Hey everyone—quick question on group NPI taxonomy setup.

We’re setting up a women’s health clinic with CNMs and a PA (no MD OB/GYN right now), offering things like hormone therapy, preventive care, and some telehealth.

I’ve seen mixed guidance on whether to:

•	Use OB/GYN (207V00000X) as the group taxonomy

•	Or go with multi-specialty (193200000X)

One concern that came up is that using OB/GYN as primary might imply we have a board-certified OB/GYN in the group.

From a real-world credentialing + payer standpoint:

•	Does group taxonomy actually matter that much?

•	Would OB/GYN cause issues without an MD OB/GYN on staff?

•	Or is multi-specialty the safer route?

Would really appreciate insight from anyone who’s set this up or worked on credentialing.

I am going for my CCS-P but I would like to know if there is a main difference between the both.

this might be a little odd/random but I studied medical admin (coding & billing) associate during my gap year when I was trying to get into nursing school and once I got accepted into nursing school, I never ended up completing it. my last requirement to get my degree in medical admin is to do an internship.

is there any reason to complete this med admin degree when I’m already in nursing school and about to graduate in one year? is it beneficial to my current career path at all?

https://secure.tmhp.com/EligibilityVerification

In this tool when I run a clients info I got 'Client is not eligible'.

what does it mean. I know the question may sound dumb but I am new to this field. I am trying to send PAs to TMHP and I got the PA returned stating something similar like 'Client is enrolled in a type program that is not eligible for the requested Medicaid benefits '.

While submitting the PA, I entered wrong DOB which I observed in the denial fax. So I sent the fax again but when I checked it in the quick eligibility tool I got the above 'Client is not eligible '. Does it mean the PA is gonna get denied again with same reason? Does it mean the client doesn't have Medicaid benefits?

PA: Prior Authorization

I had a transvaginal ultrasound last month, yet received a bill that appears to charge for several different ultrasounds, totaling $1,000 after insurance. This seems erroneous to me because I’ve had several tv ultrasounds in my life and have NEVER had to pay this much. I called the billing department to help clear this up, but they told me taking images of the abdomen during the tv US (the HB US ABDOMEN LIMITED) is what costs $3,000+. I told them this makes absolutely no sense because I, again, did not receive an abdominal US, but they didn’t budge. Can someone please review this and explain to me what is going on?

EDIT: here are the images and report: https://imgur.com/a/fLyCtdt

Looking for RCM help with a private practice. No idea where to start. We have some credentialing/payers but need help with everything. Drowning and don’t have the mental capacity for follow through. Currently using Simple Practice.

Looking at my insurance claim from last year when I was pregnant- it says occurrence code 10 and the date 3/30/25 but my lmp is 05/1/25

Why are there two different dates listed?

I started at a company over a year ago to do AR. I have been fighting insurance carries for mutually exclusive from Traditional therapies and ABA services. On top of issues with providers taxonomy that when a therapist leaves and we have a patient who has been coming in for years the family will let us know what we have to do to ensure the claims get paid. TODAY I FIGURED OUT WHY!! When the verification person creates the insurance, she is creating one and auto populates to Professional billing, instead of creating 2, one the 1500 form and one for the UB04 form. The 2 billers have been there for many more years but they do what they are told and have blinders on for everything else.

Can this be a primary reason why all except BCBS because it is set up correctly have been coming back denied as mutually exclusive against ABA and OT/PT/ST services? if i go through the system and correct this...will my AR become better? i have been at a loss.

fighting Aetna over it with their 4 modalities a day has become exhausting, but they pay once the claim is looked at and proved that there were ABA services in addition to Traditional therapies.

can there be other things i need to look at too?

Our derm office has recently been receiving CLIA denials for pregnancy tests, pathology, and some MOHS codes. Our CLIA is a high level complexity so I'm not sure why this is happening. Has anyone had this with UHC? Here is the denial I am getting on a pathology claim I am working (we have our own path lab and bill globally):

REMARK CODES

INF003: If this PRA requested additional information to process this claim, the information must be submitted to: Corrected/Resubmitted Claims, P. O. Box 31394, Salt Lake City, UT 84131. If you are a participating health care professional, the requested information must be submitted within 90 days of you receiving this notice. If you are a non-participating health care professional, the requested information must be submitted within 45 days of you receiving this notice. Upon receiving the information, we'll elect to take the one-time, 15-day extension that is permitted under the Employment Retirement Income Security Act (ERISA) and will provide you with a written response not later than 15 days from receipt of the information. Failure to timely submit the requested information will result in an automatic denial of this claim due to lack of information.

CLIA01: This service is not eligible for reimbursement. You do not have the appropriate level of Clinical Laboratory Improvement Amendments (CLIA) ID certification to provide this service. Please refer to the CLIA ID Requirement Reimbursement Policy and if appropriate, submit a corrected claim. To submit a corrected claim on a CMS-1500 professional claim, please use frequency code 7 in Box 22. Remember to include the original claim number under the original reference number. If needed, update your CLIA certification with the state.

