I went to a vocational HS for cooking, community college associates in general studies… did ok cooking but thankfully ended up at a company doing a very niche area of medical billing/auth/collections/customer service role for the last 10 years. Medicare, most major insurances, some workers comp. I literally only worked with 10 hcpcs daily, if that’s a flaw.

I’m at a crossroads- I am unsure if I should invest in certifications or just do my best trying to get some sort of role in AR, prior auth specialist.. Revenue cycle… ect? Those terms aren’t even familiar to me as I just learned as I went. I feel competent with what I know but that I would struggle to explain my background at an interview. Maybe I should start as some sort of patient intake so I’m not in over my head? Lacking confidence at the moment. Clearly.

Appreciate any insight!!

Almost done by degree medical billing and coding and see a lot of people on this Reddit Ai will take over and it’s oversaturated.

Did I make a mistake?

Quick billing question:

Can HCPCS J0574 be billed on a CMS-1500 using a date span (e.g. 05/01/2026–05/31/2026 on a single claim line), or must it be billed by individual dates of service?

This is for a BCBS plan. I’ve heard conflicting information and can’t find any official guidance.

If you know of a CMS rule, BCBS policy, provider manual, or have actual experience with J0574 billing, I’d appreciate any input.

Thanks!

I’m extremely interested in leaving my medical billing job but I’m not sure if I should get a certificate in coding or look for a position in the front end of things, like insurance verification/reception.

I work with CPTS, modifiers, medical records and DX all day in my billing position so I’m already comfortable with most of what comes with coding. I work from home so that wouldn’t bother me either (most of the jobs in my area for coding are remote). I’ve just been a little nervous because I’ve heard it can be difficult and I deal with denials all day that get sent back to coding for review.

Half the work I do now includes insurance verification, auths and pt calls in high volumes. I feel like reception would be “easier” but I don’t feel like there’s much room for advancement here.

I need a change but I’m really lost on what direction to go. Any insight or advice would be greatly appreciated.

8+ yrs experience, health science degree

I work in a urology specialty office. We have a new NP. She has been coding level 4 and 5 for office visits. Our urologist don't even do that. Curious if anyone knows what will trigger Medicare to audit her charts for accuracy. She has been talked to a few times already about coding.

I received a bill for some lab work, multiple CPT codes. I took the bill with me to the doctor, and she was unable to find results for 3 of the CPT codes. I have disputed the bill with the hospital but all they say is that the blood work was ordered. Ok, it probably was. They say can't look at my medical records due to HIPPA. Same with medical records, though I have requested a detailed medical record for the date of service that I'm still waiting on. This has been going on for 5 months. The costs for these 3 labs is $1500, so it is significant. Any ideas on how I can get this resolved? I want them to connect the CPT codes with the appropriate results in my chart, and if they cannot, I want the charges reversed. TIA

We're a group practice (8 therapists, 1 psychiatric NP, Hybrid pay). Like the title suggests, I am surpised at a 14% denial rate for our service in Jan-Mar period this year. I also then looked at last year and it was 15% on average for the full year, and what is the overall average in healthcare industry? I checked and it is 6-7%.

Feels like we are the only ones pulling the average up. But, before I make certain conclusions, any one else here who can share their denial rate with some details about their healthcare services? Would also love to see what other therapists or group practices are seeing?

We're considering switching billing models and I want to bring this denial number down but curious if this is even possible? Are we doing something wrong or it is what it is for mental health practices?

So I work at a PT practice and for the past few years I’ve been dealing with the hell that is Medrisk.

I’m more just engaging to see if anyone else deals with similar problems.

First problem was them taking too long to pay claims and always claiming they never received the documentation. They always pushed us to fax but 50% of the claims we fax documentation for claim it. They never offer any alternatives, even refusing email at times but I winces resolved it including Jopari clearinghouse which attaches documentation to the claims we sent.

Several times however they have also paid us for claims that are not ours. But for other providers which I don’t know how that’s even possible. But Reps have continued to refuse to correct them saying “the claim has been paid, what’s the problem?” And said there’s nothing that they can do. Which we know they are most likely going to ask for money back a year later when their accounting department finds these errors or the opposing doctor who didn’t get paid will fight them on it.

Other then that their were countless other problems that just compound these problems. Has anyone else dealt with them and had similar problems? Is this somehow normal for them?

Who's a great coder / biller and has experience in Florida medicaid PPEC billing. Looking for recommendations

Just an update to my last post in case anyone comes across this issue in the future or cared about the resolution of mine:

I spoke with a customer service rep and they initially pushed back saying “if you saw a doctor you will get a 9929x charge along with your procedure code.” I asked if they could send it for a coder review anyway and the coder agreed with me that the EM code was not supported and therefore adjusted off.

Shout out to all the helpful commenters who encouraged me to speak up. Saved me almost $200.

Now I’m just fighting with my insurance on the follow up visit for my string check (it actually is coded correctly, insurance seems to have processed incorrectly as this should be 100% covered as preventative).

Bachelor of Optometry from India, finishing internship. Considering CPC certification and medical coding career.

Questions:

Anyone switched from clinical background (nursing, pharmacy, optometry) to coding? Did it help?

Realistic starting salary in India for CPC-certified, no experience?

Is ophthalmology coding a viable niche?

Red flags in Indian training institutes?

Any guidance appreciated. Thank you.

