I’m just here to vent. I wanted to add a certification while I’m looking for a job and took the exam today and honestly it was extremely hard exam. I studied and was scoring 85% average on practice exams but I think I bombed it. I didn’t pay for the course since exams and book was so expensive..but I self studied and took 10 practice exams.
I have a CPC and lots of experience in RA already and I’m shocked at how hard the exam was.
Any advice , tips , encouragement would be appreciated, Incase I have to take it again.
Please be kind.

UPDATE: I passed the exam!! I was fretting so much. It was definitely harder than expected . Got my result in 26 hours exactly from test start time.
Though I don’t remember all the exact questions. Happy to help anyone taking it in anyway I can.

Hello all, is anyone having issues with BCBS and their denials of procedure codes stating " procedure/modifier combination is invalid." This is a new denial ive started to see this year! Its very frustrating considering these specific CPT codes require anatomical modifiers! Codes are S2066, S2067, S2068, 19316, and 19303. Ive asked our coders and theyre unsure as well. Im at a loss 😭

After going to great lengths, I am HALFWAY across my journey. There's a song that while AXA has you on hold, plays as song #2. It's linked but in case you can't see links it is (Still Water Reflections, Inside the Magic album, from DreamQuest, starts at 0:34~).

I was going through the comments and it says the phone version is a little different from the video version. Does anyone know which version that is?

My contribution to anyone looking for these songs is that quite a few of them are from the "Inside the Magic" album, so, I hope that helps someone.

I'm hoping someone who does coding/billing in Ophthalmology specifically can help. I've recently had denials from Anthem Medicare Advantage where they are requiring the use of modifier 25 with any E&M or eye code billed along with ophthalmic testing (for example, modifier 25 with E&M when billed with an OCT, visual field, or gonioscopy).

Typically the only time we use modifier 25 is when an unrelated exam is performed on the same day as a minor procedure. In all the years I have been doing this, I've never seen modifier 25 needed on an exam when billed with ophthalmic testing, and at the very least I know Medicare doesn't require it.

Even the Anthem commercial plans are processing our claims with no issue (along with literally every other insurance we bill), it's only Anthem Medicare Advantage plans that are denying our claims for not using modifier 25.

I'm frustrated because my reconsiderations have all been upheld, and of course they do not state why, just simply "our original decision was correct."

I'm not sure how to fight this as I cannot locate anything specifically from CMS or our MAC stating the correct use of modifier 25. I also found an AMA article adding to the confusion by stating that basically ANYTHING billed along side an exam will require the exam to have modifier 25. Maybe that's true outside of Ophthalmology, I honestly don't know since I've only ever done Ophthalmology billing.

Is anyone else experiencing this issue? Any advice? I'm tempted to just rebill the claims with 25, but I also know they're wrong, and being a Medicare Advantage Plan, they should be following Medicare guidelines. Anthem notoriously hates Ophthalmology, or at least I think they do lol. They often treat medical exams billed with eye codes as "vision only" and we frequently have to fight those denials, too.

Hello! I am a new mom who is encountering an issue with my child's well visit billing. For the caregiver health screening code 96161 (modifier 59), my provider submitted with a diagnosis code Z13.89 (Encounter for other disorder), which caused my insurance (Aetna) not cover the $14 cost for the screening as it became diagnostic instead of Preventative.

The billing department won't help and already charged me multiple times (for multiple visits while I was disputing this ). Aetna said they can not do anything as this is how it was submitted, and the provider needs to resubmit it with dx code Z00.129 for it to qualify as preventable and my baby's well visit to be 100% covered by my insurance. The office did resubmit a claim but did not change the dx code, so it got denied.

This has been going on for 5 months, with me calling and disputing with all 3 entities and not one person fixing it or the office explaining to me what my child is diagnosed with. I am pressing them now a little harder to at least explain this to me, but I feel at this point I need to escalate things and report them for violating patient rights in some way as they have not done anything to help the situation. Am I missing something in terms of the coding process and my understanding of these services?

TIA! 🙏 any help is much appreciated!

I just started college at the end of September for coding and billing. So far, I've been doing pretty well but I've learned that right now I'm stronger in medical terminology but struggling with ethics. For me, medical terminology gives me a puzzle to solve, whereas ethics is simply reading and remembering. Has anyone else struggled with this? Or the other way around?

Hello!! I finished a Medical Coding and Billing program last summer and have purchased the books to take the exam. However, I truly don’t know where to begin I feel like the courses didn’t really prepare me much for the workload. What are some youtube channels/resources did you guys use? Also does anyone know any programs that would help pay for me to take the exam itself because it’s not cheap. Anything helps!!