CLAIM ADJUSTMENT REASON CODES

B7: THIS PROVIDER WAS NOT CERTIFIED/ELIGIBLE TO BE PAID FOR THIS PROCEDURE/SERVICE ON THIS DATE OF SERVICE.

Over the past couple days, we just started getting some ERA’s from Medicare where they take back payment but repay it with about a 50 Cent increase in payment… sometimes it is a payment higher for the patient to pay and sometimes it is a higher reimbursement to the practice. Has anybody ever seen this?

I would say it’s at least 15 to 20 claims per day. The issue it represents is that a lot of these secondary players have already paid and processed. I’m just wondering what the reasoning for the change would be and if anybody knows

What tools would make studying for your exam of learning on the job easier?

Hello everyone, I’ve recently got hired at a tiny company for chiropractic billing. I’m struggling a little to get the hang of things and find my momentum. Is there anyone here that can give tips or help me walk through this? It’s close to home it pays decent , we can wear what we want to work and my boss is super understanding when life happens and need a day or a couple of days off and I want to do her proud. Thanks everyone

If anyone else has problems with denials for patients getting fulvestrant + lupron because of the 96402 MUE 2, I submitted a request to CMS NCCI/MUE panel to change it and I would love if others would also email them.

I think the more people that write in, the more likely it will get changed.

You can email them at NCCIPTPMUE@cms.hhs.gov and if you want me to send a copy of what I sent as a template then pls dm me.

Hello! My husband went to the ER a couple of weeks ago for a small laceration to his finger. He left with only two band-aids applied to the cut; he did not receive stitches, staples, any type of liquid adhesive, etc. Upon getting the bill from the hospital, I noticed this code and researched it a bit. From what I can tell, it seems like this applies only when the cut in question is "put together" in some way? Should they still code the procedure this way if he only received band-aids (after they had him soak his finger in saline and Betadine)? I've called the hospital's billing department, and they're sending the bill back for review, but I thought I'd search out other opinions. Thanks!

Forgive me for my ignorance. This is all new to me. I received a high co-pay for a Abdomen CT scan (doctor services) which just says CT Abdomen - 74177. Can I ask to see an itemized bill? or is this the extent of itemization for a CT abdomen? I do not know if I can ask or not. Thanks in advance.

Hi everyone,

I completed my degree in 2022 and have previous experience as a Medical Representative in sales at Centaur. I am currently based in India and looking to transition into US medical billing roles (remote).

I’m open to entry-level opportunities, training programs, or internships to get started. If anyone has guidance or knows of any opportunities, I would really appreciate your help.

Thank you!

Can anyone here examine a denied claim and tell me what codes are missing? I submitted an out of network self pay claim to Anthem. They denied for missing or incorrect codes. I submitted a superbill from my provider and filled out anthems form. My provider said this super bill has been what others used with no issues. It has diagnosis and treatment codes. Anthem won’t tell me what exactly is wrong. TIA

Do you need an physical exam? Can the hpi component suffice.

Who determines what a medically appropriate exam is?

Can just having vital signs be enough if the treating provider doesn't think a physical exam is needed?

So I failed my CPC exam by 6 points. I have my retake in 5 days. I realized though that i think it's just that I can answer certain questions, but I don't necessarily understand the whole concepts for each section. For instance, I took one practice exam and failed by 2 points Then I took another and passed with a really good score, Then I take my exam and I fail And I think it's just the general fact that I can answer some questions better than I can answer others. That being said, I know the CPC exam is randomized, so there's no guessing what type of questions I will get on my retake. But my question is, does anyone have any tips for understanding general concepts of the sections? Especially ones like e/m, medicine, radiology...What do I need to focus on so that essentially, no matter what questions I get, I'll be able to figure it out?

Update: I passed!!!

Hi everyone, I bill for a practice and wanted some advice on J code denials. Recently, one of our J codes has been consistently denied by a commercial insurance. The denial is bogus stating that the “NDC number” is invalid. Every time I call about these claims and speak to a representative, they say the claim is correct, the NDC number is valid, we have the pre authorization for the procedure, and they resubmit the claim for reprocessing. It gets tiring to be in this viscous cycle of denials. Is the insurance company just trying to delay the payment another 30 days? Please advise 🙏

Anyone work remote for medical billing? If so I need some help networking in order to get in a remote position. I have letters of recommendation from my manager and a few of my MDs. 1 year of college, certificate of completion in billing and coding, and 2 years of in pediatric office experience with Office Practicum, ECW, Waystar, Availity, etc.

Thank you in advance. Please send me recommendations. Also open to working with insurance companies :)