5 Must-Know Trends for Medical Billers and Coders in 2023 | XyberMed

The healthcare industry is evolving rapidly, with many of the recent changes primarily due to technological advancements. Much of the progress is the result of quick action in finding solutions to the problems caused by the sudden onset and rapid infection of the 2019 coronavirus.

Medical billers and coders play an important role in the healthcare system by ensuring healthcare providers are paid for their services. In order for them to do their jobs effectively, it's important that they keep up with the latest trends and technologies.

In this article, we explore five current trends that medical billers and coders should be aware of in 2023. These trends include the use of blockchain, the development of artificial intelligence (AI) for image analysis and clinical decision-making, the increasing automation of medical billing software, and the growing importance of virtual medical care and remote patient monitoring.

Understanding these trends will give everyone responsible for medical billing a better idea of what to look out for and a frame of reference when these topics come up in medical billing news and updates. Keeping up with trends in this area will help you provide the best possible service to healthcare providers so they can better serve their patients.

Blockchain raises the bar for EHR systems

The most obvious impact blockchain will have on medical billing is increased security. Blockchain is the technology that makes cryptocurrencies so safe from hackers. HIPAA regulations dictate that patient data be kept secure, of course, but top-level security is necessary because medical data is a valuable target for hackers.

In addition to your actual medical history, your medical records also contain your Social Security number, age, address, and most likely some billing information. This combination makes them very valuable on the black market, so hackers are always trying to get their hands on them.

Blockchain not only provides a secure system, but it also allows patients to manage their own data so that a more complete picture can be created. The more complete a medical record is, the less likely there is to be errors in treatment.

Currently, there are issues with incomplete or incorrect information being passed from one provider to another due to communication errors between EHR systems. Blockchain decentralizes information and allows everyone to collaborate.

AI is being developed for tasks like image analysis

Regardless of how high-tech imaging is used, it is only as good as the analysis of the resulting image. Critical indicators that point to a problem can be subtle and missed by the human eye, but artificial intelligence (AI) algorithms are being developed to analyze MRIs, X-rays, and other types of images.

AI is expected to develop exponentially as capabilities in one area expand to the next. As the use of AI in medicine increases, billers will need to be aware of the new codes and the rules associated with them.

Payers are known for negotiating the lowest possible charges, but new technologies are often more expensive, while automation can enable lower costs. Taken together, these factors suggest that fees for AI-related services may continue to change for some time.

Clinical decision-making can be aided by AI

With new information constantly being added to the general knowledge base of medicine, it is impossible for anyone to keep up with it all and still treat patients. Physicians have been using the internet as a resource for some time, but AI can make this process much more thorough and efficient.

By analyzing patient data, AI algorithms can help identify patterns and insights that are not immediately apparent to human analysts. This can help improve the accuracy and speed of diagnoses, allowing for earlier treatment and better patient outcomes.

AI can also help medical billers and coders identify potential billing errors or discrepancies in patient records, further streamlining the billing and coding process.

Medical billing software ensures increasing automation

Even experienced billing professionals can only work so fast, and efficient and up-to-date software is critical to successful billing. Automation can reduce the time it takes to error-check claims before submission and to perform data verification on rejected and denied claims. Comparing a claim to the insurer's requirements can be done by an automated system in seconds, so errors can be found with much less effort than manual comparison.

If claims are rejected due to missing information, automated systems can find and complete the information and then automatically resubmit the claim. Although medical billing still requires a lot of human involvement, these automatable processes will increase overall speed and accuracy.

Virtual medical care is becoming more commonplace

The Covid 19 pandemic has caused virtual care to evolve much faster than it otherwise would have. The idea of treating patients without seeing them in person was not widely accepted, aside from answering questions on "ask a nurse" phone calls. When it suddenly became unsafe for physicians and medical staff to see patients, emergency measures opened up alternatives that have since become the norm.

The concurrent expansion of videoconferencing availability was also a major factor in the adoption of virtual care. Virtual care is not just an amenity for the elite but has also made great strides in serving low-income and rural populations. Of course, new services also mean new codes and the growing range of virtual services will bring new rules for what to use and under what circumstances.

Remote patient monitoring is also on the rise

Home care has been another concern during the pandemic, both because of concerns about nurses coming into contact with the virus during rounds and because of the risk of one healthcare worker becoming infected and subsequently infecting all of his or her patients.

There are several types of remote monitoring. For example, therapeutic remote monitoring (RTM) involves the use of medical devices to monitor respiratory and musculoskeletal activity, adherence to medication schedules, and response to therapy. It includes patient-reported data and is billed as a general practice.

Remote physiologic monitoring (RPM) codes, on the other hand, are considered evaluation and management (E/M) services and have different codes and rules for who may use them. In general, remote monitoring codes have more restrictions on the professionals who can use them, but there are codes that apply to licensed clinicians who provide services under the general supervision of a licensed billing professional, such as a physician or nurse practitioner.

As these new trends intensify and new services are added to billing codes, medical billers and coders will need to update their knowledge. This can be impossible for in-house billers who are busy submitting claims on a daily basis and don't have the time to learn about code changes and their implications.