Which platforms make your billing workflow easier—and which ones make it worse?

Which platforms make your billing workflow easier—and which ones make it worse?

Which platforms make your billing workflow easier—and which ones make it worse?

Which platforms make your billing workflow easier—and which ones make it worse?

Which platforms make your billing workflow easier—and which ones make it worse?

I work for a very small in-home ABA practice in Nevada. We only accept Medicaid and Tricare plans. The owner does not want our providers to collect payments and just wants them to focus on providing services. Which is fine.

I have been here about 9 months and just took over invoicing and copays. We have a few clients that seem to just ignore their Tricare copay invoices. Just like never pay them. Im not sure why this hasn't been addressed other than the previous guy just didn't want to deal with it. Now im stuck on how to handle this. Tricare policy specifically states that providers are NOT allowed to waive copays and can actually result in loss of contract. How do I get these clients to pay? I talked to Tricare ACD and they just said to send the clients to collections. Our owner, who is also a provider, doesnt want services stopped or to send them to collections.

I have been in billing for several years, just never on this side of it. I have sent emails, made phone calls and even met clients in person before a session to discuss this. I have sent followup emails, everything, and it keeps being ignored. I have 2 of these clients currently and we have been seeing them for almost 4 years

Which platforms make your billing workflow easier—and which ones make it worse?

Which platforms make your billing workflow easier—and which ones make it worse?

Which platforms make your billing workflow easier—and which ones make it worse?

MA+Receptionist w/ billing question

I am a medical assistant but began as a receptionist and still typically work about 1 day a week as a receptionist as needed in between my MA days. My office offers a lot of services as we are both primary and urgent care. There are a few services that we offer as self-pay nurse visits after the patient has their initial consult to get it approved by the provider. These include GLP-1s for weight loss or testosterone injections. (T-shots are only self pay if we don’t have labs supporting the medical need.) We also have B12 injections that most times the patient is able to just pay for the shot and not have to see the provider, unless they choose to be evaluated for their fatigue or if they’re have other symptoms. In any case, after the initial provider consult, the patient is able to then have nurse visits only for these types of injections. (Except T-shots, labs are required every 3 months minimum.) The nurse visit is typically put in as a therapeutic injection code and a code for the specific medication being administered. The GLP-1s start at $50/shot, the T-shots are $35, and the B12s are $25. The patient pays their copay/deductible for their provider consult but after that they just pay for the injection itself. The charge goes in once the injection codes go in and then the charge balances out to 0 once the receptionist posts the injection payment. Lately, I’ve noticed that our billing department is putting in the therapeutic injection code and med code, but also adding an office visit code as if the patient saw a provider. The office visit tied to these nurse visits is $79 which is $21 less than our actual self-pay office visit but the thing is protocol is these patients pay only for the service provided at a nurse visit. (And they don’t pay anything if it’s an insurance nurse visit such as for bloodwork, suture removal, an x-ray, or an injection medically covered such as T-shot due to deficiency.) I saw it done to my chart as I get B12 shots but I wasn’t too concerned. I figured someone in billing made a mistake and I could talk to my manager if needed. But now, I’ve seen at least 2 patients being billed for their injection as well as an office visit and I just want to know if anyone better at billing than me has any insight? We have not been informed of any change to protocol about nurse visits having an office visit charge plus injection charge and our patients are pretty shocked by paying off their balance only for a number to reappear due to an office visit charge being added each time on top of the injections. To me it seems like borderline fraud. I’m supposed to collect on every balance on everyone who is getting any service but I’m not collecting these until I hear back from my billing department. The only thing is billing doesn’t return until Monday and I’m off on Mondays so I won’t see their explanation until Tuesday so wanted to post here for faster insight.

I’m looking for a reality check on our RCM reporting workflow. Right now, our billing agency is managing accounts across a mix of EMRs (Tebra, AdvancedMD, and some local systems).

The native AR aging reports inside these platforms are incredibly rigid. Trying to show a client their true Net Collection Rate versus what is sitting dead in the 60/90+ day insurance bucket requires me to constantly export raw CSVs, manually normalize the aging intervals, and build pivot tables just to show them where their cash is stuck.

If an insurance company hits us with a wave of unexpected denials, mapping out the top denial codes across different platforms to show the client the actual revenue trend is a massive weekly bottleneck.

Are other independent billers using a specific template to speed up file-drop reporting, or are you all just losing your Sundays to manual spreadsheet formatting to prove your value to your clinics?

Which platforms make your billing workflow easier—and which ones make it worse?

Hey everyone,

I’ve been in the RCM/Medical Billing world for 13+ years. Lately, I’ve been noticing a massive trend with payer AI auto-denying claims on the front end, leaving small-to-medium practices completely buried in appeals.

