In recent years, the healthcare industry in the United States has developed to include telehealth as a norm for providing medical care. As a result of this transition, medical billing and coding requirements have changed, making some healthcare providers more susceptible to compliance risks and revenue cycle disruptions.
For optimizing healthcare profits, avoiding loss, mitigating risks, and maintaining an all-around effective practice, expert staff trained to code and bill for healthcare medical services is necessary. However, keeping up with continuously changing payer standards while retaining employees will be a massive problem for clinicians and practice managers in 2022.
THE CHALLENGES OF TELEHEALTH MEDICAL CODING AND BILLING
According to a McKinsey report, telehealth use increased 38 times more in 2021 than before the pandemic.
Due to these factors, the rules governing telehealth visits and the accompanying telehealth medical billing procedures have altered and will continue to improve in 2022.
Many medical offices have medical coding issues due to these shifting trends, making it difficult to manage the revenue cycle efficiently. As a result of these challenges, there has been an increase in claim denials, unsurprising.
According to a Hayes Healthcare Audit and Revenue Integrity Analysis, up to 40% of COVID-19-related care claims were rejected in the first ten months of 2021 owing to inadequate documentation or missing diagnostic codes for billed operations. Billing problems, duplicate claims, bundling, and submitting claims for non-covered treatments all contributed to the ongoing pattern in other cases.
BILLING GUIDELINES FOR TELEHEALTH
The Centers for Medicare & Medicaid Services (CMS) recently updated its POS code guidance. As of January 1, 2022, Anthem and UHC will require commercial and Medicare Advantage plans to use POS code 10 for telehealth services provided in patients’ homes, while POS code 2 will continue to be used for locations outside the home as skilled nursing facilities or hospitals. Similarly, beginning January 1, 2022, Modifier 93 will be authorized for medical services performed in real-time between a certified healthcare provider and a patient via audio-only technology.
However, changing billing guidelines are simply one of many issues facing the healthcare industry as it evolves. People are now exploring new vocations within and outside of their areas due to a changing labor force prompted by the so-called “Great Reshuffle.” This problem has also impacted medical practices, where many facilities are experiencing staffing shortages that are not confined to front-line clinicians. Administrators, including medical billing and coding experts, have joined the bandwagon.
KEEPING MEDICAL BILLING AND CODING STAFF AMID THE GREAT RESIGNATION IN HEALTHCARE
Medical coders who discover billable information in clinical documentation traditionally convert their findings into standardized codes, which are subsequently used by medical billers to submit claims to payers, insurance companies, and patients to recuperate payments.
However, because every patient visit requires coded documentation, medical coding for doctors and practice administrators has become more complicated due to the reshuffling.
Before the pandemic-induced reshuffle, demand for medical record technicians, health information professionals, coders, and billers increased. The Affordable Care Act (ACA) aided this trend by expanding access to medical care and encouraging the use of electronic health records (EHRs). While the pandemic’s health demands posed some unforeseen obstacles, the trend was already in motion and is projected to continue for a long time.
The U.S. Bureau of Labor Statistics (BLS) projected a 9% increase in employment in this industry between 2020 and 2030, with roughly 34,300 opportunities per year for medical records and health information experts during the next ten years.
Medical records and health information specialists, such as medical coders and billers, earn $45,240 per year and $21.75 per hour. Over the last ten years, their pay has been steadily increasing (with 2020 being an anomaly). A salary study conducted by the American Academy of Professional Coders (AAPC) in 2021 indicated a 3.8 percent average year-over-year rise in medical coding, much higher than the 2.7 percent increase in other U.S. businesses.
With rising salaries and current labour market trends, it’s reasonable to predict that billing and coding workers will continue to reshuffle around the business in the foreseeable future. Both newcomers and seasoned employees will most likely look into available opportunities within the industry, which implies that medical practice managers and administrators will face workflow disruptions due to constant staff turnover.
MEDICAL CODING AND BILLING BEST PRACTICES FOR AVOIDING HEALTHCARE REVENUE CYCLE BOTTLENECKS
Medical coding and billing professionals must constantly be available to healthcare practice administrators. A revenue cycle management partnership that provides proactive counselling, data insights, and training to improve key performance indicators (KPI) may benefit practices that lack support to keep ahead of medical billing and coding challenges.
A revenue cycle management partnership that provides proactive advice, data insights, and training to enhance key performance metrics may benefit practices that lack support to keep ahead of medical billing and coding challenges (KPIs).
A collaboration like this can also assist in accomplishing the following:
- Avoid revenue cycle bottlenecks and ensure that continuous policy changes are followed.
- Follow best practices for timely and accurate claim filings in a regulatory climate that is no longer typical.
- Submit valid claims to maximize reimbursement, decrease losses, and boost revenue.