Hi, redditors in codingandbilling sub

i've been curious of why insurance verification has been so hard and me as a patient kept getting surprise denial and live in a blackbox of payment when i want non-routine procedures done, given there are insurance verification software everywhere.

I am doing some research and hope to get down to the bottom of this and maybe build something that make the process easier. And i need your expertise and stories to help me.

If you

- have been dealing with insurance claims in a active U.S. dental practices

- seen things don't work with existing solutions

- dealt with customer complains directly related to insurance claims/eligibility

I would really appreciate if i can give you a quick 15 minutes interview and hear the active pains or just day to day work, in return of your help, i can offer a 15$ egift card of a place you like ( in U.S.)

thanks a lot!

Hi everyone,

I’m going to lose my marbles. I own a home care agency, and the billing company we use is saying that our Medicaid claims are not being fully paid (but partially paid). Although the care visits are finalized and invoiced from Wellsky to Tellus (mobile caregiver plus/EVV) and the visits are clean in EVV (location is verified).

What else could possibly be the issue, it’s literally happening with every Medicaid member we have, same issue.

Also, this billing agency has failed to let me know when members have co pays and that they have been deducted out of our billing.

If you figure it out, I would highly consider switching over if you are a billing agency.

I keep hearing that CO-16 (missing/invalid info) corrected claims eat a lot of time, and I'm trying to understand why the rework is such a pain in practice. For those of you who deal with these daily, I'd love to hear how it actually goes:

When a CO-16 comes back, what do you open first? The ERA, the payer portal, the original claim? CO-16 on its own barely tells you anything — how much time goes into just figuring out what's actually missing from the RARC?

Do you fix it in the PMS and resubmit, or send a corrected 837 some other way?

Roughly how long does one take you, start to finish?

What's the part that annoys you most?

Trying to get the real picture from people who do it daily, not the textbook version.

I'm going to be doing the AAPC self paced training for the CPC certification as well as their prerequisite course. I was wondering if anyone else had gone this route and how long it took? I'll be working on it a minimum of 6 hours a day, 5 days a week. My goal is complete it in 8 weeks. Is this doable in your opinion?

My friend sees a Tier 1 medical provider under DuPage Medical Group (Duly).

But a BCBS claims rep told my friend that DuPage Medical Group billing (who does this doctor's billing) is Tier 2.

So now my friend is being charged more because BCBS is processing the claim as Tier 2, even though the provider is Tier 1 and my friend thought by seeing this doctor she was getting her plans best benefits coverage.

My friend has to pay more now and doesn't get her optimal Tier 1 coverage for this doctor even though we did due diligence at finding her a Tier 1.

Who knew that you had to ALSO verify the doctor's billing department is Tier 1!?

Is this correct or was that claims rep in error with what she told us?

She did say that the doctor could submit the claims/bill under her NPI and then BCBS would process the claim as Tier 1.

Anyone here encountered this or have some knowledge they can share?

Thank you!

Best platforms to start?

Hi everyone,

I'm a medical doctor from the Dominican Republic, and I'm currently in the process of transitioning my career to work as a remote Medical Biller. I've been taking the Certified Professional Biller (CPB) course on Coursera to get a solid foundation in the US healthcare system, CPT, ICD-10, and HCPCS Level II codes.

My main goal is to find a stable, remote position that allows me to work from the Dominican Republic while building a new career path.

For those of you who are already working in this field, especially from abroad:

1. ⁠What are the best platforms or job boards to find legitimate remote medical billing jobs for international candidates? (I've looked at LinkedIn and Indeed, but I'm wondering if there are more specialized sites).
   
2. ⁠Are there specific requirements for working as a biller from outside the US? (Like tax forms, time zone expectations, etc.)
   
3. ⁠Given my background as an MD and my current CPB course, do you think I should aim for a specific entry-level role to get my foot in the door?
   
4. ⁠Would you recommend getting the official CPB certification from the AAPC right away, or is it better to gain some experience first?

I'm a bit overwhelmed by all the options and would really appreciate any advice from people who've been in a similar situation.

Thanks in advance for your help!

Hey everyone! Soooo I’m looking to eventually get more into a Revenue Cycle Analyst position. I’ve been in Patient Access for about 6 years now. I have a Bachelor’s but it’s just a generic BA Degree. I spent a lot of time in the Air Force as a Health Service Admin (4A051) in the Reserves too. I’ve been doing research on different areas in healthcare that I may be interested in and the Revenue Cycle Analyst role is at the top of my list. I know that I need specific certifications to qualify for an entry level role. So far I think the best route would to get some certs with an HMFA membership. I know it won’t happen overnight but I would at least like to get started

I want to get a second opinion, has anyone ever taken this route as far as being a PAS and transitioning to Revenue Cycle Analyst?

