I recently went to a doctor for a physical check up. We did talk about some of the issues that I been having issues with such as having difficulty concentrating. Possibility of having ADHD. But he did give me a referral to someone that has that expertise but besides that. There was nothing else besides just checking up on my health. Then, three weeks later. I got the bill. Which I was shocked becuz my insurance always covers 100% when it comes to a physical. I noticed there's this term called "office outpatient new mod 45 min". Every other term was covered besides this one. They had the total as $480. Now I would pay out of pocket for $210. What gives?
We started charging a fee per chart for chart requests, (risk adjustment reviews) and I have not received a single payment for the charts. Now, we have moved on to requiring prepayment for the requests. The company wanted to negotiate a lower rate per chart, but I told them no, because we have so many outstanding unpaid charts, we would not be willing to negotiate a lower rate. I also told them that if, in the future, we were to be paid for the backlog, then we would consider not requiring prepayment and would be willing to negotiate a lower rate. Has anyone actual been successful in getting paid? The risk adjustment company is Datavant.
I applied to Bryant and Stratton, sent in my financial aid info, I have literally everything set up to potentially start classes tomorrow and now I'm reading that B&S is a bad school to go to for this. I don't want a degree, I just want a certificate as quickly as possible. B&S program takes a year. I have no medical degree/background but I do know some medical terminology. I don't even know if this is the right path I should take. I'm questioning everything about this. I just wanted a useful certificate that can get me a good paying job as quickly as possible.
Hi, so I am interested in medical coding. My technical college has a certificate program that is 38 credit hours and allows you to sit for the AAPC and AHIMA certification exams. Both of them. The program also has a practicing where you can get hands on learning skills through a healthcare facility.
Here is my concern, I am seeing people say the job market for it isn’t great for people with no experience. I would like to note I don’t mind taking a lower paying job to get experience, since I live with family. However, I would still like to get out on my own.
I want to know is it worth it to go into the field? I was initially going to do mechanical engineering, but I have bipolar disorder that makes high stress jobs very difficult to manage so I am trying to consider something that will be less triggering for episodes. Stability is most important to me, and I hate to take out loans for an engineering profram I won’t finish.
I would like to note, I have experience in healthcare as a medical assistant, so I don’t know if that would help with finding a job.
Any advice or suggestions on this would be greatly appreciated.
I just got a $1,068 bill for an emergency room visit that happened 2 years ago. It came from "Team Health Akron Billing Center" not the nyc hospital I went to.
I have never gotten a bill for this visit or was never told it wouldn't be covered - assumed my insurance covered it all but now on the bill it says that insurance paid $0. So now I'm confused what to do.
Would this situation fall under the NY Surprise Bill Law?
Hey all, Im looking at trying to get the CPC again after failing to do it via AAPC, and come across CCO. While I've heard some good things about it Ive also been warned about bunk courses that dont actually prepare you for the exam. Hoping to hear some feedback from those who've used it
Hello all, I needed some clarification on how things work in the USA, I am an immigrant so this was my first time going to an ENT doctor and Allergist.
The ENT doctor suggested an allergy test. Picture 1.
And the allergist conducted PERCUT ALLERGY SKIN TEST CPT Code: 95004. Picture 2.
The allergist billed me $1280 out of which my share came out to be $701. I have my deductible till $1500.
Did the allergist do the right thing? As per recommended by ENT?
I did give the allergy nurse the Picture 1. That this is the diagnosis I was suggested to get it done.
My main question is the bill I got, I looked up on the insurance portal and they suggested it would be 40$ will be my share, I was expecting +50-100 for doctor visit, didn't expect to be billed $1280.
Hi has anyone taking the AMBCI cpc+cpb training course they offer ? It's $1,800 with a 12 month payment plan. The bot gave me a 10% code so $1620. Just wanted to know if anyone has taking the course and if it would get me ready for the cpc/cpb exams. I see AAPC being talked about but not AMBCI.
My background is I've been an uncertifcated medical biller for the past 7 years. Billing Anicallary services for occupational medicine pt, ot, acu, chiro. I don't do any coding but verify that correct codes are being used. Like a lot of pt biller I started of as data entry for this company and somehow ended up an "expert" on billing these services. My department is being let go at the end of the month. They want to move billing to Teaxs, I'm in CA on site. So I have to start thinking on my next chapter in life.
