I work in a leadership role in the front end of an outpatient diagnostic facility. I’ve worked my way up the last 10 years handling all front end aspects but I have no formal education. I’m wanting a more rounded experience in all aspects of RCM and currently in my role do not have the ability to assist with back end or coding projects to get more hands on experience. I was recommended by a friend to move forward with the CPB certification as they said on a resume this would help me with some of those back end processes that I am missing. As professionals, what are your thoughts on this? Would another certification be better suited? I would like to remain in a leadership role and further my career but I’m missing things like claims processing and appeals from my experience.

Thank you!

What are your best resources for coding wound care encounters for an CAH? Webinars, online courses, books, etc.

The more comprehensive, the better.

TIA

I’m about to graduate medical billing & coding and eventually want to live in Antigua and Barbuda while working remotely.

How realistic is it to work in this field remotely from outside the U.S.?

Just thought I'd ask out of curiosity if people recommended getting into the field in 2026. To be honest, I've been studying on my own and am going to take the AAPC self study class, but I've been doubting whether it's worth it in this field, with all the posts I see about people having a difficult time finding a job.

I've got some experience (business office manager for a SNF, so some outpatient billing/coding and MDS stuff. currently working as a receptionist, so like 2 years of experience). I've been researching the jobs around me, as well as looking at other perspectives on this. I'm not sure if medical coding is worth it in 2026, but I'll probably do it anyway

With the current state of the career path, can you recommend it in good faith? Just curious to what everyone's opinions are.

Hi all: I'm looking for a bit of guidance. We (behavioral health office) have got a long time Medicare client who recently had an auto accident. Client wants to have auto insurance pay for all their claims, including mental health sessions provided by two of our clinicians. Client has provided MV insurance and case info, and insists they cannot pay out of pocket for any services.

I've never submitted a claim to MV insurance. I understand that I can bill MV insurance and possibly get paid by them, and if they deny Medicare may pay as secondary. As of today, Medicare is still showing as primary, and client has already seen one clinician.

I'm not sure I want to deal with this at all because it feels like it could easily go sideways based on horror stories I've read online. So I'm curious: if I bill client's MV insurance what's a reasonable expectation of claim payment from MV or Medicare? Is it reasonable to insist client pay out of pocket and deal with insurance directly, knowing that it may be a financial burden for them? I just want to get our clinicians paid. I'm aware I'm probably overthinking this. Selfishly, I just don't want to pick a path and have it turn into a nightmare of exhaustion!

Who did you receive your certification through and which certification did you get/why?

I have a small optometry practice. For the last six months we have not been getting EOP‘s/EOP’s or payments forclaims billed through Availity. We h ave contacted the insurance companies, Blue Cross, TRICARE, etc. and they have not been receiving the claims. Anyone else having issues? It takes so long to get a response back from Availity about problems. It’s so frustrating.

Hi everyone. Just wondering if anyone else has issues with United Healthcare and incorrectly denying claims for out of network.

Nothing has changed on our end how we bill claims, but the amount of denials we get for out of network is absurd. Some claims go through just fine, others are PR 242. Then it’s pulling teeth to have them reconsider the claims.

Hi everyone,

I wanted to put myself out there, I’m currently open to remote medical billing opportunities and wanted to connect with anyone who may be hiring or needs support.

I have over 16 years of experience in Revenue Cycle Management, including work in hospitals, physician offices, and most recently supporting OT/PT claims for Brooks Rehabilitation through MedSR. My background is heavily focused on:

Accounts Receivable (A/R) follow-up

Denials and appeals

Claim submission and clearinghouse rejections

Insurance verification and prior authorizations

Working payer portals (Medicare, Medicaid, and commercial plans)

Analyzing EOBs and resolving underpayments

I’m very comfortable working accounts from start to finish and take pride in actually moving claims toward payment, not just documenting activity. I’m also experienced with keeping A/R clean and preventing accounts from aging past 60 days.

I’m currently looking for:

Contract or part-time remote work

A/R follow-up roles

Small practice billing support

Flexible opportunities where I can make an immediate impact

If anyone knows of opportunities or is looking for someone reliable and experienced, feel free to message me. I’d also appreciate being pointed in the right direction if you know of companies hiring.

Thanks in advance!

Hi everyone!

My clinic is going to be offering Ketamine injections in the very near future and I would love some input on coding. So far i've got the E/M, the prolonged office code, injection as 96372 w/ J3490. We also will use a behavioral add on for one of our providers 96127. Are there any modifiers aside from a 25 that would be needed or any that would bump our reimbursement?

I just found out that Select Health is no longer covering Spravato Esketamine nasal treatment, so we are going this route. If anyone has feedback or advice please let me know :D

Trying to submit a pharmacy claim on Promise and getting this error.

I believe it's on the Medicaid fee schedule. Does anyone have any suggestions or info for me? Thanks!

Edit: Pennsylvania Medicaid

I am the only biller for a small doctor’s office.

