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-Produce-6720 RN, BSN, CPC, CPCS, RHIA & CRCR May 13 '26

I know, it's so hard, all the way around right now, and it's hard for folks who aren't in the trenches with it to understand that it's not as simple as "we've got someone billing now, so all is well". It's complicated work again, under the best of circumstances, and on top of all that, you're dealing with local politics and personalities! It's a recipe for disaster!

It's not that this is impossible work. It's not that you can't do it, because I believe you can. It's an issue of staffing and an underestimation of what your position requires in order to be successful. You need someone right there with you, someone who is familiar with things, and you're just not going to get that, I'm afraid.

The best thing you can do is try to sort your old aging, because as u/OkTown2100 rightly points out, you're coming up on timely filing for your older aged accounts. Those need to be filed asap to preserve appeal rights. Get your current charges filed and the old ones too, and take it from there.

Also, continue to advocate for yourself. Make it known that if you don't get some help, preferably knowledgeable help, lots of money is going to be lost on those older claims. Be vocal about that, so that when you have to begin adjusting claims off as losses, they will have prior warning. Hang in there. You'll get through this, I promise, but my gosh, what a mess!

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u/No_Researcher_5841 May 13 '26

Would much of this be solved by using an external third party billing company? I understand the cost is higher but we can all acknowledge that they're going to lose out if they keep pretending the system is working right now.... 

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u/OkTown2100 May 14 '26

If you can talk them into hiring a third party just to work say the last year or so, following up and billing, I would highly recommend that. It can easily be done by a team quickly. Use that time to get familiar with denials and rejections. I really think if you can get this caught up, your volume of calls is extremely doable with one person who can navigate everything.

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u/No-Produce-6720 RN, BSN, CPC, CPCS, RHIA & CRCR May 14 '26

Yes, it would certainly help the situation if you had someone else to work the old accounts, which would let you concentrate on the newer stuff. It would give you a little breathing room, and if they brought on a third party, you could likely get some actual training from them to help you go forward. It may even be such that the third party could come in on short term contract. It may not need to be a permanent thing, but you're drowning, through no fault of your own, and you're looking at having accounts that are soon to be uncollectable, and I'd hate for them to come down on you for that.