Trends Impacting Medical Billing Space

Tami McMasters-Gomez is the Director of Coding and Clinical Documentation Integrity Services for UC Davis Medical Center. In that role, Tami has built a gold-standard CDI program with a focus on analytics-driven performance improvement. A strong advocate for clinical documentation integrity innovation, Tami has been recognized as a thought leader, regularly speaking at healthcare conferences and interviewing with publications such as HealthLeaders.

What are some of the challenges impacting in medical billing space today?

It is a common misconception amongst most people that medical coding and medical billing are similar job functions, while in reality they are two widely different tasks.

Coding is done once the patient is discharged; coders study the medical record and code the case correctly. CDI then as per the next step ensures that medical records accurately reflect the level of care provided to patients. When coders and CDI both have completed their tasks, the case trickles down to the registration authorization and billing work queues, where the claim is handled. So billers don't code and coders don't bill, but billers then take the claim that the coders have coded and processed the bill.

The biggest challenge for coders in CDI is the adaption shortage of coders. Moreover in the industry we're challenged by needing to adapt to technology and automation and making sure that coders stay abreast of all the changes with technology and automation. However, because we're in California and our coders are remote. We recruit coders from anywhere in the nation and pay California wages which can be an advantage in attracting skilled coders to the team.

What are some of the trends impacting medical billing and coding space?

Automation is one of the major trends impacting billing and coding. Using artificial intelligence (AI) and machine learning (ML) technologies can help to automate certain aspects of the coding process, such as identifying key diagnoses and procedures from patient charts.

This further can help to improve efficiency and accuracy, while also reducing the time and cost associated with manual coding. However, it's important to note that AI and ML are not perfect and may still require human oversight to ensure accuracy. Coders may need to shift their roles to become second level reviewers, who can verify the accuracy of the automated coding results and make any necessary corrections.

What are some of the strategies to navigate through these trends and challenges??

The pandemic has shown us that we need to be adaptable and open to change, and this is especially true in the realm of healthcare technology and automation. It's also important to consider the context of each organization when thinking about implementing new technologies or processes. What works for one hospital or clinic may not be feasible for another, depending on factors such as budget and location.

As a coder or healthcare professional, it's important to stay up-to-date on the latest trends and technologies in the industry, and to be proactive in seeking out opportunities for professional development and advancement. This may involve acquiring new certifications or skills, or exploring different career paths within the healthcare field. Ultimately, the increasing use of automation and technology in healthcare is a trend that is likely to continue, and it's important for healthcare professionals to be prepared and equipped to navigate this new landscape.

What would be your piece of advice for budding professionals in the field?

As a leader I would encourage to pursue a career in coding or CDI, and continue to develop skills and credentials in order to stay current in the industry.

Adapting to change is definitely a crucial skill in the healthcare industry, especially in light of the recent pandemic. It's important to stay informed about industry trends and developments, and to be willing to pivot and adjust as necessary. Change can be difficult, but it also presents opportunities for growth and innovation, and those who are able to adapt and evolve are more likely to succeed in the long run. Overall, my advice is to stay informed, adaptable, and focused on the goals. As this will help to be successfull in the healthcare industry.