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Vision 2025: Medical Coding a $25B Market

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Rising Demand Seen to Reduce Fraud, Misinterpretations in Insurance Claims

Medical coding will be at the forefront of a U.S.$25.4-billion market within the next seven years.

This is according to a mid-2018 share and trends analysis report from California-based Grand View Research.

In its base study in 2016, Grand View said medical coding was worth U.S.$10.6-billion with an anticipated compound annual growth rate (CAGR) of 10 percent.

Moreover, it said the demand comes from a rising need for a universal language in medical documents. In particular, medical coding streamlines hospital billing procedures, among others, thereby driving market growth, the research said.

In its forecast, Grand View said the number of professional coders will rise significantly. This, is turn, will boost the billion-dollar market of firms providing platforms for medical coding professionals.

Further, it noted other factors contributing to the rise in demand of medical coders, particularly in the Asia Pacific market. These include developing healthcare facilities and booming medical tourism in China, India, Malaysia, and Thailand, it said.

Adoption of Coding, Billing Procedures

“Rising occurrence of insurance frauds and insurance issues associated with misinterpretation of medical documents is also driving demand for medical coding services, especially in developed countries,” Grand View added. “Frequent revision of classification systems, coupled with increasing adoption of coding and billing procedures in hospital revenue cycle management, (will) generate significant growth opportunities during the forecast period.”

Moreover, it sees higher demand for medical coding services in countries with universal healthcare systems or compulsory health insurance. Consequently, it said there will be a strong demand-supply scenario for medical coders in the market.

Coders will be most needed during healthcare insurance claims, it said, citing the insurance industry and associated history of fraud.

The two most common classification systems are the International Classification of Diseases (ICD) and Healthcare Common Procedure Coding System (HCPCS).

Grand View said coders use HCPCS for procedures in Medicare, Medicaid, and other third-party health insurance providers. Mostly, the U.S. government through the Health Information Portability and Accountability Act (HIPAA) mandates HCPCS use.

Medical Coding Outsourcing

Chiefly, the research noted that companies offering third-party coding usually practice HIPAA-compliant security measures.

“Outsourcing of these services reduces the burden of updating the staff with latest regulations and guidelines,” Grand View said. “Thus, the outsourcing segment is anticipated to expand at the fastest growth rate in the medical coding market.”

Additionally, it said, these companies mostly adhere to ICD-10 guidelines, ensuring quality of medical coding service. The ICD version as of its 2016 baseline study contains around 69,823 codes for diagnostics and 71,924 for procedures.

“Addition of more than 140,000 new codes from its previous version is expected to significantly increase demand for trained coders, thus, boosting segment growth. Frequent introduction of updated versions and availability of training for specialty courses in coding is expected to create multiple vacancies for coders in healthcare institutes,” the research added.


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