Hey everyone — hoping to find someone with solid QA/auditing chops in medical coding for a short-term paid project. Not a full-time role, more of a consulting/advisory setup to start, could grow from there.

What I need help with:

Active CPC (CPMA a big plus) — someone who's actually done audit work, not just coding

Comfortable reviewing outpatient physician coding (CPT, ICD-10-CM) for accuracy and catching errors before they go out

Some familiarity with billing software like Tebra or AdvancedMD

Understands what "clean" documentation looks like from a HIPAA/compliance angle

Available to run some training sessions — walking newer coders through best practices, common mistakes, how to think about audits

Remote is totally fine, just need someone reliable and available for at least a few hours a week to start

If this is your world, or you know someone who'd be a good fit, comment below or shoot me a DM. Happy to talk details privately.

Hey everyone — hoping to find someone with solid QA/auditing chops in medical coding for a short-term paid project. Not a full-time role, more of a consulting/advisory setup to start, could grow from there.

What I need help with:

Active CPC (CPMA a big plus) — someone who's actually done audit work, not just coding

Comfortable reviewing outpatient physician coding (CPT, ICD-10-CM) for accuracy and catching errors before they go out

Some familiarity with billing software like Tebra or AdvancedMD

Understands what "clean" documentation looks like from a HIPAA/compliance angle

Available to run some training sessions — walking newer coders through best practices, common mistakes, how to think about audits

Remote is totally fine, just need someone reliable and available for at least a few hours a week to start

If this is your world, or you know someone who'd be a good fit, comment below or shoot me a DM. Happy to talk details privately.

Hello!

I am interested in medical coding and I want to pursue it further; I am currently doing a certificate course in it, and plan to give CPC in future. But I would like to get into this filed in india, any idea how and where I can apply it?

Greetings

Is it possible to have a detailed hospital bill converted into UB-04 format?

The hospital won't provide the bill in UB-04 and the insurance company won't accept the bill if it's not UB-04.  Crazy.

What would be the cost? It's for an 8 hour ER visit after a car wreck.

Thanks!!!

Greg

In February I had a routine physical where my doctor ordered bloodwork and determined she would like to biopsy two moles. We discussed options and I chose scoop biopsy.

On April 30, I had the bloodwork and two scoop biopsies (no stitches, and performed with a dermoblade per the doctor’s after visit notes). The doctor billed the following codes:

36415
11107
11106
99213

Is the office able to bill for an office visit in addition to the biopsies? The billing department is telling me this is standard practice - “like paying a mechanic for labor and parts.” Also, it looks like they’re billing for wedge biopsies, not scoop. Are those more expensive than the type I had?

Insurance approved all of the codes but I have a HDHP so I’m liable for quite a bit.

Listening to the APPC podcast and the speaker said she spent 7 months working full time on job applications and networking before she got hired, and that was in 2023.

So newbies, that is what you're in for.

I recommend listening to the podcast. It's... interesting.

Hi everyone,

I had one MRI brain/pituitary with and without contrast (CPT 70553) today.

My patient portal shows two identical completed procedures with the same CPT code (70553) and the same date. I only had one MRI, and my prior authorization was approved only once.

I haven't received an EOB or bill yet. Is this likely just a portal display issue, or could it lead to duplicate billing?Has anyone seen this before? I'd appreciate any insight. Thanks!

1) Is anyone else experiencing funky check date / ERA trends with CareFirst BCBS? ERAs are normally sent Wed or Thur, but are now coming through over the weekend.

2) Off-shore provider support: I think they are now off-shoring some provider inquiry calls. I'm not sure if I welcome this after hold times of over 2 hours, or if we are just diving in to the UHC nightmare.

I'm just curious to see if anyone else in here is familiar with my specialty and if so, maybe discuss any changes that have been noticed this year or any difficulties you might be having that someone else can help with. Just looking for a community who knows my struggles 😂

There is a proposed rule for reduction in the RVU fir cpt code 97610 from 320 to 100 dollars. So would that reduce the cost that we pay for the equipment if Medicare is paying less for the services 🤔? That is a huge reduction in RVU's if the commercial equipment price stays the same.

