Developments in the Medical Billing System

Learn about updates and changes in the United States’ medical billing system.

Updating Medical Billing and Coding

Due to recent developments in American health care, exciting changes are anticipated for future health care systems. Medical billing systems have been called out as one of the many areas of health care that is due for a makeover.

While changes will take time to adapt to, it’s important to remember that medical billers will always play a key role in the health care system. Here are some of the upgrades that are occurring within the field:

Electronic Health Records (EHRs)

In the decades before software systems became mainstream, medical billing systems were not only hard to regulate, but were also carried out almost entirely on paper. The result was an unorganized medical billing system that was taking physicians’ time and attention away from the care of their patients. Today, the increasing use of electronic health records (EHR) is helping organize health care documents, reduce errors and cut costs in the health care industry. It’s also changing the medical billing process.

EHRs are used for may purposes, including:

  • Document individual patients’ conditions
  • Pass information among clinicians treating those patients
  • Justify financial reimbursement from insurance companies
  • Serve as a comprehensive legal record of medical events

Since they allow for impeccable organization and centralized information storage, the benefits of universal use of EHRs are unquestionable. Doctors will have access to not only their patients’ complete medical histories, but to databases that store disease information, medications and demographic information. The analysis of this data can be used to improve the quality of American health care.

Medical Billing Systems Affected by Health Care Reform

The industry encouragement of health care providers to adopt EHR technology is the result of these recent developments in health care:

  • In 2009, the Obama administration pledged $19 billion in American stimulus funds to health care information technology.
  • In March of 2010, President Barack Obama signed legislation to overhaul America’s health care system. Through the Patient Protection and Affordable Care Act, an additional 32 million Americans could become insured in the coming years.

To accommodate these newly insured Americans, health care providers will need to utilize the most efficient medical billing system. This will drive the need to hire additional qualified medical professionals.

Updates to the ICD-11 in 2018

The codes that medical billers and coders use to process claims and bill insurers are compiled in the International Statistical Classification of Diseases and Related Health Problems, or ICD-11. Each symptom or treatment is given an alphanumeric code. For example, 780.6 means “fever.”

In 2018, the 11th revision increased the amount of codes from 14,400 to 55,000. That’s a lot to learn!

Read a factsheet on ICD-10 Transition Basics from the Centers for Medicare and Medicaid Services.

These updates are reflected in medical billing training courses. Along with classes in medical terminology, anatomy and physiology, you’ll study clinical classification and coding systems, and health care reimbursement methods.

Future health care professionals working in the medical billing system must feel comfortable using the new EHR software, be able to effectively analyze electronic health care data and maintain EHR security.