Top 4 Medical Billing Issues of 2018

Each year, physicians and medical practices face new and unique challenges based on new laws, regulations, and a fluid financial landscape. 2018 holds challenges significantly different from 2014, and these issues range from reimbursement to technology applications. We will reveal what we consider the top four medical billing issues facing medical practices in 2018, and what we consider essential to address in order to start 2019 off right.

MACRA Metrics

MACRA is the Medicare Access and CHIP Reauthorization Act, a bi-partisan law signed in 2015, amended in 2017, and likely to change again in early 2019. MACRA dictates that the U.S. Centers for Medicare and Medicaid Services (CMS) use collected performance data from the previous year to make payment adjustments. Under MACRA, a Quality Payment Program (QPP) has been developed that streamlines multiple quality programs under the new Merit-Based Incentive Payments System (MIPS) and gives bonus payments for participation in eligible alternative payment models (APMs).


While none of these aspects are new, what does represent one of the biggest challenges in terms of 2018 medical billing services is there are rumors of changes to some very commonly used quality measures in different specialties. This means that even if your practice does not intend to change which MACRA metrics it already uses, that change might be made for them whether they like it or not. The solution to this moving target is to be prepared: know your MACRA metrics inside and out, and, even if you’re using an outsourced medical billing firm for the task, be prepared to modify your choices and anticipate the different reporting requirements the changes entail.

ICD-10 Cleanup

The transition from ICD-9 to ICD-10 in October 2015 was hardly smooth. The 17,000 ICD-9 codes switched to an entirely new ICD-10 system with over 140,000 codes and hundreds of thousands of permutations. Further, it turns out they did not really get it right: numerous delays in payments and billing claims rife with errors like extraneous digits in billing codes meant medical practices were facing the dual battle of learning a new system and fighting the bugs of the system.


The simple fact is time is only revealing new errors, not healing old ones, and you need to employ an in-house billing or private billing services company that can move with the changes and corrections to ICD coding or anticipate it before it happens. Outside medical billing companies tend to be superior in this aspect; they hire dedicated coding experts with flexible payloads and completely up-to-date knowledge.

Transitioning Payment Options

When it comes to tech, medicine always seems a step behind. EHRs were an obvious eventuality, but the transition to electronic records was and still is painful to practices ill-equipped to handle an information overhaul. Perhaps more importantly, government agencies employed punitive strategies for not transitioning without allocating necessary funding to help the transition. The newest trend on the horizon involves the changing ways people are comfortable paying.

The system of “cash is king” may hold true from a revenue standpoint, but when it comes to medical billing balances, the fact is the more options available to a patient, the more likely they are to pay. Cash, credit, or check are no longer the only options for payment. Direct mobile banking, Venmo, PayPal, and TouchID payment systems clearly represent the future of standard payment as Millennials grow older. From a medical billing standpoint, practices that are prepared for this change and are implementing new options in their own billing department will be ahead of the game; everyone else will be catching up.

Medical Legislative Changes

When presidential administrations change, U.S. healthcare law changes. These changes don’t happen overnight, but many changes regarding expansion or contraction of Medicare benefits and managed care organizations are starting to manifest in 2018. Many more potential changes are due in early 2019. While it is not (and should not be) the job of a medical practice to know the legislative procedure, they should set up scenarios and action plans to employ in the event certain large swathes of their patient population, and therefore their medical practice, are affected.

These are only four of the many medical billing challenges facing any practice in 2018. The overarching most important message in all of these challenges is to understand the problems, come up with solutions, and anticipate new challenges that may be right around the corner.