Medical Coding and Billing Industry

Goals

To understand key trends and data points in the medical coding and billing industry in the US.

Early Findings

TRENDS

  • Automation is a key trend identified to affect medical coding and billing in 2019. It is predicted to help give staff more time with patients instead of focusing on the billing side.
  • Automation will also allow staff time to strength their skills in insurance systems and deal with denials on a case-by-case basis.
  • Middle-end services are expected to see the highest CAGR between 2019-2026.

PLATFORMS AND SERVICES

  • We could not any articles, expert opinions or trade press identifying any new, innovative or disruptive medical billing platforms that have hit the market in the past couple years. It seems this space has its standard players that do not change much.
  • There is a move for more and more platforms to move into the cloud. Furthermore, more platforms are offering integration capabilities to improve effiency and allow practices to bring billing back in-house.
  • Capterra's top medical billing software in 2019 are: Kareo, Intergy, TheraBill, MedicsPremier, ChartLogic, MedEvolve, Waystar, Azalea, DrChrono and Simple Practice.
  • Software Advice's top 10 medical billing software is: AdvancedMD, DrChrono EHR, NextGen Office, athenahealth EHR, Kareo Billing, PrognoCIS, Compulink Healthcare Solutions, AllegianceMD, ChiroTouch and Practice EHR.
  • Some of the above platforms also offer services for providers to outsource billing. Kareo, Cerner, CureMD, eClinicalWorks and athenahealth are some of the largest service providers for outsourced billing.

BENCHMARK DATA

  • According to Applied Medical Systems, there are several key benchmarks when it comes to billing and coding. Some of their key benchmarks are: coding should always be completed within 48 hours; denial rates should be less than 2% ideally and 1% optimally; try to bill within 24 hours; unpaid claims should be followed up within 14 days; accounts receiveables should be 20-35 days with less than 25% at 60 days overdue and less than 10% 120 days overdue.
  • It is recommended that a practice set its own benchmarks by comparing itself to other practices in similar fields and of similar size. The American Medical Association (AMA) publishes benchmarks its annual insurance company report cards, for example. Additionally, try the Medical Group Management Association (MGMA) for comparative data, or check with one's own billing provider for their own blind client data sets.

Summary Of Our Early Findings Relevant To The Goals

  • Our initial hour of research found some information on trends, platforms and services and benchmarking information for medical billing and coding in the US.
  • We did not have time to research how effectively mid-sized physicians group bill to insurance.
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Proposed next steps:

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