Medical billing and coding is complicated and not an easy straightforward process. The multitude of rules and regulations, the introduction of the Affordable care Act (ACA) or popularly called as Obamacare, and the present switch from ICD-9 to ICD-10 coding system, has only added to the complications to medical billing and coding. It takes awareness, knowledge and expertise to translate the rules, regulations and the new updated codes, into a much more easily billed process, which can reduce denial claims and increase revenues.
Coding specialists have nothing to fear, despite the adoption of technology that has been integrated with the Electronic Health Records (EHR) or practice management systems in some healthcare provider organizations. Navigating the increase in number of codes in the new ICD-10 system requires skilled medical coders. Although, much preparations and cross-walks have already been floated across the websites, yet it should be remembered that there is no one fit for all. Each healthcare provider, will have their own way of handling patients and their ailments, and their own understanding of the disease, and given the specialization of even one disease, will require major understanding of the new codes, adjustments and adaptations. Hence medical coders will be in great demand.
Medical billers also known as practice manager, too will be required to then translate these codes and check and see how they can be transformed into bringing in higher revenues without defrauding the system. Better clinical documentation that is now demanded, and enhanced ways to confirm between diagnosis and procedure codes, will require the trained eye of a medical biller to set straight the record. It has been predicted by the US Bureau of Labor Statistics ” predicts that billing employment will grow 18 percent in the following decade, as the demand for healthcare services will be a basic requirement for medical billers. The Medical billers jobs are the most essential cogs in the wheel of the Revenue Management Cycle process. Since their role envisages a whole plethora of duties right from verification and eligibility of insurance coverage of the patient to finalizing all documentation and coding information, and process all claims and follow up the denials and Accounts Receivable (A/R), and negotiating payer contracts – makes their jobs centralized to everything in the healthcare providers arena. In-house or outsourced with enhanced technology, medical billers will always be required to check and recheck the inputs, so that the process is seamless and efficient.
Changing healthcare reforms, CMS rules and regulations, increasing footfalls of patients, and the Payment models, together are giving the physician the responsibility of focusing on the health and treatment of the patient. Against this background, where value of performance rather than fee for service will be the criteria, medical billers will be in much demand to take off the administrative burden and let the healthcare providers and specialists focus on the health of the patient.
Both, coders and billers will be in high demand to assist the healthcare providers, especially with the increase in patient engagements and medical chart reviews that will definitely require the services of these highly knowledgeable and expertly trained professionals. The future for medical billing in 2016 is both challenging and exciting, and an upward learning curve is visualized for a bright and prosperous path ahead.