The healthcare industry is evolving rapidly, with many recent changes driven largely by advances in technology—and much of the advancement is a result of taking fast action to find solutions to issues caused by sudden appearance and rapid contagion of the 2019 coronavirus.
Medical billers and coders play a vital role in the healthcare system, ensuring that healthcare providers get paid for their services. Staying up-to-date with the latest trends and technologies is essential for medical billers and coders to be effective in their roles.
In this article, we’ll explore five current trends that medical billers and coders should be aware of in 2023. These trends include the use of blockchain, the development of artificial intelligence (AI) for imaging analysis and clinical decision-making, the increasing automation of medical billing software, and the growing importance of virtual medical care and remote patient monitoring.
By understanding these trends, anyone responsible for medical billing will have a better idea what to watch for and will have a frame of reference when these topics come up in medical billing news and updates. Staying abreast of trends in the field will help to provide the best possible service to healthcare providers, who can then better care for their patients.
Blockchain Is Raising the Bar for EHR Systems
The most obvious impact blockchain will have on medical billing is increased security. Blockchain is the technology that makes cryptocurrency so safe from hackers. HIPAA regulations require that patient data be kept safe, of course, but top-level security is made necessary because medical records are a valuable target for hackers.
In addition to your actual medical history, your medical records include your social security number, age, address and most likely some billing information. That combination makes it worth a lot of money on the black market, so hackers continue to try to access it.
Blockchain not only provides a secure system, but its design allows patients to manage their own records, so a more complete picture can be established. The more complete a medical record is, the less likely there are to be errors in care.
Currently there are issues with incomplete or incorrect information being passed from one provider to another due to miscommunication between EHR systems. Blockchain decentralizes information and will allow them all to work together.
AI Is Being Developed for Tasks Like Imaging Analysis
Regardless of how high-tech imaging is used, the value is only as good as the analysis of the resulting image. Critical indicators may be subtle that indicate what the problem is, and they may be missed by the human eye, but artificial intelligence (AI) algorithms are being developed to analyze MRIs, x-rays and other kinds of images.
AI’s expansion is expected to be exponential as abilities in one area are expanded into the next. As AI moves into more medical usage, billers will need to stay aware of new codes and the rules associated with their use.
Payers are known to negotiate the lowest fees possible, but new technologies are often higher priced, while automation can permit lower costs. These factors together indicate that there may be changing fees for AI-related services for some time
Clinical Decision Making Can Be Supported by AI
With new information constantly being added to the general knowledge base of medicine, it is impossible for anyone to keep up with it all and still see patients. Physicians have been using the internet as a resource for some time now, but AI can make that process much more thorough and efficient.
By analyzing patient data, AI algorithms can help identify patterns and insights that may not be immediately apparent to human analysts. This can help to improve the accuracy and speed of diagnoses, allowing for earlier treatment and better patient outcomes.
AI can also help medical billers and coders identify potential billing errors or inconsistencies in patient records, further streamlining the billing and coding process..
Medical Billing Software Is Increasing Automation
Even experienced medical billers have limits as to how fast they can work, and having efficient and updated software is critical to successful billing. Automation can cut the time necessary for error-checking claims before they are submitted and for data verification for rejected and denied claims. Comparing a claim to an insurers requirements can be done in seconds by an automated system, so errors are found with much less effort than manual comparisons take.
If claims are rejected due to missing information, automated systems can find and fill in the information, then re-submit the claim automatically. While there is still a lot of human involvement in the medical billing process, these actions that can be automated will increase speed and accuracy overall.
Virtual Medical Care Continues to Become More Common
The Covid-19 pandemic forced forward movement in the field of virtual care much more rapidly than it would have otherwise happened. The idea of treating patients without seeing them in person was not generally accepted beyond answering questions on “ask a nurse” phone calls. When it was suddenly unsafe for doctors and medical staff to see patients, emergency measures opened up alternatives that have now become normal.
The concurrent expansion of video conferencing availability was a big factor in the acceptance of virtual care also. In fact, rather than becoming a convenience for the elite, virtual care has made great strides in offering care to low income and rural populations. Naturally, new services mean new codes and the expanding range of virtual services will bring new rules about what to use under which circumstances.
Remote Patient Monitoring Is Also Increasing
In-home care was another problem during the pandemic, both for concern of caregivers being exposed to the virus while they were out on rounds, and for the potential of a healthcare professional to be exposed and then subsequently expose all their patients.
There are several different types of remote monitoring. For instance, remote therapeutic monitoring (RTM) covers the use of medical devices to monitor such things as respiratory and musculoskeletal activity, how well the patient is adhering to medication schedules and response to therapy. It includes patient-reported data and is billed as general medicine.
Remote physiological monitoring (RPM) codes, on the other hand, are considered evaluation and management (E/M) services and have a different set of codes and rules as to who may use them. In general, the remote monitoring codes have more restrictions as to which professionals can use them, but there are codes that are applicable to licensed clinicians who are providing services under the general supervision of an approved billing professional, such as a doctor or nurse practitioner.
As each of these new trends grow and new services are added to the billing codes, medical billers and coders will have to update their skillsets. This can be impossible for in-house billers who stay busy with day-to-day claims filing and don’t have the time to research changes to the codes and their implications.
Medcare MSO has been providing medical billing and revenue cycle management services to practitioners and medical businesses for over a decade. We make it a point to stay up to date on the medical billing field and provide software that is fully HIPAA compliant and meets the strictest standards for data transmission. Because we have a large staff of billers, we can provide experts in many different specializations, making it possible to have someone work each client’s account who is fully up to date on that aspect of coding and billing. If you could use some help with your medical billing or any aspect of the revenue cycle, give us a call at 800-640-6409.