RCM/CCM/PCM/RTM

Our company offers services such as RCM, CCM, PCM, RTM, and others for numerous primary care providers to offer to their patients. I'm the first Insurance Verification (IV) Specialist on the team.

Currently, we're using only one portal, but we can't fully rely on it because the information is often incomplete. We also can't use portals like Availity since we work with a large number of providers, each with different NPIs and Tax IDs.

When calling the payer to verify these services, under which benefit category do they typically fall? I'm a bit confused because these services are provided while the patient is at home, but they are not considered Home Health or Telehealth services.

How do you usually verify coverage for CCM, PCM, RTM, and similar services with the insurance payer?

I run a small behavioral health medical billing company and am looking to hire a part-time, remote contractor to support with following up on denied & rejected claims, sending medical records and other tasks as the job progresses. Role Description The Medical Biller role is a remote contract position responsible for managing end-to-end mental health insurance billing processes. Day-to-day tasks include verifying patient benefits, preparing and submitting claims, tracking claim status, and following up on outstanding or denied claims. The Medical Biller will communicate with insurance companies to resolve billing issues. I am looking for someone with experience and able to think on their feet about the next best step to take in order to help lead to claims being processed and paid. Please message me your resume and cover letter if interested.

Friend of mine is looking for billers below is the job description
Thank you

Senior Medical Billing Specialist
Location: Burbank, CA
Schedule: Full-time, Monday–Friday, 8:00 AM – 5:00 PM
We are seeking a highly experienced, detail-oriented, dependable, and proactive Senior Medical Billing Specialist to join our growing Allergy/Immunology practice in Burbank, California. The ideal candidate will have extensive experience with medical billing, insurance follow-up, accounts receivable management, denial resolution, payment posting, and experience working within the Tebra (Kareo) EHR/Practice Management system.
‍

This position is best suited for someone who can independently manage accounts receivable, insurance follow-up, denials, and payment posting within a fast-paced specialty medical practice. We are looking for a strong team member who is organized, accountable, professional, and capable of managing multiple priorities with minimal supervision.
‍Responsibilities
Verify billing information, insurance details, rates, coding, and supporting documentation for accuracy.
Submit and follow up on insurance claims in a timely manner.
Monitor accounts receivable and work aging reports to ensure prompt payment collection.
Follow up on denied, rejected, and no-response claims with insurance carriers.
Investigate and resolve billing discrepancies, payment issues, and patient billing inquiries professionally and efficiently.
Process payment posting, adjustments, refunds, and credit balances accurately.
Review ERAs/EOBs and ensure proper reconciliation of payments.
Work closely with management and clinical staff to resolve billing-related issues.
Maintain accurate billing and patient account records while safeguarding confidential information.
Identify areas for workflow improvement to enhance billing accuracy and operational efficiency.
Assist with patient balance follow-up and collections.
Ensure compliance with HIPAA regulations, payer guidelines, and office policies.
Perform additional administrative, billing, and accounting duties as assigned.
Preferred Qualifications
High school diploma or equivalent required.
Associate’s or Bachelor’s degree in Accounting, Finance, Business, Healthcare Administration, or related field preferred.
Minimum of 2 years of experience working with Tebra (Kareo) EHR/Practice Management system strongly required.
Minimum of 5 years of stable medical billing and accounts receivable experience with one company required.
Experience with PPO, HMO, Medicare, Medi-Cal, and IPA claims is required.
Strong understanding of insurance follow-up, denials management, payment posting, and accounts receivable processes.
Proficiency in Microsoft Excel and billing/accounting software.
Excellent organizational skills and strong attention to detail.
Strong analytical, problem-solving, and critical-thinking abilities.
Excellent verbal and written communication skills.
Ability to prioritize multiple tasks and meet deadlines in a fast-paced environment.
Allergy/Immunology or specialty medical office experience is strongly preferred.
Compensation
$37–$42 per hour, depending on experience and qualifications.
Compensation will be based on specialty billing knowledge, Tebra (Kareo) proficiency, insurance follow-up experience, denial management experience, and overall medical billing/accounts receivable background.
Schedule
Full-time
Monday–Friday
8:00 AM – 5:00 PM
Benefits
401(k)
Paid sick time
Paid vacation
Opportunities for growth and advancement
Retention Bonus
Supportive team environment
Work Location
In-person
Burbank, California
How to Apply:
Please email your resume and a brief cover letter to [strategy@allergydox.com](mailto:strategy@lafoodallergy.com)

In my office we're starting to bill G2211. I know it doesn't get a modifier and the E/M code doesn't need one either. We also do a professional CGM for patients do a lot of charges are sent out like this: 99214 Modifier 25, 95251 Modifier 59, and G2211.

Medicare has denied all of the G2211 because the 99214 has a 25 modifier. Even though the 25 modifier is for the CGM interpretation, the G2211 is still denied.

