Keeping Up With New Trends in Medical Billing and Coding

The healthcare industry is constantly evolving, driven by shifts in scientific advancements, patient privacy and insurance providers' policies. However, there have been several recent events that have impacted medical coding and billing.

Adapting to these changes creates an opportunity for new technology to emerge and helps the medical billing and coding industry to stay ahead of the curve. In this article, we will discuss new trends in medical coding and give statistics that show how the industry is meeting the challenges in the following sections:

• Medical coding trends
• Medical billing industry statistics
• How to stay ahead of the curve in the medical billing and coding industry
• What are the top challenges that medical billing and coding professionals face?
• Is continuing education for medical billing and coding professionals worth it?
• How can I stay up to date on the latest medical billing and coding industry trends?
• What are best practices to follow for a medical biller and coder?

The healthcare profession felt the brunt of the COVID-19 pandemic and adapted quickly to meet the need. For example, while the concept of “telehealth” visits had existed previously, it suddenly expanded as providing medical services via telecommunications and digital platforms became the norm.

Medical coding trends also responded quickly. New codes had to be created to track the many rapidly emerging procedures and services for COVID detection, treatment and immunization. These changes will continue to be integral parts of the healthcare system as the industry advances.

The medical billing and coding industry has made the major switch from ICD-9 to ICD-10, which is a universal classification system used to code symptoms, diseases and medical procedures in the U.S. Though ICD-10 was implemented for mortality reporting in the U.S. as early as 1999, insurance companies and medical providers transitioned more recently to use ICD-10. The new ICD-10 system came with many changes including well over 140,000 new procedures and diagnostic codes.

An International Classification of Diseases 11th revision (ICD-11) was put forward by the World Health Organization (WHO) in 2019 and approved. In the U.S., this global standard officially takes effect January 1, 2022.

Proper use of these codes rests on the shoulders and expertise of professional medical billing coders. As with any new system, training is essential. To keep up with the changes, one trend that is likely to continue is a focus on continual training even beyond certification credits or continuing education units (CEUs).

Another major change is the 2021 Medicare Physician Fee Schedule enacted by the Centers for Medicare & Medicaid Services (CMS). The changes are the first implemented in over 10 years and impact payment for the services related to Medicare.

Trends in reimbursements will adjust fee schedules for the foreseeable future and will change the market response on a short-term basis. As a result, the Medicare Physician Fee Schedules will require additional training to stay abreast of the changes.

The job outlook for the medical billing industry in the U.S. is more than double the expected average growth rate for all occupations. Employment in the field is predicted to grow by 8% on a national level from 2019 to 2029 according to the Bureau of Labor Statistics¹. This large growth rate is due in part to ongoing changes in the healthcare industry such as the trends mentioned above.

In addition, as family healthcare insurance plans have shifted to a higher-deductible model, U.S. consumers are utilizing health savings accounts (HSAs) to cover out-of-pocket costs. Patients are now more aware of payment responsibilities than ever before, prompting pressure for medical billing transparency.

Traditional medical billing typically delays the process of collection by as much as 30 days. However, U.S. consumers generally want to know their costs up front and satisfy their medical bills immediately via electronic payment.

Responding to these needs, the medical billing industry is investing in new payment models such as Revenue Cycle Management (RCM). This requires skilled professionals who can use revenue management tools to manage patient payments and ensure a more streamlined process for the healthcare industry.

The healthcare industry is a continuously evolving field. Whether you’re just beginning your career or have been working in the industry for some time, you should do your best to stay current with medical billing and coding updates, follow the latest industry trends, sharpen your skills and expand your knowledge.

To stay informed of medical billing and coding trends, you should:

The ability to navigate and utilize the International Classification of Diseases (ICD) database is a must for any medical biller and coder.

New technologies, such as cloud practice management platforms, electronic health records (EHR) and the medical internet of things (IoT), have created shifts in care delivery, patient treatment and administrative workflows.

Meanwhile, changes in privacy regulations such as Health Insurance Portability and Accountability Act (HIPAA) and Payment Card Industry Data Security Standard (PCI-DSS) impact how medical billers and coders handle patients' personal identifiable information (PII) and payment details. Understanding these updates help you ensure that your practice stays compliant.

The American Academy of Professional Coders (AAPC) and the American Health Information Management Association (AHIMA) offer many resources to help members stay current with medical billing and coding updates. You can subscribe to industry newsletters, participate in forum discussions and attend conferences to gain new knowledge.

Academic study in medical billing and coding can help you build a foundation if you’re planning to pursue other roles in the healthcare industry. After gaining a year or two of work experience, you might want to study for various exams or professional certifications to help build your knowledge, allow you to consider other potential opportunities or possibly increase your earning potential.

For example, certifications such as RHIT, HRHIA and CPC-P from AHIMA and AAPC may help you prepare to pursue opportunities such as a supervisory or management role in medical billing and coding. You can also choose to develop your skills in health information management or healthcare administration and services to help expand your career choices.

Programs such as our Medical Billing And Coding Certificate Programs at DeVry can help you prepare to pursue a Certified Coding Specialist (CCS) or Certificate Coding Associate (CCA) industry-recognized certification from the American Health Information Management Association (AHIMA).

More importantly, the flexibility of online courses means that you can continue your education around your work schedule.

The biggest challenges to the medical billing and coding profession include ongoing modifications such as those discussed above. One major change was the recent switch from the ICD-9 coding system to ICD-10. Other changes include medical privacy laws, insurance regulations and Medicare policies.

Continuing education is important for medical billing and coding professionals, and in some cases, might also be required. Ongoing training might be needed to maintain certifications or CEU credits. Medical billing and coding professionals can not only maintain credentials through online learning but also expand their employment opportunities. These skills are essential to hospitals, physician offices and insurance companies.

The current trends in medical billing and coding are constantly evolving—creating the need for ongoing education. In addition to online medical billing and coding courses, many sites provide good resources to keep up with industry trends.

Websites such as the World Health Organization (WHO) and the U.S. Centers for Disease Control (CDC) provide many resources and official definitions for reference. Another resource is the Ambulatory Surgery Center Association (ASCA) site, which lists payment rates for surgical procedures or “device-intensive” procedures. Since coding rules are based on the Medicare carrier, they can vary based on state. Simply signing up for the carrier's listserv will keep you informed via email any time changes are made.

The recent COVID-19 pandemic highlighted the importance of medical billing and coding as the healthcare industry struggled to keep up with testing and immunization records.

Accurate coding ensures that patients are not incorrectly billed. It also allows hospitals and physician offices to process these payments. Keeping healthcare billing running smoothly can be a daunting task, so best practices must be followed to stay on track.

Here are some best practices for medical billers and coders:

• Simplify billing: Patient-friendly bills mean a streamlined process that cuts down on time for the accounts receivable department.
• Dedicate resources to payer reimbursements: Staying on top of what is covered and what is reimbursable requires robust revenue management cycle data.
• Accuracy of claims (coding) is essential: Claims that are not properly submitted the first time can cost extra time that could go toward treating patients. A strong attention to detail prevents mistakes and is an excellent trait for a medical billing and coding professional to have.