanding the developments in this field.

1. History of Medical Billing 

Medical costs are often unaffordable making health insurance a necessity. However, medical billing began before the concept of health insurance originated. Hospitals and clinics kept simple records of medical services and charged patients accordingly. No formal system of billing was present. Patients paid directly, or in small installments. With the evolution of medical technology, and the rise in costs, health insurance came into being.  

2. Evolution of Medical Billing  

Employers began providing health benefits as an incentive to employees. Moreover, some governments also introduced programs to aid low-income and minorities with medical costs. This increased the amount of bills that healthcare providers had to handle. Thus, we required a proper medical billing system.  Soon, companies began providing medical billing software to the healthcare industry, helping reduce the complexities of paper bills and claims. With the dawn of computers, medical billing gradually became computerized,  improving efficiency and accuracy. 

3. Medical Coding Systems

Let’s look at the most common coding systems today. The International Classification of Diseases (ICD) is the most common coding standard, approved by WHO. A certified medical coder has in-depth knowledge of these codes.

• ICD-11, ICD-10, and ICD-10-CM, which is the Clinical Modification, and ICD-10-PCS which is procedure-based.
• The American Medical Association is the authority that developed the Current Procedural Terminology. It includes CPT I, II, and III. CPT is a procedural coding system for reporting diagnostic, surgical, and medical procedures. It also collects data on treatment outcomes to assess the quality of services provided.  
• The Healthcare Common Procedures Coding System is based on CPT. HCPCS Level I is based on CPT Category I. The HCPCS Level II includes non-physician services like ambulance rides, wheelchairs, and prosthetics, which are not included in CPT.

Current Trends and Future Predictions in Medical Billing 

The healthcare industry is always revolutionizing to improve the quality of medical services. Various authorities and organizations introduce new regulations and technologies. There are new ways to make the billing process easy and fair. Let’s discuss the recent developments in this industry.

1. Introduction of ICD-11 

The WHO introduced this latest version. It covers more diseases, specific diagnoses, AI coding compatibility, and digital tools to suit advancing technology.  Some of the key features of ICD 11 are as follows;

• Inclusion of diseases of the immune system, sleep-wake disorders, and conditions related to sexual health. 
• Significantly more codes for detailed classification and structuring. This will help in collecting precise data on diagnoses. 
• It can easily run on various health-based IT platforms and software globally.

 2. Use of Digital and Automation Tools 

• Various digital tools such as artificial intelligence (AI), automation, and computer assistance have simplified medical billing in many ways.
• Computer-assisted coding helps in assigning codes to diagnoses based on algorithms. This is an efficient and error-free method. 
• Revenue Cycle Management software manages the entire billing lifecycle. This ensures easy handling of steps from patient registration to payment of services. This reduces manual labor.
• AI tools easily integrate with complex ICD-10 and ICD-11 codes to analyze reports and complete the coding process. Moreover, billers and coders are using AI In Medical Billing for predictive analysis in reviewing claims. This helps in the prevention of denials and resolving potential issues with claims.
• Professionals have started using cloud-based platforms for remote work. It allows us to access data anytime anywhere. 
• Electronic Health Records and Electronic Medical Records store the medical information of patients. This allows easy and accurate transfer of details between the patients and different healthcare providers.

3. Blockchain Technology 

Blockchains store data securely by creating a network of decentralized ledger systems that can not be tampered with. This reduces the risks of fraud. Similarly, blockchains can store data, medical records, coding structures, and payment information. This creates a trustworthy system for healthcare providers, insurance companies, and patients.  

4. Outsourcing 

Hiring a third-party company for billing and coding services is becoming common. It also includes global outsourcing to countries such as India and the Philippines. This reduces the time spent on complex data analysis and lengthy coding procedures. However, it becomes crucial to comply with HIPAA and standardized coding structures like CPT, HCPCS, ICD, etc.

5. Remote and Virtual Billing  

• Remote work (billing and coding) has become a reality with the help of cloud-based systems and telecommunication technology. This trend is growing post-COVID-19 Pandemic because of its cost and time efficiency. 
• Telemedicine is an innovation that provides virtual healthcare consultations and patient assistance. However, telemedicine billing and in-clinic billing have separate regulations.  

6. Improved Regulations 

• HIPAA: Health Insurance Portability and Accountability Act. It was introduced to protect patient information. It ensures that patient records and medical data are safeguarded throughout medical billing.

• Medicare and Medicaid: Federal health insurance programs in the US. The Federal Authority established Medicare for people aged 65 and over for financial assistance. Medicaid targets low-income populations and is guided by the central authority but each state has separate regulations.

• No Surprises Act: This Act was established as a law in 2022. It applies in emergencies where a patient may receive care from out-of-insurance-network providers. Accordingly, they shall be informed upfront of the medical costs to prevent surprise bills.  Moreover, they shall be asked for consent in certain situations before receiving out-of-network care.  