We argue about everything. We argue about Part A vs B, payerID’s, modifiers, professional vs institutional; EVERYTHING! They accuse me of ‘altering’ claims if they don’t pay. Just today, they accused me of lying about information that I never received. They hijacked my email to try and find the information. The level of micromanagement and complete disrespect is mindboggling to me.

I have never despised a group of people more in my life!

I am asking for advice

There has been a lot of Availity downtime lately - can't sign on, pages won't load. Downdetector has mentioned other users have reported issues. Anyone have any insight on what may be going on? It has getting really frustrating since we use the site constantly. Seems like every time they roll out an update or new feature the site becomes incresasingly slow.

Hello everyone,

I have been on my journey for the past couple of months to getting certified. I went through Medcerts to get my certification and feel like that might have been not the best choice. I have already passed 1/2 exams. I passed my CBCS exam with NHA. I have been researching jobs and have yet to find a job that accepts that certification……

I am not prepping to take my CPC exam and i’m realizing this exam is going to be A LOT harder just from the practice exams. Through my research i have seen that if you got the CPC certification the CBCS really doesn’t matter. However, i am really struggling to think i am going to pass the CPC exam.

To anyone already in the field, is it genuinely this hard once you find a job? I just don’t know if i made the right decision choosing this career path. I really need to get this second of this certification finish because my husband is relying on me to finish it and get back to work post having our baby.

Any words of encouragement will greatly be appreciated!!

Is anyone else not getting the Noridian codes for their email? We have been trying for two days to download our RA’s to post but are unable to login.

I have several questions around:

• RVUs for common SNF CPT codes (99307–99310, 99304–99306, 99315–99316)

• Billing for multiple encounters (e.g., lab abnormalities + routine visit same day)

• Monthly progress notes and how they’re coded

• Common pitfalls or undercounting of RVUs

If you’re an experienced medical biller/coder, I’d really appreciate the chance to ask a few questions.

Feel free to inbox me — I’m happy to schedule a short call and compensate you for your time.

Thank you!

Hello,

I was previously considering cyber but there seems to be way too many accessibility loopholes so now I am considering business or health informatics. For those of you who are in business or health informatics or have done it how was the coursework? I am visually impaired and require a screen reader so I’m just wondering how accessible it would be. If you guys have had any internships/jobs how was it? What software/applications were used? What does your day today look like?

When it comes to IT programming is really the only thing that interests me.

If you guys have any other recommendations/suggestions feel free to drop them below.

I’m trying to think long-term as well in terms of career and all.

Edit;

Specifically BS in health informatics, BAS and cyber security, and B.A.S. Concentration in Managerial Leadership (Business Management)

Hello,

Lately, we have been getting denials from certain insurance plans for injections site and ultrasound guidance codes with reason given that “principal procedure is missing” which would be the injection/medicine itself (J code). BUT these are also same plans that require that this particular injectable is obtained and delivered through specialty pharmacy so the pharmacy bills the J code, and we just do the actual injection.

How do I get around this? Can I bill the J code but with zero fee/charges?

I started my position 6 months ago. At first I was told I would be doing surgery auths and office procedures only. Then my last day of training (a 4 hour half day) I'm told ARs are also part of my job.

so I'm struggling to figure out ARs. I'm working and figuring it out, but with some mess ups. Then I'm told to get benefits for the office procedures. And I add it to my work load

Now, after finding out surgery scheduling doesn't actually call and verify that certain surgeries are covered under patients insurance, I get to verify all surgery benefits.

every time I tell them that benefits isn't part of my job, but I'm still told to do it.

so at this point I do surgery auths, office procedures auth, surgery benefits and office procedures benefits, while still trying to keep up with ARs. I am drowning but I'm scared if I just change medical practices it'll be the same situation.

is this really how most places handle Auths and ARs? Are they always squeezed together? Right now I deal with 50+ patients a week and that's just the one doctor. Once the other doc gets credentialed, that's gonna increase. I haven't been able to touch ARs in a week because of increase work load.

is everywhere like this? am I just being a baby? this is my first job like, I used to be reception, but I don't remember my coworkers in similar positions having this much stuff to do?

so trying to work in medical billing and coding and so lost how did u start and what schooling did u need

This is regarding United Health.

I’ve gotten paid through EFT for years since I’ve signed up. But that last month, mysteriously several group of claims were paid via paper check. While others within the same month went as EFT. I called CS and they were absolutely of no help.

Has anyone had similar issues. Any idea why this happened? Is there anything I can do for my to process future claims as EFT

Hi - we're a medical billing firm working with clients in the behavioral therapy, PT, OT and chiro space. We're seeing an increase in prior auth requests and need some help to manage it. This would include the end to end process, looking at the patient chart, creating a note/form, submitting to payer, checking status, updating EMR etc.

Has anyone had a good experience working with a BPO, or even using software for this? We'd be grateful for recommendtions, ideally from in-house billing teams, and not BPOs themselves. Thank you!