As we rapidly approach the end of 2024, we reflect on some changes and adaptations in the healthcare industry. The industry faced both challenges and opportunities. We witnessed a convergence of factors shaping the future of health insurance – from continual technological advancements including Artificial Intelligence, to the ever growing influence of healthcare costs. All while still trying to keep up with (or stay ahead of) the fraudsters in our fight against fraud, waste, abuse and errors.
The year was marked by a continued focus on digital health solutions. Telehealth services, once a niche offering, became even more mainstream, expanding access to care. Additionally, wearable devices and mobile health apps gained popularity, empowering individuals to take control of their health and wellness. Just scroll your preferred social media site or watch television and you’re sure to see an ad for a digital health platform of some sort. While these advancements open avenues for better healthcare, they also present more opportunities for fraud.
Some of the most impactful changes in health insurance billing and coding in 2024 were still centered around COVID-19. There were provisional codes added for new vaccines. There was also a major streamlining of other COVID-19 codes. Over 50 previous codes were consolidated for better reporting. There were also new codes added for Respiratory Syncytial Virus (RSV) immunizations. But arguably the most impactful code change was related to Evaluation and Management codes. Time ranges were removed from office or other outpatient visit codes 99202-99205, 99212-99215 and a single ‘minimum time threshold’ was added. Additionally, new guidelines were added for split or shared services, and instructions for reporting hospital inpatient or observation services were added for codes 99234-99236.
Looking ahead to 2025, the healthcare industry will continue to evolve at a rapid pace. This will translate to needed adaptations for health insurance payors too. Telemedicine tops the list with new codes for audio-video visits (CPT Code range 98000-98007) and audio only visits (CPT Code range 98008-98015). Want a head start on what to look for in 2025? Attend our upcoming webinars.
HCFS has you covered!
HCFS and our clients have had a successful year. We’ve added (to date) over 200 specific Alerts to our platform in 2024. These Alerts paired with our Artificial Intelligence (AI) models can help identify spikes in payments, unbundling, upcoding, double billing, duplicate claims, inappropriate units billed and other anomalous billing patterns.
If you’re not using the HCFSPlatform™, maybe 2025 is your year? If you’re interested in knowing more, you may email us at [email protected] or [email protected].
We are filled with gratitude for the dedication and hard work of our team, the support of our partners, and the trust of our customers. We look forward to building on these successes in the coming year and continuing to deliver exceptional value and innovation.