7. Patient-centric Care 

We can observe a gradual increase in focus on patient outcomes like recovery, overall health, experience, and safety. Healthcare providers are gradually focusing more on patient outcomes rather than services rendered. 

Moreover, clear invoices, itemized costs, and transparent billing are being promoted to prevent confusion and surprise costs. Additionally, online payment portals now allow patients to view bills and make payments with ease. Medical Writing is an important aspect that is used for increasing awareness of the health sector among patients, service providers, and professionals. 

How to Become a Medical Biller?

To become a medical biller or coder, you also need a background in life sciences or pharma among other skills. Thus, Graduates, professionals, and diploma holders can pursue this field. Further, check out Henry Harvin’s Post Graduate Program in Medical Coding. 

Henry Harvin Medical Billing Course Details: 

• You will understand Medical Terminology. You will also learn concepts like anatomy, diseases, procedures, diagnostics tools and tests, and treatments. 
• To master international coding standards, you can pursue a Medical Coding Training & CPC Examination Preparation Course.
• Receive 80 Hours of Live Online Interactive Sessions by industry experts with 10+ years of working experience.
• Access to E-learning Portal for self-study and assessments. Trainers will also provide projects for skill enhancement.  
• Further, Get Hallmark Certification of Certified Professional Biller. Henry Harvin is also affiliated with the American Association of EFL, Ministry of Corporate Affairs, MSME, UKAF, UKCert, Project Management Institute (PMI), and ISO 29990:2010 certified. 
• Additionally, you will receive a guaranteed Internship with Henry Harvin and Placement Support through the Job Portal. 
• International Brands like Google, Amazon, and JP Morgan, will hire you. You will also receive salary hikes in your current profile. 

Medical Billing Scenario In India

Medical billing is well-established in countries such as the US. The private sector dominates the medical industry in such countries.  However, the situation is vastly different in India. 

Further, look at some factors that influence the medical billing industry in India.

• Indian healthcare infrastructure is evolving. This is because of the influence of global standards and healthcare regulations.
• Additionally, India has become a global outsourcing hub for medical billing services for Western countries. This is possible due to the availability of skilled professionals trained in international coding standards and the cost-effective nature of labor. 
• Moreover, Indian companies offer BPO services like coding, bill processing, claims submission, and denial management.
• The Indian healthcare sector will reform as the global trend of medical billing grows. 
• Due to current outsourcing trends, many are taking up professional courses in medical billing and coding. 
• Job opportunities will grow significantly in the future. 

Conclusion 

Are you looking for new opportunities to expand your profile? The medical billing and coding industry is growing with incredible prospects. Finally, we have understood the history of medical billing, its evolution, and the factors that influence it. Accordingly, a good grasp of trends and developments will allow you to explore this sector easily. Outsourcing and BPO are presenting many opportunities for trained professionals even when medical billing in India is not fully developed. 

Recommended Reads

1. Medical Courses After 12th: Exploring Your Option
2. Top 10 Medical Billing Courses Online
3. What is Medical Coding? A Complete Guide (2024)
4. Top 12 Medical Billing Courses in India

FAQs

1. Why is medical billing important? 

A proper document with a list of medical procedures and medical/non-medical expenses can easily be presented for payment. Thus, ensuring that the medical staff is reimbursed for their services and that patients can correctly claim their insurance. Therefore, medical billing is crucial. 

2. What is the difference between billing and coding? 

A medical coder is a person who checks patient records. They then assign codes to each billable item. Further, a medical biller creates a bill/ claim using the coded items for a patient or an insurance company. The medical biller submits the bill and also handles appeals, denials, and follow-ups. Both processes are different but interrelated.

3. Why is the Indian medical billing sector not developed?

• The fragmented healthcare sector in India makes standardization difficult. Moreover, rural areas lack proper access to medical services.
• India has not yet developed a consolidated billing process and coding structure.  
• Health insurance is not a popular option, resulting in out-of-pocket payments for services. 

4. What are some common medical coding systems?

The International Classification of Diseases (ICD) is the most common coding standard. It has different variations like ICD-11, ICD-10, and ICD-10-CM. Further, the Current Procedural Terminology (CPT) is a standard developed by the AMA. Lastly, The Centers for Medicare and Medicaid Services (CMS) maintains the Healthcare Common Procedures Coding System.

5. What are some trends in medical billing and coding?

The ICD-11 includes many more diagnoses, diseases, and codes for detailed classification. With the rise of AI tools, consequently, we can see its use in medical billing as well. Moreover, for outsourcing and remote work, cloud-based technology is becoming popular. Blockchain technology is also a new development when it comes to storing sensitive patient information.

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