It’s no secret that COVID-19 has shaken up the medical world. From rapidly accelerating telehealth adoption to presenting new clinical opportunities for pharmacists, the changes this year have been nothing short of monumental.
With so much change and uncharted pandemic territory, one of the looming questions is about medical billing services and what the future looks like. What exactly will medical billing services look like a year from now? In the year ahead, we expect to see the following shifts in the medical billing services industry:
New Tracking and Billing Coding Standards for Patient Services
Accuracy and precision are incredibly important when tracking and billing for patient services—which is why it’s important you stay up-to-date on the latest billing code changes. New pandemic-related ICD-10 CM, CPT, and HCPCS codes were just released in October 2020, and getting them right is essential in order to get paid accurately and on time for the services you provide.
It’s quite common for medical billing claims to be denied due to missing or inaccurate data, such as outdated CPT or ICD-10 codes. Medical billing services and technology can help save time and money, while also reducing costly administrative errors that can delay or prevent claims from being approved.
“Equipping a health care workforce to accurately code medical procedures streamlines communication across the health system, reducing administrative and rework costs at a time when resources are stretched by the COVID-19 pandemic,” said Patrice A. Harris, MD, president of the American Medical Association (AMA).
Growth in the Medical Billing and Coding Services Field
Those considering a career in medical billing are in luck, because medical billing and coding jobs are a fast-growing field in healthcare. Demand is likely to continue increasing amid the COVID-19 pandemic, new coding standards, and the expanding role of pharmacists, all of which create a need for pharmacy medical billing education, services, and support.
Since the new medical coding standard, ICD-10, was implemented in October of 2015, care providers have been looking for medical billing professionals with the right expertise and training—especially because the new coding standard has six times as many codes as the previous standard.
Actions to Reduce Claim Denials and Medical Billing Surprises
An increasing number of care providers will take proactive steps to reduce claim denials and medical billing surprises. Several states are also taking action to protect providers and patients from surprise medical bills during the COVID-19 pandemic and beyond. “COVID-19 certainly brings the issue of surprise billing to the forefront,” said Loren Adler, associate director for the USC-Brookings Schaeffer Initiative for Health Policy.
Currently, two congressional committees are introducing legislation for upcoming pandemic stimulus bills and working to ban surprise medical bills nationwide. This effort comes after years of medical billing concerns, with one in five Americans reporting they’ve received unexpected medical bills from out-of-network providers before the pandemic.
Increased Demand for Pharmacy Medical Billing Support
As pharmacists take a more active caregiver role during the COVID-19 pandemic, we’ll likely continue to see increased demand for pharmacy medical billing services. This will only further accelerate medical billing needs for pharmacists, whose role has already been evolving in recent years to include more clinical care services.
Pharmacists are often viewed as the most accessible care providers, especially in rural areas where patients may be required to travel a great distance to reach a primary care physician (PCP) or hospital. Alternatively, nearly nine out of 10 Americans live within five miles of an independent pharmacy, which is why pharmacists are often the first point of care for people in rural communities.
While community pharmacists are uniquely well-positioned to deliver clinical services such as chronic disease management and preventative care due to their accessibility, they need the right medical billing support to ensure they’re adequately reimbursed for said services. Along with ensuring medical billing accuracy to avoid unnecessary claim denials, pharmacy claims reconciliation plays an important role when it comes to identifying delayed or missing payments, claims not paid in full, and money lost to processing and DIR fees.
Medical Billing Technology for Better Resource Utilization
As they take on more clinical responsibilities, pharmacists and technicians need to be well-equipped to accurately code for COVID-19 testing, as well as for a future vaccine. Medical billing solutions such as FDS MEDBILL, which is designed specifically for independent pharmacies, can help to streamline complex medical billing, automate manual workflows, improve accuracy, reduce errors, and improve resource utilization as a whole.
FDS ECONCILE, claims reconciliation and receivables software for community pharmacies, can also help pharmacists identify outstanding receivables and monitor third-party payments. Rather than relying on manual processes to track down unpaid claims and slow-paying third parties, pharmacists can utilize an automated solution like ECONCILE to spend less time chasing after payments and more time on offering better patient care.
By making smarter use of resources with the help of modern pharmacy technology, pharmacists and pharmacy technicians can free up time to spend helping patients, offering enhanced clinical care services, growing their business, and introducing new revenue streams—minus all the administrative hassles and roadblocks that can come with doing so.
Ensuring Medical Billing Accuracy and Efficiency With Technology
As you grow your pharmacy business and explore new revenue opportunities, the need for reliable, accurate, and efficient medical billing services will be more prominent than ever before. Consider investing in a medical billing solution for your pharmacy so you can move forward with a unique competitive edge and take your business to the next level in 2021 and beyond.