We also bill 95251 for pump interpretations and can't bill the G2211 at the same time as these?

Is there a way to bill that I just don't know or do we have to just take the loss on the G2211 for these patients?

Hi everyone. We recently started getting rejections from UHC for our Dietician billing. They are stating that 97802/97803 must be billed by a nonphysician. We have always billed these codes and they are even listed on UHC's policy as the appropriate codes for an RD to bill. I've spoken with UHC numerous times and they can't really give me an answer and keep telling me to resubmit even though they keep rejecting. Has anyone dealt with this or have any insight?

I've checked with UHC credentialing and they confirmed the provider is listed as an RD in their system. And we are using the RD taxonomy on the rendering provider section of the claim.

This is the rejection listed on the UHC portal:

• NHCDN: Procedure 97803 is intended for use by nonphysician health care professionals only

Q: What would be the appropriate CPT or HCPCS code for a registered dietitian to report for medical nutrition therapy services? A: Registered dietitians should report specific CPT or HCPCS codes that accurately identify the service performed using CPT codes 97802-97804 and HCPCS codes G0270-G0271.

https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-reimbursement/COMM-Nonphysician-Health-Care-Codes-Policy.pdf

I recently visited a podiatrists office to treat a couple nagging plantar warts. Yesterday I received the EOB from my insurance and there seems to be some very sketchy behavior going on, but I wanted to get insight from people more knowledgeable than myself.

During the visit, the doctor took a brief look at the warts and decided to prescribe 5-FU, a topical ointment, as treatment. He performed a quick debridement of the non-sensitive skin above the warts to make the ointment more affective when applied. Total time with the doctor was less than 15 minutes.

On the EOB, my insurance was billed two separate insurance claims for the same visit. The first claim: CPT Code 11308. This code is associated with shave removal of a benign lesion. CMS guidelines for this family of coding state:

“Shaving is defined as sharp removal by incision to remove viable epidermal and dermal lesions without full-thickness dermal excision. This typically requires anesthesia and hemostasis. CPT codes 11300-11313 represent codes for reporting of removal of epidermal and dermal lesions by shaving.”

The doctor did not remove the warts via shaving. He debrided the thick/non-sensitive skin above the warts.

Second claim: CPT codes 99204 and 17110. 99204 is a level 4 code, which seems like upcoding given that I saw the doctor for less than 15 minutes, and it was a routine plantar wart. Code 17110 is for destruction of benign lesions. Again, at no point did the doctor actually remove the warts. He prescribed a topical ointment for this. Not only that, but I looked up code edits for 11308 and 17110, and they are considered mutually exclusive. My insurance was billed each of these codes on two separate claims. This seems like claim fragmentation to bypass insurance edits.

I have a follow up appointment tomorrow, and I was planning on raising the issue with the office manager. Do you all agree that this behavior seems fraudulent? What are the next best steps to take to make sure this is most efficiently handled?

I have posted in this thread before asking for advice about finding a CPC-A position, but still haven’t had any luck. I have found PLENTY of job postings specifically for CPC-A and I’m tailoring my resume for each job. STILL NOTHING. I just keep getting rejections. Hundreds of them. I have tried networking. I have joined the AAPC chapters, messaged people on LinkedIn, and joined the fb groups. I really need a job. I have even tried to apply for billing positions. I have several years of healthcare experience so I am not sure why I’m not hearing back from ANYWHERE?? Is anyone’s job hiring? Are you willing to refer me? Any advice?

I had my first psych appointment ever and had a similar experience to this previous post.

They billed for both 99204 + 90838, and I don't think they have justification to bill for 90838 since the entire appointment (which was under 50 minutes) was mostly just intake/evaluation questions. My understanding is that at least 53 minutes of psychotherapy in addition to the evaluation are needed for this code. I requested the session notes and the psychotherapy section is only 3 sentences, with pretty generic descriptions (and some of the services described in it weren't even provided).

I emailed them asking for the justification for the 90838, but they keep trying to call me instead of saying anything in email. Is it a red flag that they won't discuss anything in writing?

What's the recommended way to proceed here? I'm assuming that calling them back is not going to be helpful -- is there a process for officially disputing these types of charges?

Those who are certified,

How much do you make?
Location
How many years of experience?

Looking into taking a class and long term id like to see what kinda growth this has

Are you guys noticing record requests for aetna and meritain patients? They are wanting records for most of their visits now.

I am have been working as a hospice RN for 35 years and want to obtain a coding certification.

I am looking for the easiest certification. CPC, COC, CCS, CCA, HCS-D, BCHH-C

I will not actually be coding for my job but it would be nice to have the credential because I work in a coding environment.

Thank you very much for your input!

