It’s time to update your awareness of what’s going on with medical coding and medical coding companies in 2021. This is because the field is changing quickly.

While the impact of ICD-10 has largely settled down, this doesn’t mean things are stable. The field of medical billing and coding is subject to trends that should directly impact your decisions regarding training your billers and coders, how you relate to your patients, and even why you might want to consider researching medical coding companies as you adapt your business strategy to a changing world. This article will get you up to speed with 5 trends that have a direct impact on billing and coding in your healthcare organization today.

Billing Lawsuits Are in the News
It might be comfortable not to examine your medical billing and coding practices, but recent news is a reminder that there are many issues that can crop up because of your billing practices.

Becker’s Hospital Review has provided a list of recent lawsuits, 11 in total, that involve healthcare billing fraud [1]. The fines reach up to $22.5 million, but the damage to the providers’ reputations is much more difficult to calculate. Here is an overview.

  • An urgent care network in South Carolina is paying $22.5 million because of allegations that it violated the False Claims Act.
  • A Wisconsin physician is pleading guilty to a $26 million fraudulent telemedicine billing scheme.
  • A New York surgeon is paying $783 thousand to resolve a civil case that alleged fraudulent billing.
  • A medical group in Virginia is paying $2.1 million to settle fraudulent billing allegations.

Why Providers Should Pay Attention
The fines and damage to reputation represent real risk to providers. Managing issues like these committed by internal employees can be complex, which is why many providers consider outsourcing to medical coding companies to help manage their risk and relieve some of the burden of monitoring for this type of behavior.

Security Has Gotten More Complicated
Medical billing security used to be relatively simple, but with the increasingly connected patient-provider relationship, companies like yours need to consider new security strategies. For example, today, you might be linked with multiple patient portals or virtual telehealth platforms, along with your billing and payment services. This means that you have new considerations to make in safeguarding your sensitive data. Security professionals recommend a few steps, including [2]:

  • Ensuring that the right people (and only the right people) have access to data and only for the proper duration of time. This also includes making sure the data is being used properly and in the context of the task that’s being performed.
  • Adopting a “zero trust” approach in their overall security strategy. This differs from strategies in the past that focused on keeping threats out and securing the IT perimeter. With the use of cloud-based architectures and breaches increasing across the industry, organizations should work from the perspective that nothing should be trusted — inside or outside your perimeters.
  • Considering automation to identify potential compromises more quickly. This helps surface the most severe threats faster, giving your team time to investigate.

Why Providers Should Pay Attention
A breach can slow your organization down and ruin your reputation. Security is now a full-time consideration, even in your medical billing and coding practices. But it can be a lot to keep up with, which is why many organizations have considered outsourcing to experienced medical coding companies as part of their security strategy.

Whistleblowers Are Getting Attention
Recently, the United States Department of Justice settled a $2.675 million case against Massachusetts Eye and Ear.

The case covered an eight-year period in which Massachusetts Eye and Ear was found to have improperly billed Medicare and the Massachusetts Medicaid program (MassHealth) for office visit and procedures, in the process defrauding the government over $1 million. The fraud involved mischaracterization of billing for office visit types, since the visits were not allowed under Medicare and MassHealth. The lawsuit was brought by a whistleblower, and their actions are protected against retaliation under the whistleblower provisions of the False Claims Act [3].

Why Providers Should Pay Attention
With more attention being paid to cases like these, providers should stay aware of potentially illegal activity of people in their organization.

Patients Are Getting More Involved
But it’s not just internal personnel who are paying more attention to what’s going on with billing practices. Patients are becoming more aware, and are being encouraged to scrutinize their medical bills and even request itemized bills to better understand their responsibilities.

An article from Insider, for example, advises patients that errors occur often and that they should request an itemized bill if they’re ever unsure about a charge. It also encourages patients to negotiate charges by comparing what they were billed with a hospital’s listed prices [4]. This is happening when CMS’ price transparency efforts are taking effect.

Why Providers Should Pay Attention
As patients become more aware of potential errors in their bills, providers should expect to feel pressure to minimize coding issues. They should also be prepared to consider their billing and coding efforts as a part of their patient engagement and patient satisfaction strategies, considering working with medical coding companies if the additional pressures are too much of a strain on internal resources.

Outsourcing to Medical Coding Companies Helps Address Pandemic Challenges
In the wake of the COVID-19 pandemic, there’s more discussion of outsourcing medical billing and coding — in no small part because shifts to remote work have opened up new possibilities for providers to rethink how they address these functions. Now is a great time to look at the potential of outsourcing and the benefits it provides including:

  • Improved cash flows
  • Lower costs
  • Heightened compliance
  • Reduced errors

These advantages, though, will be specific to your organization. To discuss the kind of cost savings, efficiencies, and error reductions you can expect, contact us and we’ll be glad to have a conversation.

References
[1] A. Paavola, “Healthcare billing fraud: 11 lawsuits, settlements,” Becker’s Healthcare, 27 April 2021. Available: https://www.beckershospitalreview.com/legal-regulatory-issues/healthcare-billing-fraud-11-lawsuits-settlements.html.
[2] B. Siwicki, “As patient-provider experience gets more interconnected, new security strategies needed,” Healthcare IT News, 26 April 2021. Available: https://www.healthcareitnews.com/news/patient-provider-experience-gets-more-interconnected-new-security-strategies-needed.
[3] E. Gunasekera and R. Brooker, “Whistleblower Rewarded for Alleging False Claims Act Healthcare Billing Violations Against Eye, Ear, Nose and Throat Healthcare Providers that Resulted in a $2.675 Million Recovery for the Government,” The National Law Review, 22 April 2021. Available: https://www.natlawreview.com/article/whistleblower-rewarded-alleging-false-claims-act-healthcare-billing-violations.
[4] K. Walsh, “How to spot expensive errors on your medical bill, and when you should ask for an itemized bill,” Insider, 9 April 2021. Available: https://www.insider.com/itemized-bill.

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