Through 2026, the worldwide medical billing outsourcing market is expected to grow at a compound annual growth rate (CAGR) of 11.5%, according to ReportLinker.com. This reflects an increasing tendency for solo practitioners and small medical practices to outsource their medical billing as a way to reduce their overhead and eliminate labor-intensive, in-house billing operations. In fact, the medical billing service industry is projected to reach a market value of $30.2 billion by 2030, according to Grand View Research. In short: In 2023, a growing number of medical practices are expected to outsource their medical billing to third-party services.
As technology improves, so do medical billing services’ offerings. Automation has been a key driver of growth in recent years, streamlining not only in-house medical billing operations, but also the way practices work with third-party RCM providers.
As cloud-based medical billing software and electronic claims processing become more common – especially with more effective integrations for EMR systems and practice management software – automation offers new opportunities for medical billers to quickly and easily scrub claims and submit them through clearinghouses to payers.
For example, practices and medical billing services often automate the creation of superbills. They may also automate the processes through which they verify that a superbill’s coding is accurate and billable. Claims transmission and patient statement generation may also be automated.
For example, Outbound AI has recently introduced generative AI technology to lessen billing staff administrative tasks. Through this technology, which includes ChatGPT, staff can more easily manage denials, process EOBs, and verify eligibility and benefits.
From the moment a patient’s insurance eligibility is verified to when payment is remitted, software is an essential element of the modern medical billing process. As healthcare IT products integrate machine learning algorithms, expect new opportunities for automation and increased accuracy in medical billing.
Modern medical billing software and services also allow healthcare organizations to personalize the patient experience in how they deliver statements and capture payments. Many services have begun implementing payment plans and other useful features to improve the patient experience. Expect more RCM providers to follow suit and double down on the trend of personalizing billing on a patient-by-patient basis.
Medical billing teams may also be expected to prioritize transparency throughout 2023 in response to both consumer and legislative concerns. For example, in Texas, Gov. Greg Abbott recently signed a bill mandating that hospitals not send patients to collections without first providing clear, itemized invoices.
Additionally, one consumer filed a complaint to Colorado’s Division of Insurance regarding a medical billing error that could affect tens of thousands of people. National news outlets have reported on this story, suggesting that transparency in medical billing will be of paramount concern nationwide in 2023.
In Minnesota, the Attorney General’s office has been holding public listening sessions about medical billing. These sessions are occurring as part of an investigation into the medical billing procedures of the health systems Allina Health and Mayo Clinic. This investigation suggests that medical practices and their billing teams must prioritize a positive, transparent patient experience in 2023.
Similarly, the No Surprises Act – implemented in 2022 to safeguard patients from unexpected medical bills – has come under scrutiny in 2023. Namely, when a federal district court invalidated part of the law, the American Medical Association voiced its support for this decision. However, in July 2023, federal executive agencies requested that the court reverse its ruling. Medical billing requirements may change as the Act’s provisions continue to take new shape.
Medical billing services should also be ready to accommodate potential changes to Medicare. For example, the U.S. Centers for Medicare and Medicaid Services (CMS) has expanded Medicare dental coverage for 2023. This expansion mandates that Medicare Parts A and B cover dental services key to patient treatment and disease outcomes. It also covers a broader set of circumstances, such as treatment to eliminate infections before organ transplants and some cardiac procedures. Billing services must adapt to such coverage shifts to be effective.