5 Changes You May Expect with Medical Billing this New Year

December 14, 2016


With the medical industry shifting its focus from fee based services to value based care, independent practices are being measured against other practices on the basis of value added service offered for cost effective prices. This indicates an immediate necessity to lower healthcare rates while increasing value and quality. While this is certainly a noble venture, it is not one without risk. Medical practitioners will be seeing a growing need to improve their medical billing services in 2017 to sustain their practice. Here is why:

  1. A marked importance of HCC system and risk adjustment coding:
    The growing attention on Hierarchical Condition Category (HCC) and risk adjustment coding finds root in the Medicare Advantage plans. HCCs are designed to adjust payment to ensure higher reimbursement for the more severe medical cases, who present a higher risk. Accurately coded diagnoses are sufficient evidence that justify risk adjustment. This, in turn, helps prevent a loss of revenue.
  2. Increased use of Natural Language Processing (NLP):
    The adoption of NLP technology, along with big data analytics, allows practitioners to retain high revenue by optimizing HCC coding, quickly identifying top priority claims for review, eliminating errors, reducing labor-intensive tasks, and correctly identifying opportunities for incremental revenue. Naturally, professionals trained in NLP will be in high demand to effectively utilize this high-end technology.
  3. Growing emphasis on medical eligibility verification:
    While the Affordable Care Act (ACA) has helped improve access to healthcare in the US, it has been brought to notice that there is still a large number of Americans who remain uninsured. Add to this the volatility of the exchange market place. It is evident that it will soon be crucial for patient eligibility verification to be a priority in order for practices to survive.
    It is also helpful to remember that the changed emphasis in healthcare practice to value based service, requires practitioners to adopt an ethical error-free strategy to receive payment from both uninsured and insured individuals. Overcharging and medical billing errors will have an increased likelihood to result in dire legal consequences for medical practitioners.
  4. Specialization of medical billing:
    Traditionally, medical billing remained an in-house process. However, as medical billing gets more specialized with every New Year, more practitioners are outsourcing to qualified medical billing companies. According to the US Bureau of Labor Statistics, IT opportunities within the medical field are expected to increase by 22% until 2020. Safety and security protocols, specialized billing processes, and the evolving need for new mechanisms demands efficient handling by professionals trained in this particular field. This has become nearly a necessity to guarantee adequate revenue to keep up with the changing market.
  5. Emphasis on quality reporting and analytics:
    The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 will be less relaxed in its requirements. Medicare will be evaluating practices through claims and other sources of information. Practices that embrace the point system put forth by this plan will experience more success, as payment in 2019 will be determined by performance in 2017. It is absolutely essential for practices to measure and analyze their performance and take steps to improve to avoid payment reductions and penalties in the coming years.

While we have been able to predict certain outcomes of the changing healthcare industry in regard to medical billing, there is still a lot that remains uncertain. For example, it is yet to be seen in which ways the Trump administration plans to replace or repeal existing healthcare plans and systems. Nevertheless, one thing that remains sure is that qualified medical billers will be in high demand this coming New Year, to effectively assist medical practitioners in receiving their due payment that will continue to enable them to provide value based services at cost-effective rates.


Category : Outsource Medical Billing