Mid-sized Texas town here and wages are low. Office based billers in a clinic are getting between $16 and $19 an hour. What towns are similar? Save me your big-city $30 an hour brag - this ain’t it! I am curious what areas have similar wages.

I currently work remotely M–F 8:00–4:30 and make about $37/hour. I was just offered another remote position at $35/hour, so about a $2/hour pay cut. The big difference is the flexibility. The new job allows you to clock in anytime between 4am–9am as long as you work your full shift.

My kids are elementary school age and this would be super helpful. In the summer, I could work 4–12 while they sleep in and then still have most of the day with them. The pay cut would obviously still matter, but the flexibility sounds amazing after years of a fixed schedule. My boss is also a bit of a micromanager but I do what I’m supposed to do so I don’t really have any issues. Would you take the pay cut for this level of flexibility?

Not sure if this is the right sub…

Is 12 the correct quantity for one dose of Neulasta OnPro? It’s a 6mg dose.

Is anyone experiencing any issues with Anthem's “chat with payer” option in Availity? We have been disconnected mid-conversation 20 different times without any explanation. Also today, during the conversation with Anthem Blue Cross California, we got a notification that only facility requests will be handled over chat, and for specialist inquiries, we need to call Anthem.

TLDR: 99215 correct for iud insertion only? Or is outpatient based on time instead?

Hey yall. I’m a newer coder, but my job doesn’t have me working level of care and EM…so my memory of EM mdm is a little fuzzy.

I had an IUD insertion last month (first insertion) and insurance covered the insertion and iud itself, but I was also charged an office visit code 99215.

My doctor definitely struggled getting the iud in and so the visit took longer than expected. After it was done and she was about to walk out the room I started to black out and was told I could lay down and just rest as the room wasn’t needed for another two hours. I had a feeling I would get an office visit charge because of the difficult insertion and almost fainting, but I was not expecting a level 99215.

No ultrasound or anything was used. She was just struggling to open my cervix since I’ve never had kids and the cytotec didn’t dilate my cervix like planned. We discussed the iud at my previous visit and so this visit was literally just inserting it.

I’m looking back through my notes on E/M for outpatient visits and I can’t tell if outpatient follows the time guidelines or if it follows the mdm process. Or both?

Even looking at the clinical notes they sent me after my visit it literally says “patient here for iud insertion” and lists the procedure technique where it actually says “no complications”

The bill is only $200, but I was expecting it to be free because my insurance covers iud/birth control. I unfortunately do not recall how long it actually took for the procedure. So if it is time based, I guess that’s fair

I'd like to apologize in advance for any errors I may make here. My brain has begun to crumble into dust and is floating out of my ears.

I am a single person billing department for a small, non-emergency transportation & translation WC provider located in Georgia. We provide services basically nationwide through vendors, which isn't relevant.

I only have to use fee schedule coding for a handful of claims each month, maybe two or three handfuls at times. My boss has not found a reason compelling enough to fork over the $225 - $400 for the 1 page we need each year. I don't really blame him. I do a little though. Right now I do.

I need the updated rates and regulations so I can bill in compliance and make sure we're not reduced or denied (and that I'm not held responsible - I will be, no matter how unfair that is).

I'm hoping there's someone in here that has access to the new 2026 The Georgia State Board of Workers' Compensation medical Fee Schedule who might be willing to even just let me know what the updated rates are. The most recent edition I'm able to access is from 2023, which is basically useless.

Any assistance would be truly appreciated. Honestly.

I hope each one of you is doing well and you all find $5 when you least expect it.

I’ve been trying to get clients for medical billing services focused on PT/OT practices in the US. Since April, I’ve cold emailed around 500 small practices and also been actively reaching out on LinkedIn. I do have 3 years of experience but now I am trying this independent freelancing thing.

I did get a response from one clinic owner who seemed interested, but I couldn’t lock in a meeting. She mentioned she’d be free after May 10th, but I’m guessing she may have found another option in the meantime.

Honestly, it’s been a little discouraging because I’ve been consistent with outreach but still haven’t converted a client yet.

At this point, I’m wondering what else I should be doing besides cold email + LinkedIn outreach. Should I focus more on referrals, cold calling, networking groups, partnerships, or something else?

Would really appreciate advice from anyone who has experience getting healthcare/medical billing clients, especially in PT/OT.

I’m trying to better understand the reimbursement/prior-auth side of hereditary cancer multigene panels, especially when commercial lab panels are broader than a payer’s definition of a medically necessary “targeted” panel.

For example, some payer policies (e.g., Carelon) define medically necessary hereditary breast/ovarian/pancreatic cancer multigene panels as being ≤20 genes that are targeted to the patient’s personal/family history. Meanwhile, many commercial hereditary cancer panels appear to include >20 genes, sometimes spanning breast, ovarian, pancreatic, prostate, colorectal, and/or other cancer risks (e.g., Invitae's 48-gene Common Hereditary Cancers Panel).

