Adapting to changes in medical billing and coding: A 2022 healthcare challenge

Specialized staff trained to code and bill for medical services are essential for maximizing healthcare revenues, reducing loss, mitigating risks, and maintaining an all-around successful practice. But staying on top of the constantly changing payer guidelines while maintaining staff is a major challenge that providers and practice managers will be navigating throughout 2022.

Adapting to telehealth medical coding and billing challenges

A McKinsey study reported increased use of telehealth in 2021 that was 38 times the pre-pandemic baseline. Similarly, a Greenway client survey conducted in August 2021 confirmed that telehealth isn’t going anywhere any time soon. About 96% of practices surveyed said they offered some form of telehealth services in some capacity. Meanwhile, 78% of respondents said they expected their telehealth use to increase to some degree as they respond to the ongoing COVID-19 pandemic and new variants of the virus expected to emerge over time. 

As a result of these dynamics, the rules for telehealth visits and the associated telehealth medical billing policies have also changed, and in 2022, continue to be refined. These changing trends present medical coding challenges and hinder the efficient management of the revenue cycle for many medical practices. Not surprisingly, there has been an increase in claim denials as a direct result of these complications.

According to a Hayes Healthcare Audit and Revenue Integrity Analysis, in the first 10 months of 2021, up to 40% of care claims related to COVID-19 were denied due to incomplete documentation, or for missing diagnostic codes for procedures that were being billed. In other cases, plain billing errors, duplicate claims, bundling, and submitting claims for non-covered services also contributed to the ongoing trend.

An example of such changing guidance can be seen in the use of coding modifiers. COVID-19 Public Health Emergency (PHE) guidelines initially allowed physicians to use in-person place of service (POS) codes for services provided via telehealth.

Telehealth Billing Guidelines

More recently, the Centers for Medicare & Medicaid Services (CMS) issued updated guidance on POS codes, and as of Jan. 1, 2022, Anthem and UHC now require commercial and Medicare advantage plans to use POS code 10 for telehealth services provided in patients’ homes, with POS code 2 still in use for locations outside the home such as skilled nursing facilities or hospitals. Similarly, effective Jan. 1, 2022, Modifier 93 is being allowed for medical services provided through audio-only technology in real time between a qualified healthcare professional and a patient. 

But these changing billing guidelines represent only one of many challenges experienced in the evolving healthcare landscape. A changing labor force, spurred on by the so-called “Great Reshuffle,” is also now causing people to explore new careers within, and outside of their fields. This phenomenon has affected medical practices too, so much so that many facilities are facing staffing shortages not limited to providers on the front line. Administrative staff — of which medical billing and coding professionals are an integral part — have also joined the movement.

Maintaining medical billing and coding staff amid the great resignation in healthcare

Traditionally, medical coders who identify billable information in clinical documentation translate their findings into standardized codes, then medical billers use these codes to submit claims to payers, insurance companies, and patients to recoup payments. But with the reshuffling — and because every patient encounter requires coded documentation — medical coding for doctors and practice administrators has become increasingly complex. 

The demand for medical record technicians, health information specialists, coders, and billers had been on the rise prior to the pandemic-induced reshuffle. The Affordable Care Act (ACA) contributed to this trend by making medical care more widely available and promoting more widespread use of EHRs. So, while the health demands of the pandemic added some unexpected challenges, the trend was already underway and is expected to continue long into the future.

The U.S. Bureau of Labor Statistics (BLS) projected 9% growth in the number of jobs in this field between 2020 and 2030, and stated it expects about 34,300 openings for medical records and health information specialists each year over 10 years.

Medical records and health information specialists — including medical coders and billers — have a median salary of $45,240 per year and $21.75 per hour. Their salaries have maintained an upward trajectory over the past decade (with 2020 being an anomaly). In fact, in 2021, an American Academy of Professional Coders (AAPC) salary survey revealed an average year-over-year increase of 3.8% for medical coding, significantly more than the 2.7% increase across other U.S. industries.  

With rising salaries, and the current trends in the labor market, it is reasonable to expect that billing and coding staff will continue to reshuffle throughout the industry in the immediate and near term. Both new entrants and experienced personnel will likely explore available opportunities within the space, which means medical practice managers and administrators will inevitably experience disruptions in workflows due to continuous staff turnover.

Avoiding healthcare revenue cycle bottlenecks: medical coding and billing best practices

Healthcare practice administrators must always maintain a full complement of medical coding and billing staff. Practices that lack support to stay ahead of medical billing and coding problems may benefit from a revenue cycle management partnership that provides proactive consultation, data insights, and training to improve key performance indicators (KPIs).

Such a partnership can also help practices do the following:

• Avoid revenue cycle bottlenecks and ensure compliance with ongoing policy changes.
• Adhere to best practices of timely and accurate claims submissions in a regulatory environment that is no longer typical.
• Submit accurate claims, maximize reimbursement, reduce loss, and increase revenues.