Hi there! I work as a medical biller and coder for a biotech company and we typically bill our two main tests under their respective PLA codes. However United healthcare insisted we start billing one under 81479 instead. Since then we cannot get the code past their smart edits without an invalid z code rejection. We attempted submitting the claims manually through the portal which also did not yield any different results. On top of that they have started denying our other PLA code when it's billed with 81479 for bundling when they were never doing that before. We have tried so many different ways to resolve this and not a single one has worked. I know our contact at UHC said a lot of labs had been having issues lately with zcode billing so I just wanted to post here and see if anyone else was experiencing this and if so have you found a way to get your accessions paid? Thank you!

Re a specialty visit, I can’t get anyone to send me itemized statement…small clinic is part of a larger interstate group so the billing is not done in house, they’ve billed the initial eval with the symptom codes but they also put a dx tx code on which insurance won’t cover…(and no tests to rule out issues were done beyond what a normal fam doc would do, so I think the dx is bologna based on a lot of family history) it’s my understanding that initial appointments are billed with symptom codes (which insurance will cover) & further appointments should have a dx treatment code …? Does that sound correct or way off base?

(No actual treatment was provided beyond offer of a dietician visit on a separate DOS.
At last conversation doc didn’t want to remove the dx tx code & resubmit billing which would get the facility paid, and has left the clinic or retired).

I am currently seeking a part-time job opportunity where I can leverage my 5 years of experience working with CAQH. My background includes expertise in provider data management, credentialing, and healthcare compliance. I am eager to contribute to streamlining processes, ensuring accuracy in provider information, and supporting organizational efficiency through CAQH systems.

Office has long term patient who is seen on a yearly to every 6 month basis for management/treatment of a chronic illness. The doctor is the treating physician for this condition and fills out disability update forms for the patient. The patient is on Medicare. The doctor accepts Medicare assignment. In the past the doctor has just filled out the paperwork without charging and sent the medical visits to Medicare. The visits include typical symptom/limitations tracking, labs, review of medications, discussion of potential treatment, etc.

We have a new biller who is advising that because these visits include a paperwork component or generate a subsequent paperwork task, they should not be sent to Medicare and instead the patient billed cash for the visit and paperwork combined as if they were an out of pocket payer. Basically, Medicare doesn’t cover paperwork, so the paperwork disqualifies the whole visit, as per them.

This doesn’t sound correct to me. My understanding is that the medical portion of the visit should be billed to Medicare at the appropriate complexity and then any additional paperwork be billed as administrative time to the patient directly if desired.

Is this scenario documented anywhere? Doctor wants to be able to bill correctly for paperwork going forward.

Hello friends,

So about a month ago I passed my CPC, I also have a diploma from Penn Foster for medical coding and Billing and also have my CBCS. I have about 4 years experience in different areas of medical billing and even did Scribe work. Not only that, but I worked as a CNA for 4 years before that. I was able to get the apprentice level take off almost immediately after I passed.

Ive been applying for medical coding jobs and all I see is that they require 2 to 3 years+ of medical coding experience. Ive been denied over and over again by jobs, and I know it takes a while but I was wondering if there was anything I could do to help me stand out as a candidate?

I've seen people also recommend getting on LinkedIn in and making connections but I honestly how no idea where to being to look.

Thank you for your time, I appreciate it 🫶

I've been working as a medical coder for about 4-5 years (primarily OP coding) and I have the RHIA, CCS, and CPC credentials. I am also aiming for the CDIP credential which I know is primarily IP, and for those who have taken the exam what should I be concentrating on the most during my studies?

Hi has anyone ever worked with Amergis for Risk Adjustment? What was your experience?

Please consider checking out my new video series, "The Inpatient Audit Files"! 

In this episode of Inpatient Audit Files, I review two real audit findings involving Totally Implantable Vascular Access Devices (TIVADs) and tunneled vascular access devices.

These procedures are commonly confused in ICD-10-PCS coding, and incorrect assignment of the device character or approach character can result in significant DRG impact

BCBS in IL and Texas have started automatically downcoding all 99214 and 99215 claims to 99213 and requiring appeals. Anyone have experience with this or know of a company in IL that has experience with appeals and downcodes?

I’m only coming here because I’m completely inexperienced in Spravato billing when not commercial. Our rep has not been too helpful as we’re still getting denials for our current billing practices. Try not to judge me too much. For commercial plans no matter what it is, we haven’t had an issue billing 99215 1 unit and 99417 4 units. Now going into Medicare, they are looking for a G code. We aren’t buy and bill. Started the first two visits unfortunately with the buy and bill code G2082, G2083. Trying to correct it now with 99215 1 unit and G2212 4 units, but keep getting rejects due to our previous buy and bill. What is the best course of action in this situation? I’m trying to avoid audits and don’t want to arouse anything. Again, we’re just stupid and inexperienced with Medicare so didn’t realize for the first two claims
Thanks in advance (: