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3 Trends that Holds the Key to the Future of Medical Billing Solutions

Cygnet Infotech

Medical Errors are the third leading cause of death in USA!(source) A small error in the diagnosis chart can prove lethal. Well thank god, the errors in the medical bill are not lethal but, they can certainly affect the cash flow of a hospital ultimately by being a roadblock in providing optimal care. And it is logical to say that higher the human interaction, higher the chances of error. Now, the general scenario says that a medical bill of a patient admitted in a hospital consist of inputs from approx. 300 people! So, do the math.

Technology cannot help in avoiding Human Errors, but it can definitely help in identifying the common errors with detailed reports and analysis. It can also automate the mundane repetitive tasks and allows medical practitioners to focus on their primary concern i.e. optimized care. Based on such principles, healthcare ISVs have integrated various services under the billing solution umbrella like revenue cycle management, payment verification, end-to-end medical claim management, claim denial analysis and real-time reporting services.

But still, there are certain issues like claim denial, slower amount receivable cycle, complex bill coding structure in medical billing procedure that still needs better solution. Emerging medical billing solutions are focused on solving these problems and are placing their bets on the following 3 trends that might hold the key to the future of medical billing solutions:

ICD-11 - Conqueror of Complex Bill Coding Structure:

While, the leading capitalist economy USA is still trying to cope-up with ICD-10 and its updates that was implemented in October 2015, WHO has already announced in their January 2017 Newsletter that they will release the 11th revision of ICD in early 2018.

WHO claims that the 11th revision is better than all their historical releases and will solve one of the major problem of simplifying the codes by defining them in detail to make them “human-readable”. Currently, ICD-10 codes only display the headline with no additional description. To solve the problem of duplication and confusion of codes in the medical bill, the ICD 11th update will have content model that has following 13 parameters to enable better understanding of the medical bill for non-medical entities like the insurance companies and common public:

  • ICD Entity Title – Full Name of the entity
  • Classification Properties - disease, disorder or injury to the entity
  • Textual Definitions - brief standard description
  • Terms - synonyms
  • Body Structure Description
  • Temporal Properties – bifurcating the nature of disease like acute, chronic or other
  • Severity of Subtypes Properties - mild, moderate or severe
  • Manifestation Properties
  • Causal Properties
  • Functioning Properties – impact of disease on daily life: activities and participation
  • Specific Condition Properties
  • Treatment Properties
  • Diagnostic Criteria

The update will not only help the medical coders and doctors, but also the medical investigators from the Insurance Companies will be able to better categorize the condition of the entity and speed-up the procedure of claim settlement and medical reimbursement.

EHR- The March Towards the Future:

EHR solutions have managed to create a buzz in the market and all for good reasons. The internet is flooded with statistics like the adoption rates of EHR solutions, success rate of EHR, Meaningful Use incentives and other such figures. Undoubtedly EHR solutions have revolutionized the medical industry but, the latest survey reveal something really interesting. Half of the EHR installed in the initial phase were just the basic versions adopted to get the benefit of the Meaningful Use Incentives. They were not integrated billing solutions. And now, organizations are shifting towards a new vendor or are looking out for options to integrate Billing Solution into their current systems. Due to such scenario, many EHR vendors have introduced Medical Billing in their solution and are also planning collaborations with independent Billing solution providers.

Remote Care Enablers- The Need of The Hour:

The global video and telemedicine market is expected to reach at $1624.4 million by the end of 2020 (source). The market is booming and medical practitioners are looking out for mobile solutions that enables them to provide remote care to their patients by breaking the traditional clinical setup. There lies a great potential market for ISVs who can design secure and industry compliant solutions that can fulfill the industry wide demand of Remote care. But, the challenge that lies ahead is the integration of such solution with other EHR solutions to provide 24/7 access of vital patient information to the doctors to optimize care.

Digitization have helped medical industry to optimize care. But, the problem like interoperability and complexity of solutions have hindered the medical practitioners to unlock the true potential of the digital transformation. If the technology enablers succeed in capitalizing on the upcoming trends, future Medical Billing solutions holds great potential in creating an ecosystem that is simple, fast and error-free. Many ISVs have been gearing-up for the bright future of medical billing solution, if you also have any such idea and want to cash on it, Cygnet Infotech can be your ideal product engineering partner.

Cygnet Infotech

Cygnet Infotech is a CMMi level 3 and is ISO 27001:2013 and ISO 9001:2008 certified, 18 year old global technology provider enabling ISVs & enterprises through emerging technology, software engineering, technology consulting, SAP Implementation, advisory & maintenance services. It’s proven 18-year track record boasts of successfully delivered 1400+ valuable software solutions to its diverse clientele across the globe using a global delivery model.

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