Are You Ready for These Medical Billing Changes Coming in 2016?

Anyone that runs a medical practice and supervises a billing staff (as well as oversees numerous and ever-changing rules and regulations) knows that medical billing is complex, which is putting it mildly. Keeping a practice financially sound these days takes up more and more valuable time for physicians and their administrative staff.

Of course the switch to ICD-10 didn’t make things any less complex for practices this year. The transition has caused physicians to spend even more time searching for the most precise diagnostic codes. Choosing the wrong code can mean the difference between getting paid and not paid, which is why 2015 saw more physicians turn to medical billing companies for help.

So what sort of medical billing changes can we expect in 2016?

Widespread EHR Adoption

In 2011 the National Center for Health Statistics reported that 54 percent of physicians had adopted an electronic health record (EHR) system. This number raised significantly to 83 percent by 2014 according to an ONC Data Brief. Because of financial incentives from CMS’s Meaningful Use incentive programs, more healthcare providers can be expected to make the switch to EHRs in the coming year. The goal of the healthcare industry for years has been interoperability, where operational, clinical and financial software systems can all communicate seamlessly. Once this happens, and doctors are connected, there will be greater efficiency that will speed up payment cycles.

More Precise Reimbursement

The recent ICD-10 transition spurred myriad conversations in the healthcare community, many of which were of the negative variety and focused on administrative and cost-related burdens. What we should begin to see in 2016 is a streamlining of the claims submission process. Greater specificity, while a pain in the butt (code K64.8), will inevitably lead to more precise, and in some cases, higher, reimbursements.

Healthcare Premiums Will Rise

According to the Spring Healthcare Trend Survey from Wells Fargo Insurance, health insurers are reporting that premiums will rise above regular inflation rates in 2016. This rate hike is a response to the predictions that medical claim costs will rise by 7 to 10 percent in the coming year. Rising drug costs are also playing a part in the premium hike.

Greater Adoption of Alternative Reimbursement Strategies

2015 saw many healthcare providers move away from the standard fee-for-service payment model toward alternative reimbursement strategies. Thanks to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) we can expect to see more providers adopt value-based care models in the coming year.

We can also expect to see the Centers for Medicare & Medicaid Services (CMS) spread bundled payments throughout the various segments of the industry in 2016.

More Physicians Will Outsource Their Billing Needs

Traditionally, physicians have preferred to keep their billing services in-house. But thanks to recent coding changes and ever-evolving legislation, more and more providers are turning to outside vendors for help. As more physicians make this shift, experts predict the quality of care delivered in this country will improve, as providers will be able to focus more on patients’ need and less on administrative duties.

Qualified Medical Billers Will be Even More in Demand

Growth in the medical billing job market is expected to significantly increase. These greater demands for professionals who can handle stricter coding guidelines and ensure reimbursements will result in higher wages and more career opportunities. The US Bureau of Labor Statistics estimates that IT opportunities in the medical field will increase by 22% throughout 2020. If you’re going to keep your billing in-house, expect to pay higher wages.

Physicians Will Turn to Front Office Technology to Collect Payments

We can expect to see more physicians turn to (and benefit from) front office technologies to help them collect payments. This Medical Billing Software will assist providers in patient payment responsibility estimation, pre-authorizations, online scheduling, mobile payments, and more. This will allow physicians access to a more reliable cash flow.

How Will the Bipartisan Budget Act of 2015 Impact Your Medical Billing?

The government’s Bipartisan Budget Act of 2015 incorporated quite a few key changes to healthcare reimbursement which may impact your medical billing in the coming year in the following ways:

  • The date of service for transitional care management (TCM) codes will no longer be the end of the month but rather the date of the visit. CMS also has stated the claim can be released on that same date as well. This is in an effort to streamline the billing process.
  • CMS has also stated it will cover advanced care planning (ACP) and set the work RUVs to 1.50 (99497) with 1.40 for each additional 30 minutes (99498). It should be noted that these codes are subject to cost-sharing for patients (unless they are billed at the time of the patient’s Annual Wellness Visit).
  • Medicare has placed more telehealth services on the “paid” list. These include prolonged service inpatient codes 99356 and 99357, as well as end stage renal disease (ESRD)-related services 90963 through 90966, with the originating telehealth site reimbursed a $25.10 facility fee for each patient.
  • New measures were set forth in the Physician Quality Reporting System (PQRS) and the Shared Savings Program. There was also a modification of the Value-based Payment Modifier (VBPM). As a means to address any reliability concerns, the minimum number of patients has been increased to 125 to include the practice in the cost assessment.
  • There are more than 350 code changes to 2016 CPT®. 140 of these are new, 93 have been deleted, and 134 have been revised. Physicians are encouraged to review their 2016 CPT® Manual before the end of the year to fully understand the changes that will impact them.

Are you and your staff ready for these upcoming medical billing changes?

Author Bio

Daniel Schwartz is a content strategist who sheds light on various engaging and informative topics related to the health IT industry. His belief in technology, compliance and cost reduction have opened new horizons for people in the health care industry. He is passionate about topics such as Affordable Care Act, EHR, revenue cycle management, and privacy and security of patient health data.

He can be contacted at


Comments are closed.