How a Medical Billing Company Keeps Up With CPT Updates

Staying current with healthcare regulations and coding standards is crucial for maintaining a healthy revenue cycle. Among these standards, the Current Procedural Terminology (CPT) coding system plays a central role. Developed and maintained by the American Medical Association (AMA), CPT codes are updated annuallyand sometimes even quarterlywith new codes, revisions, and deletions. For medical practices trying to juggle patient care, staff management, and administrative tasks, staying on top of these updates can be challenging and time-consuming.

Thats where a professional medical billing company comes into play. By outsourcing your billing operations to a trusted partner like Thrive Medical Billing, your practice gains access to a team of experts whose sole focus is to ensure your claims are submitted accurately and in compliance with the latest CPT coding standards. This not only prevents costly errors and denials but also ensures that your practice captures the full revenue it is entitled to.

In this article, well explore how a medical billing company keeps up with CPT updates and why that matters for your practice's financial health.

Why CPT Code Updates Matter

CPT codes are a standardized system used to describe medical, surgical, and diagnostic procedures and services. These codes are essential for:

• Submitting insurance claims

• Documenting medical services provided

• Receiving timely and accurate reimbursement

• Maintaining regulatory compliance

Each year, the AMA releases an updated version of the CPT code set, which typically includes:

• New codes for emerging services and technologies

• Revisions to existing descriptions or guidelines

• Deletions of outdated or redundant codes

Failing to apply these updates accurately can lead to claim denials, reduced payments, compliance issues, and delays in reimbursement. For busy practices, staying on top of these changes can be overwhelmingwhich is why many turn to a dedicated medical billing company for help.

How a Medical Billing Company Stays Current With CPT Changes

1. Continuous Staff Education and Certification

One of the most critical responsibilities of a medical billing company is ensuring its staff remains educated and credentialed. At Thrive Medical Billing, our billing and coding professionals are:

• Certified through recognized organizations such as AAPC or AHIMA

• Required to complete continuing education units (CEUs) to maintain certifications

• Trained on all CPT code updates as soon as they are released

• Tested regularly on coding accuracy and compliance

This ensures our team is always aware of changes and knows how to apply them effectively for various medical specialties.

2. Collaboration With Coding Experts

At Thrive Medical Billing, we employ certified coders who specialize in CPT, ICD-10, and HCPCS codes. These experts not only stay updated with CPT changes but also:

• Interpret AMA's coding changes and guideline shifts

• Work directly with providers to ensure documentation supports the updated codes

• Provide training and education for your clinical and administrative staff

• Identify trends and recurring issues related to CPT application

Their job is to ensure that the codes used match your documentation accurately, eliminating confusion and reducing billing errors.

3. Subscribing to Industry Resources and AMA Updates

A professional medical billing company doesnt wait for mistakes to happen before actingit proactively tracks changes from credible sources. At Thrive Medical Billing, we monitor:

• AMAs official CPT code updates and bulletins

• CMS (Centers for Medicare & Medicaid Services) coding guidelines

• Payer-specific coding changes or policy updates

• Industry journals and newsletters like Coding Edge or JustCoding

By staying ahead of these updates, we ensure that every claim reflects the most recent coding standards and payer requirements.

4. Updating Billing Software and Systems

Technology plays a vital role in accurate coding and billing. A reliable medical billing company maintains billing platforms that are updated in sync with CPT releases. At Thrive Medical Billing, we:

• Ensure our billing software is compliant with the latest CPT changes

• Work with software vendors to deploy updates as soon as they are released

• Configure system alerts to flag outdated or incorrect codes

• Test the systems claim scrubbing features after every update

This automated layer of protection reduces the chance of human error and ensures claims are scrubbed for accuracy before submission.

5. Internal Audits and Quality Control

Even with the right tools and training, quality control is essential. Thrive Medical Billing conducts regular internal audits to:

• Verify that claims include current and valid CPT codes

• Ensure billing practices remain compliant with all guidelines

• Review denied or returned claims for coding-related issues

• Recommend workflow improvements based on audit findings

These audits help maintain a high standard of accuracy and uncover any gaps in coding knowledge before they impact your revenue.

6. Client Communication and Education

At Thrive Medical Billing, we believe that education shouldn't stop with our team. We help our clients understand how CPT updates may affect their documentation and workflows. We do this by:

• Hosting webinars and training sessions on major updates

• Sending newsletters that highlight critical changes

• Offering personalized guidance for specialties most affected by new codes

• Advising on documentation adjustments to support new requirements

Our proactive approach ensures that your providers are well-prepared to adapt to CPT changes without interrupting patient care or billing operations.

How CPT Updates Affect Reimbursement

Lets say a new CPT code is introduced to replace an older one. If your billing team continues using the outdated code, your claims may be rejected, or reimbursed at a lower rate. Similarly, using a deleted or incorrect code can:

• Trigger denials

• Cause compliance flags

• Delay reimbursement cycles

• Lead to underpayment

A professional medical billing company like Thrive Medical Billing ensures that your billing is always aligned with the latest CPT codes, reducing these risks and ensuring you're compensated accurately and quickly.

Specialty-Specific Considerations

Each medical specialty is affected differently by CPT updates. For example:

• Primary care might see changes in evaluation and management (E/M) guidelines

• Surgical practices may encounter updates in procedural bundling

• Mental health services often have new telehealth billing codes

• Cardiology or orthopedics may be impacted by new technology-driven procedure codes

At Thrive Medical Billing, we tailor our CPT update strategies by specialty, ensuring that the codes we use are specific to your practice's services and patient demographics.

Real-World Example: Successful Adaptation

One of our orthopedic clients faced a significant change in surgical coding with the annual CPT update. Our team at Thrive Medical Billing:

• Held a training session with the providers

• Updated their EHR templates and documentation prompts

• Re-submitted claims that had been denied due to outdated codes

• Increased collections for specific procedures by 17% in the following quarter

This is just one example of how a vigilant, detail-oriented medical billing company can make a real financial difference.

Final Thoughts

CPT codes are the language of reimbursementand like any language, it evolves over time. Without constant attention to updates and rule changes, even the best medical practices can fall behind, lose revenue, and face compliance issues.

By partnering with a skilled and proactive medical billing company like Thrive Medical Billing, you gain peace of mind knowing your coding and billing processes are always up to date, accurate, and compliant. We take on the complexity so your team can stay focused on patient carenot paperwork.