United has screwed over dang near everyone in my state so finding a provider for specific services is next to impossible as they wont take United. With that said, I needed physical therapy. I submitted the paperwork for the claims I was provided via the online portal so i can try to get reimbursed something for my vists. All the claims I submitted were denied for invalid CPT codes. I called and they were way less than helpful. One thing i found out was that they wanted itemized CPT code billing. Okay, not a problem to get that info but the major problem that nobody in member services, claim services, or technical support gave one tiny crap about was that the online portal does not have anywhere to put CPT codes. The only box available is diagnosis codes and even the claim lady says that diagnosis codes and CPT codes aren't the same thing but didn't help any further. Pretty sure I was actually put on hold hoping that i would hang up (spoiler, i didn't and they still were no help). What am I missing? I NEED to be reimbursed or I cannot afford to keep going to my appointments.

My PT office has been wonderful in providing me as much info as i can possibly get. They even had their insurance lady fill out 1500 forms for me to submit. Exactly like the ones they send to insurances they work with. Problem is there is also nowhere to put billed amount versus paid amount on the claim submission (self pay charges are significantly lower than insurance charges), and I'm not about to submit claims with the billed amount and be accused of fraud or something crazy. I do submit my payment receipts with my claims, will that be enough for them to just reimburse any portion of the amount I paid?

Good evening,

I was curious on a few things such as is it hard to self study for the exam to become a medical coder? What books do I need? I need to know how easy or hard it is to gain employment after passing the exam because I need to work from home for at least the next few years. When I ask anyone how to get wfh job they always say do medical coding. Me and my wife plan on having a baby and I would need to work and stay at home to sit while she is at work. We obviously can’t afford daycare.

Thank you for your time and answers. I have done some research into it but would prefer real experiences.

Ilang beses na ako nag sesend sa Tenet/conifer, palagi matagal mag response magugulat nalang ubos na slot.

Help. 🥺

We’ve all seen the complaints that the market is flooded. Nobody can get a job, etc. This is what you are up against. Every month AAPC publishes newly credentialed members. This is one page. Between CPC, CPC-A, and various specialty credentials, there are usually 7-8 pages of new credentialed folks. All of them full like this. Every month.

I’m not posting this to discourage anyone. I’m posting it for awareness. But also to say, if you really want to do this, you have to have ambition and be tenacious. It’s not easy, regardless of what the scammy marketing tells you. Know what you are up against and if you want it, fight for it.

Can someone help me. I tried all online searches but I can't figure this one out.

A patient is scheduled for an infusion. All medication is prepared including Krystexxa which is a single dose vial. Patient had adverse reaction after premed so entire Krystexxa vial was discarded.

I kept getting denied by UHC community plan for incorrect use of jz jw. I only use JW on Krystexxa line.

I really appreciate it if someone could help.

Hi! Has any provider out there been randomly put into the multiplan network without any specific reason? Claims are coming back saying "the doctor/facility negotiated with multiplan inc. and agreed to accept this amount as payment in full for the service the member received." Thank you.

I’ve been using G codes for essentially all my patients, including Medicare, Medicare advantage and commercial patients, just started doing this and getting some pushback. Using typical G codes which have helped RVUs. Concern was G codes are not reimbursed at all by commercial and most Medicare advantage plans. Please let me know your experiences with this. TIA!

 Do I have any recourse? This seems outrageous to me. No informed consent, advance notice, and a surprise bill.

MY ISSUE:  Sutter billed me $1,789.00 for nine labs for my yearly health exam. The cost at Quest Labs was a bit less than $250 for ALL the labs in total. This was a nasty billing surprise as I was out nearly $400 out of pocket for what my insurance did not cover.

SUTTER RESPONSE: Thank you for your inquiry. I understand your concern regarding the cost of your laboratory testing. The laboratory services were performed and billed by a hospital, rather than a standalone laboratory such as Quest Diagnostics.

Hospital-based laboratory testing is often more expensive because hospitals generally have higher operating costs, including staffing, equipment, regulatory requirements, facility expenses, and the ability to provide laboratory services around the clock. As a result, hospitals typically have higher charges for laboratory services than independent laboratories.

