5 Big Challenges for Medical Billing Companies in 2022
The Healthcare industry has always been evolving with constant changes and new challenges due to significantly increasing regulatory guidelines, advanced technologies, newly introduced payment models, and a rise in telehealth. Because of advancements in EMR, EHR, and telehealth, billing companies will have to incorporate crucial changes in their RCM software and billing claim processes.
As stated in a CMS healthcare cost report, the total U.S healthcare spending is growing 1.1% faster than the annual GDP. In addition, it is predicted that total healthcare costs will reach 20% of the GDP by 2028. The covid-19 pandemic is the primary reason for the constant increase in spending. This has dramatically affected the companies providing the billing and coding services. Have a look at some significant expected challenges medical billing will face in 2022:
New Medical Codes:
After 2019, medical billing and coding service providers had to deal with the clinical documentation and coding for a virus they’d never documented before. This was a big challenge for coding companies to incorporate major changes to medical coding sets. Moreover, similar changes are expected in the fiscal year 2022; the Centers for Disease Control and Prevention have released the changes in ICD codes and their reporting guidelines, which are expected to roll out on October 1, 2022.
CDC incorporated 159 new codes, 30 invalidated codes, and 22 revised codes in the ICD-10 code set. The guidelines for coding and reporting ICD-10 and ICD-11 have been in effect since January 1, 2022. These changes will provide access to 17000 diagnostic categories. Therefore, coding companies must be prepared to face these changes and help healthcare providers in managing their revenue more efficiently.
New Healthcare Payment Models:
Price transparency has always been a blockade in the healthcare industry for a long time now. However, due to current ineffective payment models, most consumers fail to meet their finances. In addition, new healthcare payment models are because of the shifts in consumer expectation demand of patients, payers, and stakeholders.
The changes in payment models include:
- Increased payments for some specialties.
- Reduced price for some procedures.
- Cost of telehealth services covered by Medicare and Medicaid.
These additions will have notable indications for medical billing and coding companies.
Covid-19 Billing Claim Denials:
Denied claims are frustrating to providers, while they also consume much time in management. Covid-19 services billing has been a significant challenge for billing companies. Because of the continuous change in medical codes since 2019, it is difficult for service providers to accomplish their goals, with so many denied claims.
Haye’s Healthcare analyzes that 40% of charges against Covid care resulted in denials in the first ten months. The reason for this was incomplete documentation, claim submission / billing errors, non-covered services, and many more. As a result, providers and billing companies will need to advance their documentation and claim process to achieve their goals.
Documentation and Billing of Virtual Visits:
With Covid-19, there is a dramatic shift from outpatient visits to telehealth visits. According to a study, this shift has increased by 34 times in 2021. Telehealth and telemedicine have constantly been changing since the Coronavirus started. Commercial and Medicare payers have specific regulations for virtual visits instead of Medicaid and other insurance services. In addition, there are particular codes for telehealth and E&M visits new guidelines for billing them, which are affected from January 1, 2022.
In addition to the pandemic-driven factors, shortage of physicians, growing population, rise in chronic diseases will drive adoption of telehealth in 2022. While dealing with ongoing changes, medical billers and coders must stay up to date about every change on documenting and billing for the new services. Otherwise, they may face claim denials which will result in a lower customer satisfaction.
No Surprise Act Change:
A surprise medical bill arises when an insured patient gets Healthcare from out-of-network providers or other doctors that they did not choose. According to KFF, it’s a common situation in 1 to 5 emergency room visits. The estimated implementation of NSA is on 10 million surprise medical bills per year.
Taking effect from 2022, the No Surprise act establishes federal protection against surprise medical bills. This regulation will ban many forms of balance or surprise billing, in which a person gets Healthcare outside their insurer’s network. The law establishes penalties against the violation of balance billing, grants appeal rights to consumers, and requires a consumer complaints process whose health plan is not covered under surprise medical bills. Hence, billing service providers should be updated with all the changes to overcome the issues.
Conclusion:
Trends in billing and coding are constantly evolving in the healthcare industry. The leaders of medical billing and coding companies should know the importance of ongoing education to overcome challenges and industry trends. They also stick to the best practices to meet the payer guidelines and ensure accurate, timely claim submissions. Characteristics of a quality RCM services company include ongoing support, updated and customizable billing and reporting tools, and a history of clean claims.
