Texas Tech University Health Sciences Center
The Ongoing Transformation of Medical Billing

The Ongoing Transformation of Medical Billing

Forty years ago this month, I walked into Methodist Hospital on 19th Street (now Covenant) and started this long career that I enjoy. I have met many wonderful people over the years—one of the more satisfying aspects of work. It was back in those days, for example, that I first met our President, Dr. Lori Rice-Spearman, at Methodist Hospital.  Don’t worry, I’m not going to turn this into a “stroll down memory lane.”  Rather, I want this brief column to be focused on billing for medical services. It was important then and, of course, it is important today.  

In the 1980s, most healthcare providers handled their own billing. Physicians set fees for a diagnosis and treatment and then sent bills to insurance companies, who in turn paid the bill. Paper was everywhere because little technology was utilized. During those early days, it was common for medical coding and billing specialists to decipher handwritten patient documents and use typewriters to process insurance claims. We didn’t start using the UB82 until about 1983.

Billing and coding were time-consuming, as most patient files that contained sensitive information such as test results and doctors’ notes were not digitized but rather kept in large folders. And, of course, only one person could be using the hospital chart at one time. So, when the coder needed it, the chart might be, for example, at a specialist’s clinic. Each doctor also maintained his or her own medical record. Therefore, information was scattered. 

Even after arriving at Texas Tech Physicians in 2007, we were not fully digitized.  I remember one of our faculty members telling me "he would meet me in the parking lot” if we made him use the EHR! Now, in the digital era, our providers use electronic medical records to keep track of patients, eliminating our previous reliance on paper.  I must say it has not been an easy journey and the digital record is not accepted by 100% of users to this day (but then, what does have 100% support?)

The medical billing and coding profession continues to grow and change. We are proud of our billers and coders at Texas Tech Physicians. They keep up with constant change. For example, it seems a long time ago now, but the switch from the ICD-9 to the ICD-10 coding system made waves in the medical coding and billing fields. 

More waves are coming. In the future we will see more bundled payments and even more monthly predetermined payments as opposed to strictly fee-for-service payment. Two things that will not change—we will need a record of the visit and somebody will have to pay for care received.