Twenty-Five Years of Evolution: How Medical Billing, Auditing, and Credentialing Have Transformed 

As we celebrate our 25th anniversary, it’s worth looking back at just how much has changed in the world of medical billing, auditing, and credentialing. When we opened our doors, the industry looked dramatically different. Paper claims still dominated many practices, credentialing involved mountains of physical documents, and audits were relatively infrequent affairs. Today, the landscape has been transformed by technology, regulation, and an entirely new understanding of what quality healthcare administration means. 

Medical Billing: From Paper Chase to Digital Revolution 

A quarter-century ago, physicians could bill patients directly and wait for reimbursement, or accept assignment and request payment directly from carriers. The process was manual, time-consuming, and remarkably inefficient by today’s standards. 

By 2021, approximately 78 percent of office-based physicians and 96 percent of non-federal acute care hospitals had adopted certified electronic health records, representing significant progress from 2011, when only 28 percent of hospitals and 34 percent of physicians had implemented such systems. This wasn’t just a technological upgrade—it fundamentally changed how billing worked. 

The early 2000s saw billing professionals drowning in paperwork. Claims were printed, mailed, and tracked through phone calls and paper trails. The first electronic medical records were reportedly invented in 1972, but it wasn’t until President Obama mandated incentives through the American Recovery and Reinvestment Act of 2009 that medical facilities began digitizing their records on a large scale. That timing meant our company grew alongside this digital transformation, adapting as the industry modernized. 

What specialists miss from those earlier days isn’t the inefficiency, but perhaps the simplicity. Before ICD-10, before countless coding updates, before the explosion of payer-specific requirements, billing was more straightforward—if slower. The transition from ICD-9, approved in 1975, to ICD-10, approved in 1995, introduced a fundamental change in classification structure, moving from simpler codes to three-to-seven character codes, with the first being alphabetic and the rest potentially alphabetic or numeric. This created both precision and complexity. 

Today’s trends point toward even more dramatic changes. Blockchain technology is emerging as a game-changer, creating secure and immutable records of transactions where each billing transaction can be recorded as a block in the chain, creating an unalterable audit trail that can significantly reduce fraud and disputes. 

The challenges have evolved too. Data from 2025 shows that payer audits increased by 30 percent year-over-year, with average denied claim amounts for hospitals rising 12 percent for inpatient and 14 percent for outpatient claims. The No Surprises Act, effective January 2022, made it illegal for healthcare providers and insurers to surprise privately insured patients with bills for out-of-network services, representing a rare victory for patients against exploitative healthcare costs. 

What hasn’t disappeared, despite all the technology? The human element. Medical billing errors remain a prevailing issue, costing an estimated $935 million weekly, with around 80 percent of medical invoices containing errors and typos accounting for more than 25 percent of these inaccuracies. Technology helps, but expertise still matters enormously. 

Medical Auditing: From Occasional to Constant Vigilance 

Twenty-five years ago, audits were events—periodic, somewhat predictable, and often focused on specific issues. Today, they’re continuous, data-driven, and increasingly sophisticated. 

The shift has been dramatic. Medicare auditors increasingly rely on AI tools to analyze large volumes of claims data quickly, flagging unusual patterns or anomalies such as excessive billing for certain procedures or services that don’t align with established clinical guidelines. What once required manual review of hundreds of charts can now be accomplished through algorithmic analysis of thousands. 

In 2024, payer audits rose by 15 percent, and the pressure on providers has only grown, with Medicare Advantage-related claim denials increasing by over 22 percent on average. Medicare audits in 2025 place more emphasis on high-cost services including surgeries, specialty procedures, and long-term care services, which are particularly vulnerable to billing errors or fraud due to their complexity and significant reimbursements involved. 

The expansion of telehealth brought entirely new audit considerations. Telehealth-related denials rose 84 percent, while denials related to outpatient coding increased by 26 percent from 2024 to 2025. Practices had to quickly adapt their documentation and billing practices for virtual care—a service category that barely existed when we started. 

What do specialists miss about the old audit environment? Perhaps the breathing room. When audits were episodic rather than continuous, practices could focus on patient care without the constant awareness of scrutiny. Today’s reality demands ongoing vigilance. Healthcare audits are increasing with 2025 bringing stricter rules than ever, making regular revenue cycle management audits essential to improve claim acceptance, reduce denials, and protect revenue. 

The trend toward proactive compliance has created an entirely new approach. Rather than reacting to audit findings, sophisticated practices now conduct regular internal audits, use predictive analytics to identify risks before they become problems, and invest heavily in compliance infrastructure. This shift represents maturity in the industry—and recognition that audit preparation isn’t optional. 

