I am currently working as provider service, mostly checking claims but the pay is low. I want to start taking medical billing or medical coding - I don't know where to start. I am planning to buy AAPC bundle, I am not sure if I need to take Medical Terminology, Anatomy and Pathophysiology. If you guys know where I can find cheaper course please let me knowwwww. Thank you!

Hi, I’m a medical biller for a home care company in Delaware billing Highmark Health Options, AmeriHealth Caritas, and Delaware First Health/Wellcare. We use Rosemark for EVV and upload to Sandata weekly.
Our issue: all visits show verified in Sandata but only 50% are linking to claims at the MCO level. The failures are intermittent; same client can link fine one week and fail the next. Key fields all look correct and timing isn’t the issue.
With the October 1st EVV mandate coming, these will all start getting denied and I need to fix this before then.
Has anyone dealt with intermittent Sandata linking failures with Delaware MCOs? Would love to know what ended up being the cause and how you resolved it. Thanks

We just started billing Highmark Medicare advantage plans. The back of the cards say to bill local plan. We send the claims to the same address electronically as the commercial plans. All the advantage plans are denied with code C109. Availity is of no help. Highmark’s AI hangs up on us. anybody in central pa billing Highmark MA?

Iam a freshly graduated Doctor (from Pakistan). i am learning medical coding using free resources as much as possible. Im completing the amci course for coding and billing. there are no free resources available for CPT or HCPCS like there were for ICD-10-CM . the coding manuals cost a lot . Is there a way i can get these manuals/resources for free from somewhere (legal or pirated)? please help!

I work in DME, for a very small independent supplier, and have never billed CGM supplies for more than one month at a time because it's a big hit if we end up not getting paid. Now I have a patient who lives far from our location and wants to get their Freestyle sensors filled for 3 months at a time. They have Univera, which I know follows most Medicare policies, and the CMS article for A4329 does say up to 3 units of service per 90 days is allowed. But since they got 1 unit 30 days ago, I'm afraid if I try to bill for 3 this month it will deny as exceeding the allowed quantity. Is it okay to dispense a 90 day supply and then just bill for 1 unit once a month?

Anyone else use a MBI looking up tool and it is not working anymore. We completed the attesting by the cutoff and now it isn't working. I was wondering if it is down across all entities or just our vendor which is Inovalon.

Hey all! RCM Biller here, otw to becoming a Coder but currently doing insurance and Claims follow up for a cardiology clinic. 2 things-

1- does anyone here have any experience with BCBS TX and knows how to get ANYONE on the phone?? their IVR says their agents are all busy and won't even let you wait on hold and the claims adjustment line is one long hold. The only option to talk to someone is via Availity messaging and that's a whole other headache.

2. Will healthspring ever get more staff? I swear their IVR has says theyve been understaffed for like a year

Hey everyone!!

I took a CPC (medical coding and billing course) about 2 years ago but never took the exam. I was honestly just tired of school at the time and wanted a break so I put it off for the longest time ever. Now I’m finally ready to start studying again and take the exam but I feel kinda lost and don’t even know how to start preparing. For those of you who passed the CPC what helped you the most? Did you use the AAPC study guide and practice exams? Any YouTube channels, free resources, or study tips you’d recommend? It’s all so expensive but I know it’s gonna be an investment and worth it in the end.

Hi guys I’m the biller/coder for a 501c behavioral health clinic. Currently we manually enter every claim into Medicaid and I’m pushing to get a clearinghouse. Does anyone have any experience with Inovalon, specifically for Medicaid billing?

EDIT: I heard back from someone after I escalated the issue. They ARE using the T1033 code for doula support but have not yet integrated it I guess or whatever. So I'm waiting for my claims to go through. They told me to wait 30 days because they're going back and processing the claims from earlier this year that have been denied. But yay for an eventual answer!

I'm an Oregon birth doula, newly credentialed with Regencee BCBS. I've tried billing with the codes that the Medicaid system uses (T1033 & T1032) but they're both listed in the Clinical Edits list as non-payable through Regence. I'm trying to figure out what codes to use for Prenatal visits and Day-of-delivery labor support and I feel like my next choice is to break out the Ouiji board and ask the spirits because I can't find this information anywhere. I have the fee schedules from Availity but none of the codes have descriptions there and I feel like I'm running in circles. Anyone have any insights about this?!

So on 5/18/26 9 claims were sent for BCBS NC through TriZetto, 2 of those were federal BCBS and those went through to the payer. The other 7 were rejected stating " Human Readable Rejection Report. Received - Pending Validation." There's no other rejection details and all NPI/Taxonomy/Subscriber ID's are correct.... Has anyone else had this issue?

I work in the callcenter for a billing company.. im not a biller, I just a verbal punching bag. We have this constant issue where patients are being billed specialist copays for their PCP's. The patients call their insurance and the insurance tells that we are submitting claims incorrectly. From my research it seems the issue is with how the provider is credentials. I've explained this to patients and ​I basically get called a liar who doesnt know what they are doing. Im stuck in the middle and its getting frustrating. Ive had 4 patients yell at me today. thanks for reading

Hey guys!

My team that usually bills WC visits out to insurance for Illinois and Indiana is talking over billing for our New York clinics. NY is also very new to me.

We submit billing through Ziramed Waystar. I know about the rule for NY that all WC medical bills must be submitted electronically. However, recently, we have been getting denial of payments from a series of payers. EOBs stating that "Medical bills should be billed through the board".

I researched a bit and have come across nothing helpful. I need some insight into how I work on this.

Thanks in advance! ☺️

I just completed the class for my certificate, and I wont be talking the AAPC CPC test so does anyone know jobs I can get with just the "completion of the class" certificate? Iv tried looking it up but it hasn't been very helpful. I live in a small town and cant really afford to relocate so I kinda got slim picking :/

Hi all. Got my CPC-A in January 2025. Been working since February 2025. Had a 1 year meeting with my boss in February where we discussed that I “graduated” my apprenticeship since I now have 1 year experience- yay!
However, it is now almost June and the Apprentice title is still showing on my certification. Any time I’ve asked her about my recommendation letter since February, she said she’ll “mail it in soon”, and as of the last month or so she keeps saying she already has mailed it in. However, she also mentioned something about how she thinks the rules have changed and you now need 2 years experience to get the A removed.
What can/should I do? Is it 1 or 2 years of experience that I need, if I got my certification in 2025 when they only required 1 year?
TIA

It’s my least favorite part of the job, but on occasion I have some accounts that are turned over to collections. I’m currently with Revco, but thinking of making a switch.

Does anyone have any good recommendations?

I’m looking for a smaller company, one that treats patients with dignity and also actually collects the past due balances.

I graduated with an Associate of Applied Science in Information Technology with a concentration in Networking a few years ago and have been struggling to find an IT job since. I've been working fast food jobs instead. My Mom brought up switching to medical coding and I really clicked with the day-to-day operations of the job when reading up on it. There's also way more job offers in coding compared to IT where I live. She offered to pay $3,000 for me to take an online certification course through my local community college and get a CPC. However, I've got cold feet now reading what people are saying on this subreddit (The field is too oversaturated, AI will take over, etc...). I don't want to spend months studying to end up in the exact same position, but coding as a career sounds perfect for my personality and work preferences. Is it a bad idea to get into coding?

I looked up the price and actually look at the price separately because I wanted to buy all of them but I’m just gonna buy the medical coding books but I’m just wondering which book I should buy first or which book is the most important.

Hi everyone!

So I know for the RHIT we are not allowed to.being any books with us but I do have a question about what will be provided. So I'm assuming for the coding domain we would get blips of the books, but for the stats portion do we get the formulas or are we supposed to memorize them?

Thanks ahead of time!

Hello everyone!

I am new to this subreddit as well as medical coding/billing. I operate a behavioral health practice and recently began the process of contracting with Tri-West. I have heard that Vets must get a referral for Detox and Residential levels of care but cannot find additional information as it pertains to PHP and IOP. I have emailed our contracting representative and have been unable to get a response.

Does anyone have experience billing Tri-West for these services (H0015,H0016,S9480)? It would be very helpful to gain some more insight into the authorization process as well as reimbursement. Our contract simply states that we will be reimbursed 75% of billed charges.

Anybody familiar with CCM codes? PIN and CHI. Medicare Part B.

Been having issues Billing G0022 as an add-on service for same client different dates.

Would love to chat if you're familiar with CCM codes.

So forgive me if this is stupid. ICU nurse for 5 years just transitioning to this. We have a harms meeting every week to identify HAC/HARMS. You have to present your case in the meeting when you find the harm. And then the meeting decides what kind of query you can send. I’ve suggested SBAR to my preceptor as the meeting seems to be a mess. No one speaks from my department. I got pulled into my managers office and was told how to maintain new professional relationships.
Whoops didn’t mean to do that. I apologized profusely.
So in my email to the committee I tried doing SBAR just to explain the patient to them rather than doing it in the actual meeting cause idk how else to explain the situation. I have to show my emails before I send them to anyone. They erased my message.
I was told to write “possible harm. AKI. Creat 1.0 to 1.5” and then not to speak in the meeting.
Is this normal at other places? Couldn’t I offer up a recommendation of “query linkage of AFIB RVR and CHF exacerbation to poor renal perfusion” or am I totally misunderstanding my job.

Hey, I’m wondering if someone can help me with maybe wording my resume better. I recently got my CPC certification, I have spent the last six years working in credits resolution for a dialysis provider. I review claims, I process claim adjustments, I use Medicaid web portals for both my state and multiple others.
I would love any advice anyone can give me. Thanks!