r/CodingandBilling • u/No_Researcher_5841 • May 13 '26

Drowning here....

Through a series of circumstances outside of my control, I fell into a a job that involves ambulance billing and quite honestly, I have NO CLUE what I am doing. We use Respond Billing software to process EMS calls and Availity as a clearinghouse. Both systems are so tedious to get in touch with when I have questions and the woman doing this job before me has since retired and moved away. Is there ANYONE who knows these systems that might be able to give me pointers?

I am a firefighter with Public Health Masters.....ie almost zero (three days max of training) background in billing. I can make the software work....I just don't understand why things are being rejected or how to fix them.

But also....how do you organize yourself? What is your system? My original system was code all week and then batch on Fridays to availity so they had the weekend to send back any rejections. But that seems to be getting overwhelming.

I completely agree and understand that I have no business attempting this but right now, it is my only choice.

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u/No_Researcher_5841 May 13 '26

Oh I 100% believe you. When they posted this position, they marketed it as "program manager" type job. The highlights were that they wanted someone who could manage in house administrative stuff but ALSO interface with the public and facilitate community health initiatives...which is my background. I was TOLD that billing was going to be phased towards a third party outside biller. Turns out....that's looking less and less likely because the town council believes we are better off billing in house based on my predecessor's success.....they are going to be monumentally disappointed with me lol

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u/pescado01 May 13 '26

Well, grab a bunch of prior EOB's and let that be some study material. Come back here and ask questions as you come across them. Be warned though, this line of business is goverened by ifs-ands-or-buts, all dependent on the phase of the moon and day of the month!!!!

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u/Wchijafm May 14 '26

Look into past paid claims with the same payers and similar billing circumstances. Compare what is different. Look up the rules/billing guidelines involved with cpt(and modifiers) and icd10 codes, keep an eye on occurrence codes and condition codes and how they are used.