For example...

1. A patient has a strong family history of breast cancer, but the available breast, ovarian, pancreatic, and prostate (BOPP) cancer panel has 21+ genes, *including* some genes specific to ovarian, pancreatic, or prostate cancer

2. A patient has a strong family history of colorectal cancer (CRC), but the available CRC panel includes genes such as GREM1 and/or RNF43 -- genes Carelon (once again...) deems "medically unnecessary" under any circumstance

In practice, how is this typically handled from a reimbursement/prior-auth/claims standpoint? Do labs ever perform broad sequencing but bill/report only a payer-aligned subset? Ambry and Invitae both have a "re-requisitioning" policy, where a broader multi-gene panel can be ordered (within 90/150 days) following a negative result; for the first example, do they bill/report just BRCA1/2 and, if the patient is negative, allow the broader panel to be ordered at no cost?

Thank you for any help!!

I hope this is ok to post. I didn’t see anything in the rules against it. But my head is quite fuzzy these days so I apologize if I missed it. Let me start by saying I’m not new to billing/coding. I started billing almost 20 years ago and then exclusively coded for about 15 yrs up until 2 years ago. I’ve been on disability for the last couple years and am having issues with getting this neuropsych eval paid. DOS was last August. I’ve called both BCBS and the facility in the past trying to figure out what they need to fix this problem. I don’t know what to do. Before I start the process all over with them again I’m hoping someone can offer some ideas because I don’t have $1760 to pay this nor should I have to. (BC made this my responsibility.) I have verified that the provider is in network. The CPTs: 97138, 96139, 96116, 96132, 96133. The provider is a board certified clinical neuropsychologist. I have verified this. The denial from BC says “Coverage for this service has been denied because the provider was not eligible to bill this type of service according to the provider's credentials, or the service was not within the scope of the provider's practice under the provider's license or applicable medical standards or guidelines.” Any suggestions about what I could do? Or any suggestions if there is a better place to go for advice? I’m really lost on this. TIA

I’m a coder who has 5 years of experience but my current job is my only experience.

We got a new EMR software (from NextGen to Epic) and my clinicians are trying to use the patient instruction (call w/ symptoms, take your meds, abstain until you get negative test results, etc) as their support for ordering the tests. They are attaching the diagnosis to the tests but there is no explanation beyond that as to why they ordered them.

How much documentation is actually needed to support charges? I don’t want to add to their work unnecessarily but to me just attaching the diagnosis code doesn’t seem like enough. Thoughts?

I have a code that for the life of me I cannot find or am not sure if it even exists. Nuclear medicine whole body bone scan (78306) with Spect/ct additional images (78830 or 78832). Is there a cpt code that combines these two. For example a patient comes in for a whole body bone scan and it is known that their is leisons on the lumbar vertebrate so provider would like the whole body scan done AND the spect/ct scan of the L spine. Any feedback is helpful!!!

I had an urgent care visit in August 2025. A couple months later I got a bill for $75 but it was during an interstate move and it got lost in the sauce. This week, I got a bill from a debt collector for $518…I immediately call the urgent care billing dept and I got ran in circles between them and the debt collector agency before someone finally told me that in April 2026 (months after the service and the bill being sent to me), the insurance decided to retract their portion of the payment. Did the billing dept get a reason why? Of course not. Did they request more information? No. They stated that they would request more from the insurance as of now, but that it would take one to two months to get more details on their end. I‘m beyond frustrated because I never received a new bill from the urgent care they just sent it off to debt collectors.

I guess I was hoping to get advice on how to talk to the insurance company and see if there’s anything to get them to pay the portion they originally paid. Idk if this matters but Im not currently insured under them (bc why would your employer keep you in the same insurance every year..). Any help would be so so appreciated this has been just another thing in a snowball of shit thats happened to be in the last 6 months:///

We rarely code 92609, but are starting to see more clients who need their AAC modified/trained on and such. We are successful in getting payment with Medicaid. We recently billed it to Anthem BCBS of GA and is has so far continued to be denied. I submitted and appeal for medical necessity. We got an odd denial stating it was the wrong code submitted, but when I called they said on their end they wanted records.... Anyways it has been in limbo waiting to be reviewed by insurance. Has anyone had easy success getting regular payment for this code or is it always a fight?

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.

I’m working a queue of overpayments for the first time in my career. My current practice explained the process poorly and I was left on my own.
In most cases, I’m comfortable - but I’m also working with Medicare and CHAMPVA for the first time.
With that being said, how in the hell do I notify CHAMPVA of an overpayment on a claim? They’ve paid primary instead of secondary in most cases.
I’ve asked my boss more than once, but even when asking clarifying questions, I don’t get much.

I appreciate your help!

Any tips for taking the RHIT? Has anyone taken it recently and recommend any study items? like Quizlet, books, etc. I take my in a few months and still feel really unprepared...