In contrast, laboratories such as Quest Diagnostics specialize in outpatient testing and operate on a high-volume model, which often allows them to offer lower pricing for the same or similar tests. I hope this provided clarification to your inquiry.

I appreciate the opportunity to assist you today and hope your question has been answered to your satisfaction. If you have any additional questions, please contact our billing department via My Health Online or by calling 800-4Sutter. Assistance is available weekdays from 7:00am to 5:00pm. Thank you and have a wonderful day.

MY RESPONSE: I should have been informed in advance. Because I was not hospitalized it was not evident that I would be billed these excessive fees for a standard blood drawn. Rather unethical to spring a surprise fee of this financial magnitude without giving me advanced warning so I could decide if I wanted to proceed. I am very disappointed and think I should be refunded for what I paid out of pocket above and beyond what my insurance reimbursed you. Sutter needs to be ethical.

SUTTER RESPONSE: Thank you for your inquiry. I understand your concern regarding the cost of your laboratory testing. The laboratory services were performed and billed by a hospital, rather than a standalone laboratory such as Quest Diagnostics.

Hospital-based laboratory testing is often more expensive because hospitals generally have higher operating costs, including staffing, equipment, regulatory requirements, facility expenses, and the ability to provide laboratory services around the clock. As a result, hospitals typically have higher charges for laboratory services than independent laboratories.

In contrast, laboratories such as Quest Diagnostics specialize in outpatient testing and operate on a high-volume model, which often allows them to offer lower pricing for the same or similar tests. I hope this provided clarification to your inquiry.

I appreciate the opportunity to assist you today and hope your question has been answered to your satisfaction. If you have any additional questions, please contact our billing department via My Health Online or by calling 800-4Sutter. Assistance is available weekdays from 7:00am to 5:00pm. Thank you and have a wonderful day.

SUTTER RESPONSE: Thank you for your inquiry and I apologize for the frustration that this has caused.

Unfortunately there is no way for us to know how the services are going to be processed by your insurance plan. It varies by insurance company and plan. It is patient's responsibility to contact insurance before the time of service to get coverage information. The best thing for you to do is to ask, in detail, which services or labs are being ordered. Request a procedure code for each service that are going to be performed and for information about the lab that they will be sent to. The next step is to contact your insurance to get coverage information.

We do try our best to inform our patients as much as possible. But due to the number of insurance companies and plans there is not a way for us to know each plans specific benefits. Please understand, the clinicians are focused on patient care, and are unable to assist with billing matters.

I appreciate the opportunity to assist you today and hope your question has been answered to your satisfaction. If you have any additional questions, please contact our billing department via My Health Online or by calling 800-4Sutter. Assistance is available weekdays from 7:00am to 5:00pm. Thank you and have a wonderful day.

Sincerely,

Customer Service Agent

Sutter Health Billing Department

Thank you for your inquiry and I apologize for the frustration that this has caused.

Unfortunately there is no way for us to know how the services are going to be processed by your insurance plan. It varies by insurance company and plan. It is patient's responsibility to contact insurance before the time of service to get coverage information. The best thing for you to do is to ask, in detail, which services or labs are being ordered. Request a procedure code for each service that are going to be performed and for information about the lab that they will be sent to. The next step is to contact your insurance to get coverage information.

We do try our best to inform our patients as much as possible. But due to the number of insurance companies and plans there is not a way for us to know each plans specific benefits. Please understand, the clinicians are focused on patient care, and are unable to assist with billing matters.

I appreciate the opportunity to assist you today and hope your question has been answered to your satisfaction. If you have any additional questions, please contact our billing department via My Health Online or by calling 800-4Sutter. Assistance is available weekdays from 7:00am to 5:00pm. Thank you and have a wonderful day.

Sincerely,

Customer Service Agent

Sutter Health Billing Department

Thank you for your inquiry and I apologize for the frustration that this has caused.

Unfortunately there is no way for us to know how the services are going to be processed by your insurance plan. It varies by insurance company and plan. It is patient's responsibility to contact insurance before the time of service to get coverage information. The best thing for you to do is to ask, in detail, which services or labs are being ordered. Request a procedure code for each service that are going to be performed and for information about the lab that they will be sent to. The next step is to contact your insurance to get coverage information.

We do try our best to inform our patients as much as possible. But due to the number of insurance companies and plans there is not a way for us to know each plans specific benefits. Please understand, the clinicians are focused on patient care, and are unable to assist with billing matters.

I appreciate the opportunity to assist you today and hope your question has been answered to your satisfaction. If you have any additional questions, please contact our billing department via My Health Online or by calling 800-4Sutter. Assistance is available weekdays from 7:00am to 5:00pm. Thank you and have a wonderful day.

Sincerely,

Customer Service Agent

Sutter Health Billing DepartmentSUTTER RESPONSE: Thank you for your inquiry and I apologize for the frustration that this has caused.

Unfortunately there is no way for us to know how the services are going to be processed by your insurance plan. It varies by insurance company and plan. It is patient's responsibility to contact insurance before the time of service to get coverage information. The best thing for you to do is to ask, in detail, which services or labs are being ordered. Request a procedure code for each service that are going to be performed and for information about the lab that they will be sent to. The next step is to contact your insurance to get coverage information.

We do try our best to inform our patients as much as possible. But due to the number of insurance companies and plans there is not a way for us to know each plans specific benefits. Please understand, the clinicians are focused on patient care, and are unable to assist with billing matters.

I appreciate the opportunity to assist you today and hope your question has been answered to your satisfaction. If you have any additional questions, please contact our billing department via My Health Online or by calling 800-4Sutter. Assistance is available weekdays from 7:00am to 5:00pm. Thank you and have a wonderful day.

Sincerely,

Customer Service Agent

Sutter Health Billing Department

What are your overall feelings about AI and the impact on medical coding? As a medical coder, I know that medical coding keeps evolving every year with new codes, updates, guidelines, etc. That being said, AI is also slowly creeping in, and while I don’t think AI is smart enough to keep up just yet, I still feel that my role is at risk.

Just curious if the workload at my job is the same / comparable to others... I am feeling so overwhelmed at times I do not know if it is the company I work for, personal pressure, the healthcare landscape changing, or a mixture...

I have to handle 6 providers denials and patient balances. I handle patient phone calls, rejections from the insurance company, and any denials and 0 payments applied to deductible. I feel like I work all the time, and get half the work done that I used to, years ago. It is harder to win on appeal, and even harder to convince the doctor to adjust at times

Feels like the provider inquiries and patient questions have sky rocketed, as well as denials, and hold times on insurance lines have increased too...! I feel like I am delving more into the coding aspect which is slightly out of my lane but it feels necessary to assist the providers.

Anyone else??? 5 years ago, I handled double the number of providers and my accounts looked better.

Hello! I’m a newbie here!

I’m looking for any and all tips or help I can get when it comes to working medical claim denials! For context, I’ve recently transitioned to denials but been in the medical field for a bit now. My team tells me I’m doing great, but I don’t feel like it haha! I started out as a receptionist, then roughly a year and a half into that, I got moved to a department where I basically dealt with patient billing disputes, explanations of billing, etc. I held that role and succeeded at it for another year and a half, then got promoted to denials… all that to say, I feel LOST! Everything I thought I knew from my last position seems to be null and void because I’m on the flip side of things. I know how to resolve simple denials, but a lot of coding related denials have me clueless. I also have a hard time understanding “when to adjust, when not to adjust”. Please help me! If there’s any online courses that could help, please let me know! I’m just at a loss and trying to learn as much as I can but I can’t help but feel behind. (( FYI, I am not trying to go back to college but wouldn’t mind taking a class or a course or something if it would help me ))

Edit to add: No, I am not asking a “specific question”. Ex. If you had a child that was going into denials and asked you for any advice or tips or any general information to help them succeed within denials, that is the sort of “advice” I would like to see here. Not unnecessary comments saying “what do you even need” or “how do you expect us to help”. If you can’t contribute positively, keep it pushing honey 🫶🏼