Medical Billing in 2015: 4 Takeaways from the Year that Was

January 12, 2016 by Antonio Arias, MBA, CHBME

Topics: Practice Management, Medical Billing Company

Before launching into the new year, it’s important to reflect on the developments and trends that made medical billing in 2015 so important to the healthcare industry at large!

It’s been far too eventful a year to cram into a brief “year in review,” but in looking back it’s clear these four stories marked the most significance for medical billers, coders, and practice managers over the last twelve months. Plus, we predict they’ll continue to reverberate loudly in 2016 ahead.

ICD-10 is Upon Us – But its Impact is Yet to Come
Years of postponements put the healthcare industry in the most prepared position possible for ICD-10’s ultimate implementation, and like Y2K before it the hype around the shift was more inflated than warranted by reality! With several months of ICD-10 exclusivity behind us, most practices have taken the new code set in stride, with almost 80 percent of healthcare organizations reporting a successful transition, according to a KPMG study. Yet we’ll all be staying tuned to the impact as ICD-10 helps tie healthcare billing and coding more closely to outcomes through the application of better data and more specific diagnosis codes. (Here’s hoping it doesn’t hit doctors where it hurts through lower reimbursements.)

Obamacare is Here to Stay
Public opinion of the Affordable Care Act, and the changes it has reaped on the state of the healthcare industry at large, remains hard to gauge (and divided mostly on party lines). But Obamacare isn’t going anywhere – and 2015 was the year that consumer adoption truly took off. The Affordable Care Act has brought down the percentage of uninsured Americans to about 11.5% in 2015 (down from 18% in early 2013) and a whopping 8.3 million Americans signed up for health coverage during's 2016 open enrollment period.

Mergers Create for the New Insurer Norm
At this time last year, the “big five” insurers (Aetna, Blue Cross Blue Shield, Cigna, Humana and UnitedHealthcare) remained separate forces to reckon with. But that started to change this past summer of 2015, when talks of mergers between Anthem & Cigna and Aetna & Humana began making the rounds. While the deals are still under review with the Federal Trade Commission and the Department of Justice, they’re expected to be finalized in late 2016 – meaning medical billing companies and departments will soon have two less titans to wrestle with, for better or for worse.

Outsourcing is on The Rise
Thanks to uncertainty over ICD-10, shrinking reimbursements from payers, and the rise of high-deductible health plans, 2015 marked a watershed year when it comes to interest in outsourced medical billing and revenue cycle management. The medical billing outsourcing market is expected to grow at a compound annual growth rate (CAGR) of 9.29% between 2014 and 2019, and a reported 72 percent of hospital CFOs consider end-to-end RCM outsourcing to be their best option until value-based payment models are better established. If you’re looking to outsource your back-office operations, you may be wise to do so now before demand exceeds the bandwidth of the best medical billing company or service for your needs. Click here to learn more (before it’s too late!).

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