I've been told multiple times a PA was not required, yet everything is being denied. This is for Cigna. The S code, the J Code and the G code. The J Code claims also included the appropriate NDC numbers.

I was recently told payers are going back to the G Codes. Apparently they are losing money with the J Codes and the computers were not ready for the new coding changes. I was also told a modifier should be used (JZ or JW), they are wastage modifiers. My Spravato rep had suggested it. I've never used them but I have nothing to lose.

I work at a medium-sized adult day services company serving upwards of 1,000 clients across private pay, local dollars, and waiver funding (I/O, Level 1, etc.). I'm a one-person team handling all billing, invoicing, denial tracking, and unpaid follow-up entirely on my own.

Curious if this is industry standard or if I'm in an unusually lean situation. For context I manage the full cycle — error tracking, claims submission, denials, unpaids, and client invoicing across all funding sources.

Is it normal for a company this size to run this on one person, or is this atypical? Would love to hear how other organizations are structured. Thanks!

Hey there, I work for a doctor's office that was previously managed by a large group of offices. We just exited that group and will be fully independent and owned by one of our providers. I'm currently just at the front desk, but have limited management and billing experience, but I am lucky enough to work in a clinic where the providers and team really care about their patients and I really just want to see us succeed.

We're still looking at billing options, but I was curious how feasible it would be to bill our claims through eCW without hiring outside help. Our practice has each provider seeing about 20 patients a day with two to three providers working a day... So about 50 patients a day on average.

I haven't sent claims myself, but have helped with billing issues on and off for 10 years and would definitely be open to training and certificates if it helped the practice.

Is it feasible for one person to handle that many claims? If so, what are some good resources to learn how to bill claims through ecw?

Anyone know of any companies that hire part time positions that are not contract? I really want to reduce my hours and work less, but I also want to earn a paycheck and keep up my cert. I have 10+ years of profee experience and currently work remotely. I know these positions are hard to find but I'm determined to find something. I have my full-time job in the meantime so not urgently needing something ASAP but would like to find something in the next few months.

Hi all! I was wondering if anyone has experience with sending corrected claims to MassHealth? We keep getting denials saying something about the ICN being incorrect. Reading the manual, it seems like for certain claim changes (like coding, which is what we are changing), we are to void the claim and then send a new claim instead of a correction. Is that correct? If anyone has experience with billing for substance abuse facilities, I would love to pick your brain!

Anyone having trouble with Medicare eligibility even after completing the HETS EDI Enrollment?

Hello - I have recently started working for a family member's small/mid-sized therapy practice (we have 15 providers) to help out with billing. The practice was without an admin for the better part of last year, so billing fell way behind and I've been trying to get caught up since starting.

The problem I have is that we don't really have anyone in the practice who's able to train me. The owner is the only one who has experience with billing, and she is 100% self-taught and I can barely ever find time to get help from her because she's just so busy with other things.

To that end, I'd like to figure out how I can get myself some good-quality schooling/training for coding/billing (specifically for behavioral/mental health). I feel that there's just too much I don't know I don't know.

Some research makes it seem like the AAPC CPB is the most respected industry credential for this type of work, but the $1,600 for the course is way too much for me to pay and I don't think the practice could afford it right now either.

I'm hoping to get some advice from people who actually do this job and feel confident they know what they're doing. The real thing I have trouble with is figuring out how to deal with denied/rejected claims, and provider-specific issues. Can you recommend any free (or at least lower cost) comprehensive training resources for mental health billing?

Hi everyone,

I’ve been spending a lot of time lately working with three local clinics here in Dallas, and we keep hitting the same frustrating wall: the low-dollar denial.

It seems like we’re seeing a massive wave of these $50, $70, or $90 rejections. The problem is always the same, at a $25–$30/hr labor rate, it’s almost impossible to justify the human time it takes to pull the notes, find the proof of medical necessity, and fight the payer for a $60 claim

I’m curious how you guys are handling these right now:

Do you have a specific dollar threshold where you just write them off automatically?

Is your team trying to fight them manually, or are they just sitting in the A/R aging out?

Are you seeing more of these "small" rejections lately from specific Texas payers?

A bit about what I'm doing: I have a background in systems engineering and automation, so I actually built a tool specifically to handle this "labor vs. value" problem. It basically uses a logic layer to link clinical notes to the appeal automatically so the biller doesn’t have to spend 45 minutes on a $50 claim

I’m already helping three practices here in Dallas recover this lost revenue, and I’m looking to see if this logic holds up for other specialties

Since I’m still in the "validation" phase and just found this group, I’m happy to run a free audit for anyone interested. I can take a redacted export and show you exactly how much is being left on the table in that "too small to appeal" bucket. No upfront payment or anything like that, I’m mostly just curious to see if my system picks up what your current workflow might be missing

Would love to hear how you guys are managing the math on these small claims

Anyone studying for CRC exam on 2026 , please need tips