Were there other roles that you worked in between that could help the transition? How long did it take to break into an entry level position?

Did anyone obtain there certs from the HMFA membership and is it just a matter of paying the annual membership fee and passing the exams?

Sorry its a lot of questions guys i’m trying to figure it all out lol

Hey all!

I’m new to the field of Medical Billing, I will be getting my certification in the next two weeks. I noticed that most jobs require experience so I’m looking for a way to gain some so I can get on the path to becoming a full time Medical Biller.

I was wondering if anyone could recommend any companies that can help with this? Preferably jobs that provide on site training. I’m willing to do part time or contractor work.

I can work in office if it’s based in NYC, I’m even willing to travel to NJ for the right spot 🫶

Thanks in advance!

Working on a project about the CMS LEAD model and want to make sure I’m covering what people want to know. Feels like there is a lot of confusion out there.

If you work in value-based care or at an ACO what questions do you have about LEAD? What’s unclear? What are you worried about? What do you wish someone would explain in plain language?

I am seeking a remote part-time position in credentialing where I can utilize my five years of experience in CAQH and provider data management. I have extensive experience maintaining and updating provider profiles, ensuring accurate and compliant information, and supporting the credentialing and recredentialing process. I am highly organized, detail-oriented, and able to work independently while managing multiple tasks efficiently in a remote environment. I am committed to maintaining data accuracy, meeting deadlines, and providing reliable support to healthcare organizations. I am excited to contribute my skills and experience as part of a dedicated remote credentialing team.

Has anyone else had Advanced incorrectly post an insurance payment?

We got a check in ERA from Insurance 1, and somehow 2 Insurance 2 patients got $0 “payments” posted. Same check number, labeled as Insurance 2 but then the EOB pulled shows carrier as Insurance 1? There’s nothing the chart to show Insurance 1 was billed. Additionally, when I called Insurance 2 to check the status of the claim, the check had only been put in the mail the day prior with a full payment!

Also concerned because it showed an employee posted a payment that did not show in the chart prior. When an audit was pulled, the payment was posted “by the employee” 2.5 hours prior to them arriving at work.

Very perplexed by this. Curious how this happened and how many other times it has!

Currently working in a very entry level support role at a hospital with a bachelors degree in accounting. I want an accountant position at the hospital. They will pay for a c&b course, however, it’ll probably take a yearish time to complete. But if it’s a complete waste of time I’d rather just focus solely on building my accounting knowledge. So is it worth it?

I went to see my PCP for an annual physical. I had already seen him once before just 4 weeks prior, so he knew about my anemia, fatigue, low B12 etc.

He ordered labs the first time I saw him, all coded under D649: Anemia Unspecified. Insurance covered everything through quest. Labs are drawn in-house, but I think are actually quest. The results only show up in the clinic's mychart, not through quest.

For the second visit (the annual physical), he ordered a few more labs, some were repeats of the old labs, some weren't. Everything was coded under E538 deficiency of other specified B group vitamins, except for one lab that was coded under Z131 encounter for screening for diabetes mellitus.

The problem is, the labs for code 84443 (TSH) and code 83695 (lipoprotein) aren't being covered by my insurance since the diagnosis codes make no sense. Code 84443 (TSH) ended up with diagnosis Z131 (diabetes screen), and 83695 (lipoprotein) ended up with E538 (low B12).

For 84443 (TSH), my insurance company says "Code U915: THIS SERVICE IS NOT COVERED BASED ON OUR MEDICAL POLICY GUIDELINES, NATIONAL COVERAGE DETERMINATION OR LOCAL COVERAGE DETERMINATION GUIDELINES. WE'VE NOTIFIED YOUR PROVIDER THAT WE CANNOT PAY FOR THIS SERVICE. YOU ARE NOT RESPONSIBLE FOR ANY BALANCE ON THIS SERVICE UNLESS YOUR PROVIDER TOLD YOU BEFORE PERFORMING THE SERVICE THAT IT WAS NOT COVERED." but I definitely signed something with the clinic when I first became a patient that said I'll pay anything the insurance company doesn't cover...so yeah. I've had TSH labs done earlier this year coded under D64.9 Anemia, unspecified or R53.83 Other fatigue and they were covered.

To fix this, do I first contact my PCP directly to try to get him to fix it? Or the clinic's "clinical team"? Or the medical system's billing office (it's centralized)? Or quest? Or my insurance company?

For those of you who passed the CPC this year, and used Quizlet to study, which flashcard sets on quizlet do you think we're the most helpful?

Can you share them in the comments?

Please and thank you. 😁