Medical Credentialing: From Filing Cabinets to Blockchain 

Perhaps no area has transformed as dramatically as credentialing. In 2000, credentialing was a rudimentary process relying heavily on personal references and informal assessments of a provider’s qualifications. The system was paper-intensive, slow, and prone to errors. 

The credentialing process has become more refined and thorough over the past 50 years, with several national agencies now dedicated to maintaining credentialing standards, and the National Committee for Quality Assurance establishing standards that serve as guidelines. Only hospitals used to perform credentialing in the past, but today almost all healthcare facilities, ambulatory care centers, long-term care institutions, and even urgent care clinics perform credentialing. 

The paper era of credentialing was mind-numbing. Providers submitted physical copies of diplomas, certificates, and licenses. Verification meant phone calls to medical schools, training programs, and state boards—calls that might take weeks to return. The days when credentialing meant mountains of paperwork, endless phone calls, and months of waiting before a physician could see patients are rapidly disappearing, replaced by streamlined digital processes. 

The widespread use of digital technology in 2025 represents the biggest change to healthcare medical credentialing services, with complex software solutions automating and streamlining manual operations that were formerly laborious. Online application portals have mostly replaced paper applications, allowing providers to upload documents and credentialing details while monitoring application status in real-time. 

What specialists genuinely miss from earlier credentialing? Perhaps the personal touch. When verification involved direct conversations with training program coordinators or colleagues, there was a human element that’s been lost in automation. But few would trade today’s efficiency for yesterday’s delays. 

The future looks even more streamlined. Blockchain technology is making significant advances in medical credentialing by keeping an unchangeable record of all transactions across many systems, ensuring decentralization for greater safety and reliability. With blockchain-based credential systems, once a medical school verifies a physician’s graduation, that verification becomes permanently recorded and instantly accessible to any authorized party, eliminating waiting for registrars to respond to verification requests. 

The conventional credentialing model, with its recurring rounds of re-credentialing is giving way to one of ongoing monitoring, with modern credentialing solutions easily interfacing with human resources databases, payer administration tools, and provider enrollment systems. This shift from periodic verification to continuous monitoring represents a fundamental philosophical change—from snapshot assessment to real-time validation. 

Telemedicine has created new credentialing complexity. The growth of telemedicine is forcing accrediting bodies to change requirements, ensuring that remote medical practitioners have the right skills and knowledge as telemedicine grows. Multi-state practice, once rare, became common almost overnight during the pandemic, requiring practices to navigate varying state requirements. 

What’s Forever Gone 

Some aspects of the old system have disappeared completely, and few mourn their passing. Physical claim forms are gathering dust in file rooms. Weeks-long waits for payer responses with no status updates. Manual calculation of reimbursement rates. Filing cabinets full of credentialing documents that might or might not be current. The assumption that physicians could practice without sophisticated compliance programs. 

Also gone is the relative simplicity of relationships between payers and providers. The sliding scale fee structure, where physicians charged patients according to what they thought each could afford, was eventually weakened by changing economic conditions, with health insurance sounding its death knell. By the time we started, that model had largely disappeared, but the current system’s complexity was still developing. 

What Remains Essential 

Despite all the changes, some fundamentals endure. Accuracy still matters more than speed. Documentation remains the foundation of everything. Expertise—genuine understanding of coding, regulations, and payer requirements—cannot be fully automated. Relationships between billing professionals and providers still depend on trust and communication. 

The human element persists too. Technology can flag potential issues, but judgment determines appropriate responses. AI can analyze patterns, but experience recognizes nuances. Blockchain can verify credentials, but someone must ensure the system serves patient safety, not just administrative efficiency. 

As we begin our next 25 years, the pace of change shows no signs of slowing. The shift towards value-based care has continued gaining momentum in 2025, significantly impacting medical billing practices as this model ties reimbursements to quality of care rather than quantity of services, necessitating fundamental changes in how healthcare services are billed and paid for. 

The specialists who’ve been with us since the beginning often reflect that while technology has transformed their daily work, the mission hasn’t changed: helping doctors get paid fairly for the care they provide, so they can focus on patients rather than paperwork. That goal guided us in 2001, and it guides us today—even if the tools we use to accomplish it would be unrecognizable to our former selves. 

The next quarter-century will undoubtedly bring changes we can’t yet imagine. But if our first 25 years taught us anything, it’s that adaptability, expertise, and genuine commitment to serving providers will never go out of style—no matter how sophisticated the technology becomes.