Medical Coding Market Overview
The global medical coding market is expected to expand during the forecast period, mainly on account of rising number of patients suffering from diseases, increasing number of patients visiting hospitals, implementation of information technology (IT) in healthcare settings, and adoption of medical coding for health insurance claim management. Rising occurrence of insurance frauds and insurance issues associated with misinterpretation of medical documents are also responsible for driving the demand of medical coding services, especially in developed countries.
Medical coders convert medical reports from doctors, which may include a patient’s condition, the doctor’s diagnosis, a prescription, and procedures the doctor or healthcare provider performed on the patient, into a set of codes, which make up a crucial part of the medical claim.
On the basis of classification system, the medical coding industry can be categorized into International Classification of Diseases (ICD), and Healthcare Common Procedure Coding System (HCPCS). ICD is a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases. HCPCS is a set of health care procedure codes based on the Current Procedural Terminology (CPT), which is a medical code set maintained by the American Medical Association.
Based on mode, the medical coding market can be segregated into out-sourced and in-house medical coding. Hospitals or medical practitioners either hire part-time or full-time coders, or sometimes outsource the work. The selection of in-house or outsourcing medical coding depends on various factors including availability of skilled labor, healthcare system in the country, and size of the business. The out-sourced medical coding is growing rapidly owing to its low cost and rising number of medical coding outsourcing companies, especially in the Asian countries. Further, based on service, the market can be segmented into medical coding audits, hierarchical condition category (HCC) coding and risk adjustment data validation (RADV) audits.
Based on end user, the medical coding market can be split into hospitals, insurance companies, private healthcare organizations, and government organizations. Hospitals require medical coders to create a proper record of patient care and manage the massive amount of data generated. Medical codes are required by insurance companies to review clinical statements for the approval of insurance claim. Hospitals are the largest users of medical coding services due to large number of patients and huge amount of data generated in hospitals.
Geographically, North America leads the medical coding market. The market in Asia-Pacific is anticipated to exhibit lucrative growth during the forecast period, owing to developing healthcare facilities and booming medical tourism in countries, such as China, India, Malaysia, and Thailand.
Medical Coding Market Dynamics
Increasing number of patients visiting hospitals and the implementation of IT for managing the large amount of patient database is expected to boost the medical coding market growth in the future. According to the National Health Interview Survey, 2016, 92.7% children had contact with a health care professional in the previous year, which signifies the high amount of database generated that needs to be managed by the use of medical codes.
Rising occurrence of insurance frauds and insurance issues associated with misinterpretation of medical documents is also driving the demand for medical coding services, especially in developed region like North America and Europe. Besides, the demand for medical coding services is increasing within developing countries. For example, in Nigeria, adoption of universal healthcare systems and compulsory health insurance is likely to boost the medical coding market.
Moreover, frequent revision of classification systems, coupled with increasing adoption of coding and billing procedures in hospital revenue cycle management, is expected to generate significant growth opportunities for the market players during the forecast period. Addition of more than 140,000 new codes from its previous version is expected to significantly increase demand for trained coders, which in turn, will augment the growth of the market.
Furthermore, the number of coders is constantly rising as a result of career opportunities in this field. Availability of certification courses and training for specialty courses in coding offered by the American Academy of Professional Coders (AAPC) and the American Health Information Management Association (AHIMA) is expected to create multiple vacancies for coders in healthcare facilities.
However, cyber threat and insecurity among healthcare providers and patients is expected to hamper the market growth in the coming years.
Medical Coding Market- Competitive Landscape
Ongoing partnerships and collaborations in the industry are expected to increase the market share of the key players in the coming years. For instance, in January 2017, Aviacode Inc., a medical coding and compliance services company acquired the assets of Florida-based Revant Solutions, a provider of coding outsourced services.
Other competitors operating in the global medical coding industry are STARTEK Health, Parexel International Corporation, Maxim Health Information Services, Oracle Corporation, Aviacode Inc., Verisk Analytics Inc., Nthrive Solutions LLC and Medical Record Associates LLC.
The study provides historical as well the forecast market size data for various countries including the U.S., Canada, France, Germany, U.K., Italy, Spain, Japan, China, India, Brazil, Saudi Arabia, South Africa.