Every year brings new changes in the way medical billing services must operate. In 2022, those changes will include new CPT codes, a new ICD system, and new ways of doing business.
Hospitals, clinics, and medical practices are increasingly outsourcing their production of medical billings. The market for medical billing services increased by 9.4% in 2019, by 10% in 2020, and by 10.3% in 2021. Industry analysts project annual growth in medical billing outsourcing of more than 12% by 2028.
To meet the increasing demand for medical billing services, medical billing companies are increasing their hires of trained and qualified medical billers and coders. The Bureau of Labor Statistics projects that the medical billing and coding job market will grow by 22% through 2026.
Coders always have a lot to learn to keep up with the changing demands of the job. Here are some of the changes that the medical billing industry will see in 2022.
New CPT Codes
Current procedural terminology (CPT) codes are always a work in progress. As physicians adopt new procedures, the American Medical Association creates new CPT codes to describe them. The Centers for Medicare and Medicaid Services (CMS) also dictates changes to CPT codes that must be used when billing Medicare and Medicaid.
About 250 new CPT codes have been adopted or will likely be adopted for use in 2022. Several new codes relate to COVID-19 vaccines, including codes for booster shots and vaccine administration. Other new codes relate to therapeutic remote monitoring and principal care management.
New ICD System
In addition to mastering new CPT codes, billers and coders will eventually transition to a new system of coding symptoms, diseases, and other medical conditions. Insurance companies have increasingly required billings to reflect the International Statistical Classification of Diseases and Related Health Problems (ICD) developed by the World Health Organization (WHO).
The tenth revision of the ICD (ICD-10) was implemented in 1994. Its use in the United States became widespread in 2015, when CMS mandated ICD codes for all billings that are covered by the Health Insurance Portability and Accountability Act (HIPAA).
The WHO’s eleventh revision (ICD-11) took effect in January 2022. At this point, the CMS has not mandated the replacement of ICD-10 with ICD-11 in the United States. Given that ICD-10 is clinically outdated, a transition to the international standard is inevitable. The only question is when ICD-11 will be implemented in the US. Coders will at least want to be trained with an overview of ICD-11 so that they can begin to prepare for a transition to ICD-11 when it is finally implemented.
No Surprises Act
The No Surprises Act (NSA) requires most emergency services to be covered by insurance, even if they are provided by an out-of-network provider. When an insured patient receives any services at an in-network facility, the NSA bans the practice of billing the patient for services rendered by out-of-network providers unless the patient has been advised of those services in advance and consents to pay for them.
The NSA presents challenges to the collection of medical bills by out-of-network providers. When the NSA prohibits billing a patient for services, billers must be clear about the services they can bill directly to the patient and those that they cannot.
Under the NSA, uninsured patients must be given a good faith estimate of the cost of medical services. Billers will need to keep that estimate in mind to avoid preparing bills that substantially exceed the estimate unless the excess billing is justified.
Automation and Billing Software
Healthcare providers continue to experiment with automation in all phases of the medical industry. They rely on technology to improve diagnoses and to make correct judgments about treatment. Providers hope that billing automation will reduce insurance claim denials and produce billings more efficiently.
Just as computers are not ready to replace doctors, billing automation cannot remove qualified billers and coders from the billing equation. Software is only as smart as the human who operates it. Still, improvements in billing software should help reduce human error in medical billing.
“Automating the revenue cycle” has become an industry buzz phrase. Companies that offer “automation solutions” to the medical industry promise to increase efficiency, reduce costs, and minimize errors. There is no doubt that, over time, technology will help integrate processes from patient registration and medical records management to coding and insurance claims submission. Each process is complex, however, and seamless integration is difficult to achieve.
Medical billing services are often challenged to find software that will serve the needs of multiple clients. Different providers keep records in different ways. Some are in digital form and online. Some involve a physician making notes with pen and ink. Billing companies need to work with each provider to find technological and human solutions that maximize efficiency and reliability while minimizing errors and cost. While those solutions continue to evolve from year to year, medical billing services need to keep their finger on the pulse of automation regarding every aspect of medical services delivery and revenue management.
Changes in ACA
Efforts at healthcare reform bring changes to health insurance every year. Unfortunately, different policy makers have different ideas about what “reform” should entail, making it difficult to predict how the health insurance industry will operate from year to year.
Most rules governing the Affordable Care Act (ACA) remain in effect in 2022. The American Rescue Plan, legislation that responded to the pandemic, increased subsidies for insurance premiums while making subsidies available to millions of Americans who previously did not qualify for them. The income cap for subsidy eligibility has been eliminated through the end of 2022.
The Build Back Better plan would extend subsidies for individuals who received unemployment compensation through 2025. Those subsidies expired at the end of 2021. While the House passed a version of the plan that extends the subsidies, whether the Senate will do so is unclear.
Insurance premium subsidies are important to the medical industry, as are limits on out-of-pocket expenses for essential medical services covered by ACA-compliant plans. That limit increased to $8,700 for 2022. When more people and services are covered by insurance, it becomes more likely that healthcare providers will maximize their revenues.