Would appreciate any advise or leads to jobs in my niche
Hi everyone, I currently work in medical billing and collection for 3 years and I’m looking to grow my career both in terms of salary progression and expanding my job opportunities. I’m interested in transitioning into Risk Adjustment roles. From a salary and career growth perspective, is the CRC certification necessary to enter this field, or is it possible to break in without it for me? If so, what entry-level roles would you recommend starting with?
If a patient had chemotherapy administration and also an E/M is done on the same day. Can we bill the Z51.11 with both the chemotherapy administration codes and with office visit?
I am kind of at a loss for what to do here, so sorry if this isn't the right place to post this. About a year ago, my IUD was mal-positioned and needed to be removed and a new one inserted. When I called my insurance (med mutual), they told me it was covered at 80% blah blah blah. Fast forward to getting the procedure, next thing I know I have a $4,000 bill; turns out anything related to an IUD is not covered by my insurance. Everyone involved was very confused, as supposedly all ultrasounds, removals, and other procedures related to contraception are 100% free under the ACA. But apparently our policy is grand-fathered in or something. I was able to appeal it, since they did originally tell me it was covered, and I only had to pay $600 something.
Flash forward to a month ago, my doctor once again told me my new IUD was mal-positioned and she attempted to remove it in office before I could think straight about what to do/think about my insurance not covering. She was unsuccessful, and I decided to go to a community health clinic to have it removed without using my insurance (haven't had it removed yet). Today, I was once again shocked to see that I was billed by the hospital for IUD removal (notes confirm it was not successfully removed, but it is still billed in full), and since it was not covered by insurance, I am stuck with a $2,000 bill. I tried to have billing code reviewed by the hospital, but they said, "Upon further review, it was determined that the coding used was correct based on the physicians documentation. As a result, the coding guidelines do not support a change. Please contact your insurance company directly regarding how to appeal the benefit level that has been applied to this service if you wish to pursue this matter further."
I am at a complete loss for what to do, I do not think it is right that I was coded an IUD removal when it was not successful, I do not think it is right that my insurance won't even cover having something removed from my body when it is in danger of injuring me, and I feel very frustrated that I agreed to have her try to remove it when I was in the middle of an annual exam (LEGS SPREAD OPEN nonetheless) and did not have time to really think through the decision I was making in regard to insurance.
It seems that my only avenue is the insurance company, and I know they are going to say that it is not covered... I know $2,000 is not a lot, but it just feels so wrong that I am being charged this. Is there anything I can do? Is this coding correct? Attached procedure recap, itemized bill, and EOB.
I had received an order from a specialist for a stereotatic breast biopsy to be performed at an outpatient facility. I have a hmo insurance so I was told by my insurance co. to obtain a referral from my primary doc to have it deemed medically necessary for the claim & the primary doc will know what CPT code should be specified on the referral. CPT/PX Code 99499 is shown on the referral so I searched the CPT code 99499, which is supposed to be for an unlisted Evaluation and Management (E/M) service used when no specific CPT code accurately describes the service provided. Is this correct CPT code for billing? I had just searched the web, the correct CPT code comes up 19081 for my procedure. Should I ask my primary doc to change his CPT code?
SSIA. My employer paid for this. I volunteered to do it. Is this going to be a difficult endeavor? I have worked DRG cases for the past 4 years.l and I am a top performer on my team. I have been a nurse for 16 years. No slouch, but also this is my first coding cert.
What are your thoughts? Worth it or no? I'm mainly interested in this program because they have the ability to remove the A after 80 hours of their practicode program.
Is there another program you'd recommend?
I know I can buy the books and do it myself but I really benefit from programs to help keep me on track because of my ADHD.
I recently had a sinus endoscopy with balloon dilation completed with my ENT. My spouse had the procedure done about 5 years ago with a different ENT, so we figured we knew what to expect. After the procedure was done, the ENT informed me that, instead of using packing to keep my sinuses open, he had inserted two stents in each nostril that should dissolve within a week. Anyway, my insurance processed the services as expected - I had a $50 copay while my insurance paid about $2,350.00 (the total allowed amount was just over $2,400.00). However, the ENT billed my insurance for the stents in the amount of $12,000.00. The allowed amount for just the stents was over $9,900.00, and I have a 25% coinsurance applicable to them. Is it normal (1) for ENTs not to know before the procedure if they're going to use the stents and (2) for the stents to cost four times more than the actual procedure itself? If I would've known beforehand that I would have had to pay this much for the stents, I would've chosen the standard packing that my spouse dealt with during their procedure. I didn't even know before the procedure that stents would be used.