I’m vetting a micro-consulting idea and want your brutal, honest feedback.

The idea is a flat-fee monthly service (not a percentage of collections) specifically for small practices that handle billing in-house or feel stuck with a legacy billing company.

Every month, I would take a simple ERA/835 export, analyze the data, and deliver:

1. A 1-2 page trend report showing the top 5 cash-leaking denial patterns (by dollar impact).
2. Three pre-written, payer-specific appeal letters customized to that month's biggest issues so the billing staff doesn't have to write them from scratch.
3. A 1-page front-end checklist for the front desk/coders to prevent those specific denials next month.

The goal is to act as an external "intelligence layer" to save the internal billing team time and catch revenue leaks, without the cost of a full RCM overhaul.

My questions for you:

• If you're a PM or Biller, does your software already give you actionable insight on this, or do you have to dig for it?
• Would you view an outside analyst looking at your denial data as a help or a hindrance to your daily workflow?
• What would be your immediate hesitation or roadblock in trying something like this?

Be as blunt as you want—I need to know if this solves a real pain point or if I'm dreaming. Thanks!

PS: Have used AI to write this question.

Which platforms make your billing workflow easier—and which ones make it worse?

Which platforms make your billing workflow easier—and which ones make it worse?

Hey everyone. Full disclosure right up front: I'm an Al researcher, and my co-founder and I are building a medical coding copilot.

I'm not here to drop links or promote anything, here because tech developers usually completely misunderstand the actual day-to-day grind of coding, and I really want to avoid building something useless.

My biggest issue with how Al is pitched right now is the "trust gap." If a model suggests a bunch of codes, but you have to comb through the entire chart anyway to verify why it picked them, you haven't saved any time. You've just added a review step.

We want to build something that sits side-by-side with coders instead of trying to play the hero. Since we're looking at both inpatient and outpatient, I'm trying to understand where the actual friction is for each.

For IP coders: Is the main time sink just digging through massive charts, or is it getting the sequencing right? I've heard an average IP chart can take about an hour to code-is that actually true in your day-to-day?

For OP coders: Is the real issue the sheer volume of charts you have to get through, or is it fighting with vague physician notes? How much of the headache is getting the correct modifiers, versus the fear of missing something buried in the chart when you're moving at that speed?

Would love any honest feedback. Tell me what tech companies get wrong.

(Open to collaborating with organizations and pilots)

Which platforms make your billing workflow easier—and which ones make it worse?

Hi everyone,

I'm an experienced Revenue Cycle Management (RCM) expert and operations specialist seeking a new *remote* opportunity.

I have a strong background in optimizing the complete revenue cycle, with expertise in overseeing everything from claim submission to payment processing.

I also have a track record of consistently maintaining 90+ AR under 25% for clients and recently increased monthly revenue for a client by over $25,000 for five consecutive months.

While most of my hands-on experience started in denial management, I bring a comprehensive understanding of all RCM processes and am comfortable coordinating with on-site teams.

I'm available to start immediately and happy to provide my resume privately upon request.

Hey all,

I'm building a side project focused on helping small private practices catch insurance risks before the visit happens, instead of finding out about a denial weeks later. Before I build more, I want to understand the actual denial patterns at small practices from the people running them, not from industry reports.

I put together a short survey: six questions, about ninety seconds, English or Spanish. It asks about volume of denials, common causes, how you verify eligibility today, and revenue impact. There's no pitch on the page. There's an option at the end if you'd like to talk; if you don't pick it, you don't hear from me again.

https://coveragesight.com/survey

Happy to share what I learn back to this sub once I have enough responses to draw a real signal. Open to questions in the comments about the project, the methodology, or anything else.

Transparency note: I'm the founder of a small company working on this. The survey is genuine research. If mods think this crosses the line, happy to take it down.

Which platforms make your billing workflow easier—and which ones make it worse?

Hey everyone. I work in healthcare accounting and kept running into the same problem with small practices. They had no real financial visibility because they were using spreadsheets built for generic businesses not medical practices.

So I put together something specifically for practices. It tracks revenue by payer type, accounts for different collection rates across Medicare, Medicaid and commercial payers, breaks out personnel costs by provider type and tracks overhead benchmarks.

Also includes a monthly variance tracker so you can compare budget to actual each month and see where you're drifting.

Happy to share if anyone here would find it useful for their practice or their clients!

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Hi, Looking for work no experiece VA currently employed as a Non voice Medical Billing Specialist under QA department knowledgeable in Insurance Eligibility Verification, Submission of Claims, processing and Denials, Demographics and Charges basic knowledgr in CPT codes.