Latest Developments in Medical Billing

Latest Developments in Medical Billing

As for 2024, the medical industry of the US has gone (and is still going) through a lot of remarkable changes, featuring various new developments that are potentially aiding in medical billing. These developments are making the whole billing process incredibly easy, smooth, and convenient. They have significantly reduced doctors’ stress and anxiety & increased reimbursement rates along with eliminating frequent claim denials. These are some of the notable developments worth mentioning:

AI-Powered Technology

The first development, and probably one of the most anticipated & most important revolutions in the medical billing industry, is the introduction of AI and other AI-powered technologies.
Before AI, or even more advanced technology (like what we have right now), medical billing was a headache for both doctors and patients. All the tedious work that doctors had to do alongside treating their patients was painful and treacherous. Since the introduction and availability of AI in normal medical billing tasks, the workload has been greatly reduced and productivity has been increased. Now AI has a direct impact on processing medical bills, making the overall process smoother for everyone involved.
AI-Powered Technology
Think of AI as a super-efficient office assistant. He takes care of the boring stuff like data entry and insurance checks. As a doctor, this frees up a lot of your time slots so you can focus on what truly matters aka patient care.

Along with making tasks super efficient, AI has a keen eye for spotting errors, saving you from revenue leaks, and preventing patient confusion. Artificial Intelligence is just like having a trusted partner working around the clock to keep things running like clockwork.

E/M Coding Updates

E/M coding updates (or Evaluation and Management coding updates) are another addition to the medical billing industry. It is basically the use of CPT codes that range from 99209 to 99499.
These codes may include office visits, home services, preventative visits, etc. However, the other types of codes, like the codes for surgeries, are not included in this range.
Usually, adopting E/M codes is usually a complex and time-consuming task. That’s why in 2021, there was an E/M coding update, basically a new set of guidelines that emphasized the codes based on medical decision-making and the total time a doctor has spent with the patient. Before these new guidelines, the E/M codes were processed on the basis of the number of history and physical exam bullets.
By streamlining the coding process, E/M code updates are enabling practices to allocate more resources toward patient care and less towards documentation. Moreover, as a doctor, when you focus on medical decision-making – it encourages a more patient-centric approach to care, as providers have to document the complexity of their clinical reasoning.

ICD-11

ICD-11 was a much-needed advancement in medical billing, along with AI and automation. ICD-11 is the 11th revision of the ICD codes, proceeding with the ICD-10-CM codes that were already running in the medical industry.

ICD-11 code updates were introduced by the World Health Organization (WHO) and were officially launched on January 1st, 2022. The need for ICD-11 codes was based on the fact that the codes that were already mentioned under ICD-10-CM were getting outdated and were very limited to address modern diseases.

ICD-10-CM codes were launched and running for almost 2 decades, During this time, there were tons of changes made in medical advancements and new treatable diseases that were supposed to be mentioned in the new set of codes. That’s why 14,400 codes that were a part of ICD-10-CM codes were expanded to 55,000 unique codes in ICD-11. This increment of codes made doctor’s lives easier since now they were able to define illness and diseases in new, better, more comprehensive, and precise medical codes.

Automation in Medical Billing & Processing

Medical billing is no easy feat. There are tons of repetitive and time-consuming tasks that statistically take up a lot of time and energy. Things get a lot worse when a billing error comes up; which most likely decreases the chances of the payer’s paying out to you.

Now when you’re dealing with medical billing day in & day out, you’ll face these errors more often. This means you’ll also have to calculate the time and budget you’ll allot to fixing these claims, filing appeals, and discovering the source of the issue. Oftentimes this whole process eats up a big chunk of your profits – leaving you with little to no revenue.

Automation in Medical Billing & Processing

To avoid all this hassle, you have to work on the root cause of the issue, aka fixing the repetitive nature of medical billing. And the best way to avoid these errors is to put the medical billing process into automation. Medical Billing Automation is a procedure where charge input, claim scrubbing, and revenue processing are done automatically through timers and natural language processing. This can be done on a daily, weekly, or even monthly basis – depending on the frequency of medical billing in your practice.

Automation in medical billing significantly reduces human errors, giving you more precise, accurate claim submissions. It also helps you detect errors upfront so you don’t have to go through the critical procedures of actual claim denials – resulting in real-time financial loss.

Correct Coding Initiative - CCI

The National Correct Coding Initiative (NCCI, or commonly known as CCI), is developed by the Centers for Medicare & Medicaid Services (CMS). The main goal of CCI is to reduce improper medical coding and allow correct coding methods. CCI specifically focuses on Medicare Part B and Medicaid claims.

Basically, the correct coding initiative (CCI) is a set of guidelines that you can follow in order to ensure correct coding and billing practices. By following these guidelines for medical billing, you’ll be able to bill your patients accurately and get reimbursements accordingly. This also ensures delivering high-quality care to patients, preventing different billing frauds, and improving general healthcare quality.

Benefits of AI in Medical Billing​

Artificial Intelligence came in with a bang and completely changed a lot of industries. One of the prominent industries is healthcare in which AI has a significant contribution in medical billing and coding.
Due to the nature of medical billing, tasks can get complex if they’re handled manually. And this is where AI jumps in and takes charge. AI initiates its assistance by automating the coding process and creating a system that is less dependent on humans. It also assists in reducing claim errors and claims denials which result in an improved cash flow.
AI also helps in reducing standard work hours which results in more quality work done in much less time. This all results in saving all the revenue you lose in human errors. You’re able to process more billing and hence, get more reimbursements.
Benefits of AI in Medical Billing

Conclusion

And here you go, these are a few major updates that are revolutionizing the medical world & have significantly boosted processing speed, efficiency, and accuracy of medical billing, coding, and claims processing.

Unfortunately, not many practices have integrated these latest additions into their systems. Luckily, MaxRemind readily adapts these solutions and provides a holistic approach to day-to-day medical administrative problems. To see how MaxRemind can truly help you increase your revenue without causing stress, check out our products and services.