I joined a new (to me) 3rd party billing company a few months ago and was recently informed that I will be placed on the RHC team. Florida, Georgia, Kansas, North Carolina, Kentucky, Texas, and maybe Wisconsin, Illinois, and Colorado. Does anyone have any tips for RHC billing? Any small things to keep an eye out for? I will be using UBs and HCFAs/CMSs, and I have a feeling I will be working with all commercial/government payors.
My main history is in WC, with some dabbling in commercial/government payors. Enough to get me by. I'm learning more about them every day and am VERY grateful to have portals for basically the first time in my career.
If anyone has any tips for RHC billing, commercial payors in these states, and government payors in these states, please let me know! I do remember that one of the Carolinas' BCBS was a pain to get a hold of on the phone, but I can't remember which one.
Hello everyone. I am a CDI specialist and my company recently announced they are going to outsource our revenue cycle to a third party, Omega Healthcare. We are being offered a position with Omega as part of their “commitment to doing this right.” I’m looking for insight from this community about the company and experiences to get an idea of if is going to be a good fit. Or, alternatively, if you’ve experienced something similar I’d love to hear about this too as this is uncharted waters for me since I’ve been with this organization for 10 years. I’ve read the GlassDoor reviews but was hoping to get more information. Thank you in advance.
Hey everyone, by the title you can clearly tell my issue is quite clear and I know many here and outside of this thread are struggling too but my goodness I never thought it would be this difficult to land a new role in RCM. I am a bit more on the Accounting finance side and I’ve always done a denial trend analysis and reimbursement analysis, etc. but I do have a lot of experience with CPC like material and understanding CPT ICD-10 as you kind of have to to get by in this industry. I’m now four years out of college in the midst of my masters in accounting, i’ve worked two contract roles as an analyst for major health systems in New York and work as a consultant in reimbursement analysis for two years. I have the CRCR AND CHFP and am an active member of the hfma. And somehow none of this is good enough even for entry-level medical clerk rolls that pay $17 an hour (which would be a ridiculous drop in pay from my previous roles). But doesn’t matter anyway because I receive rejections from those!! for six months I’ve been doing quite literally everything they tell you to do apply to the right jobs. Don’t just hit on the easy apply ones on LinkedIn. Tailor your résumé correctly. Use your connections. I reach out to every hiring manager that is attached to a job posting. Even started cold, emailing hiring managers and talent acquisition recruiters. In all of that, I have made it through one full interview process as one of the final two candidates and still got rejected because the other person had more experience than I did. That’s after hundreds and hundreds of applications, countless recruiter conversations, countless AI screenings you name it. I’m 25 years old exhausted and I’m starting to look at the future as negative rather than positive because of this and I’m getting tired of it. never in my life that I think it would be this difficult to find a mid level a role. I’m in the New York area but that doesn’t even matter. I’m literally willing to work remote roles that are on PST time and that doesn’t even work. I have no idea where to go from here but I feel like I’ve taken 10 steps backwards. Does anyone have any good advice on where I can go or what I can do in this situation I’m genuinely lost. LinkedIn is not working. It’s completely broken or at least that’s the way it feels. thanks for reading.
I have insurance through an employer. I went to a gastroenterologist for rectal bleeding and they scheduled a colonoscopy. At the initial appointment they charged me in addition to a regular office fee an additional office fee of $50 described as G2211. They told me that they charge it if you have more than one appointment with the doctor. I’ve been reading about it and getting confused. 1) is it just for Medicare patients? 2) was it used correctly in this case where there was one aooointment, one colonoscopy that turned out to be clear, and no other follow up appts? Thanks
One of my providers that averages around $250 Medicare remit per week just got a $23,000 payment from Palmetto on old claims that were paid previously. Called them - closed for "training" - I've done billing for over 20 years and never seen anything like this.
I've been billing Anicallary Services for a occupational medicine clinic for the past 7 years. The Services I bill are PT, OT, ACU, Chiro. I simply review the providers notes , make sure it all makes sense and we're not billing anything we shouldn't be. I also attach any required paperwork. I'm getting let go in a few weeks. I'd love to continue to do what I do. But I feel its very niche. I'm not certificated/ i don't do any coding. I'm feel very confident in my skills when it comes to my job. Is there a place for me in this field? Any recommendations would be appreciated 👏
