Top 4 Challenges that Medical Billing Companies Will Face in 2021

Posted by Andrew Philips on January 22nd, 2021

What started as a vision and a mere contemplation a few years ago will materialize for the healthcare industry in the year 2021 with medical billing companies being an intrinsic part of it. The pandemic-induced deluge of healthcare services demand, major changes in regulatory frameworks, healthcare consumerism, technological inroads will bring an all-round facelift of the global healthcare administration system. While there is no doubting the fact that it will be a welcoming change, medical billing companies will have tread an extra-rough terrain to adapt to these changes. Here’s throwing light on the top four challenges that medical billing companies will have to address in 2021.

Changes in CPT codes- The newly adopted ICD-11 that has over 55,000 diagnostic codes will bring major difficulties for medical coders. To browse through code books to find the right code to classify the ailment and its subsequent treatment is a time taking process and can also spell interpretation mistakes. Medical billing companies must phase out such a manual process of finding codes with AI-driven coding systems to make the process faster and more accurate.

Demand for a patient-centric payment model- The gradual shift from a fee-for-service model to a quality-based pay structure will prompt expectations of introducing newer payment models such as shared savings, bundled payments, reimbursement to care providers based on the quality that they provide. However, to implement these challenges will necessitate major organizational changes to align the existing system with the new rules. It is critical for medical billing companies to draw a leaf from the early adopters of these new payment models and accelerate their process of tweaking their system to adapt to these changes.

Telehealth becoming mainstream- Social distancing norms set forth by authorities to contain the contagion has led Telehealth service cement its position to permanence in the healthcare sector. However, medical billing companies are facing significant challenges in adapting to this innovation that is expected to continue till this year. Telehealth adoption will continue being a challenge in remote areas which lack adequate access to broadband internet. Telehealth reimbursement rates are guided by regulations across states in terms of usage the technology, the extent of patients’ access to telehealth services, and the compensation rate to providers. Conforming to these regulations and adapting telehealth services will be a daunting task for the administration in the year to come.

Payment processing challenges- Patient payment preference is another offshoot of the proliferating healthcare consumerism. To adapt to such preferences, medical billing companies must implement newer measures such as multiple payment options and advanced payment technologies. However, to set an in-house team to execute these measures is an uphill task. They require special expertise to negotiate with each payment processor and maintain the necessary infrastructure which calls for a recurring expenditure.

To look at the brighter side, the challenges and the urgency to mitigate the same will bring a major overhaul of the existing healthcare system in terms of quality. The adoption of technology on a war footing will help medical billing companies to be future-ready in case of emergencies in the form of pandemic or natural calamities.

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Andrew Philips

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Andrew Philips
Joined: September 1st, 2018
Articles Posted: 35

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