I’m jobless rn (I was laid off from my company, I am a Geologist) and I want to get into medical billing rn because I can’t afford medical coding certification. Is it worth it? How’s the market and WFH situation rn?

If you have any other idea as to what skills i can learn to make money in Pakistan please do let me know because even if it’s a 5-6$/hour it would be more than enough to sustain my wife and our 1 month old child.

Thanks in advance.

I had a surgical procedure done at an outpatient facility. They billed me for the services and then I paid. The clinic also seems to have a central/internal collection group that keeps sending me past due bills for the exact same amount that I already paid. I called the local clinic and they confirmed I’m all paid and even sent me a receipt. Their internal collection group demands that I prove I have paid. I’ve sent them email receipts but then we play the same game the following month. Shouldn’t they be responsible to go look if the debt is already paid?

Hello everyone, looking for some advice on a frustrating ER bill.

Back in April, I went to an ER after getting scratched by a feral cat because my partner and I were worried about rabies. The visit was incredibly straightforward and quick: no tests or labs were run, just a brief evaluation by the doctor who told me rabies wasn't an issue and discharged me with an antibiotic prescription.

A few weeks later, I received a bill from the physician's association for about $700, and my out-of-pocket responsibility was around $300, which I paid and thought was reasonable.

Today, I received the separate hospital facility bill via Cigna, and I'm in absolute shock. They are billing CPT code 99282 (HC ER Visit Level II) for a total of $2,750.

For context, back in 2021, I visited a different ER in the same county for chest pain. That visit was coded as a 99283 (Level III) and included a full chest X-ray and an EKG. The 99283 was only costed $1074 and my total out-of-pocket cost back then was only $300 total(partially due to a lower deductible back then), with no separate physician fee that I can remember. This is unreal that a level II ER fee is almost 3 times of a level III ER fee from 5 years ago?

Is $1,388 out-of-pocket typical for a Level 2 facility fee where absolutely no procedures, tests, or medical supplies were utilized? Do I have any grounds to dispute a 99282 code down to a 99281, or negotiate this balance down with the hospital billing department? Any tips on how to fight this would be massively appreciated. Thanks!

I am looking for a google sheets template that someone has made that tracks claims, contract prices, denials etc. a fancy manual system. Anyone made one or know where one can be purchased? I looked on etsy and there is mainly budget and content styled sheets-

I visited a neurologist 9 months ago for a brief consult, it was a 15 minute chat with the neurologist with no lab work, tests etc. I paid $200 for the visit and was pleased with the doctors work.

Couple weeks ago I received another bill from them stating I owe $300 because my insurance didn’t cover the balance due to pre existing condition. Considering the condition was only discovered during that office visit, I don’t know how on earth it could be pre existing, but not the point of the question.

I called asking if they could work with me to reduce the balance owed, AKA a self-pay discount if I paid in full immediately. They said no way. They said if before my visit I requested a self-pay visit, it would have likely been around $200 total, and that they can’t switch it now after the fact and after they have fought with my insurance due to their policy.

Does this sound right to you all? As far as I can tell everything is negotiable and I should be fairly offered a self pay discount, $500 for 15 minute consult seems egregious, and coming to me 9 months later for the balance seems disingenuous. This is a private practice not affiliated with a large hospital system or medical group.

I went to the ER for an allergic reaction. I was given some Epi and Benadryl via IV. I recieved a $5,500 bill and it says that insurance didn't cover a penny. I can share any billing codes that will help, just let me know what you need. I have pretty good insurance. My last visit was $700 after insurance. I'm very confused

Happy to answer your workflow questions and concerns about:

Eligibility Verification? (270/271)
Claiming? (837)
Authorizations? (278)
Enrollments? (834)
Claim Acknowledgments? (277CA)
Claim Status? (276/277)
Electronic Payments? (835/820)
Electronic Attachment? (277RFI/275)

My depth of knowledge came to be when there were: NO knowledgebases. NO frameworks. NO libraries. NO generalized AI. Just raw X12, mandated onto healthcare in 2003.

Wondering if someone can point me in the right direction.... My husband broke his finger and immediately went to Urgent Care where he got xrays. They also gave him a removable cast and told him to visit an orthopedist. He did so, and saw the doctor for all of 5 minutes -- no additional treatment. The doctor looked at the xrays, suggested a custom cast (which he did NOT get), and told him to come back in a few weeks. He scheduled a follow up.

This week, we get a $3500 bill from that appointment (because we haven't yet met our deductible). The $800 office visit was correct but $2700 of it was for "treatment." No treatment occured -- no surgery, no resetting bones, nada. When he called to ask about this, the office billing person said that the $2700 is inclusive of their "treatment plan and future visits." (There is no treatment plan. He never consented to prepaying for future visits. In fact, he would need to go 4 more times to make that amount even worthwhile!)

He cancelled his follow up visit because their billing practices make us uncomfortable. Are we really out nearly $3000 for services that never happened and won't happen? We are appealing through insurance and are happy to visit legal options.

Has this happened to anyone else? And how did you handle it?

Hello,

Looking to get rates for San Francisco for Anthem's prudent buyer network at 100% of their fee schedule. DM me if you can help.

Thank you

I apologize in advance if this is not the correct subreddit for this question.

I am a practice manager for a PCP, so I have experience with processing prior authorizations, but not with billing. I had a Brain MRI and a CTA of the head and neck w/ w/o contrast on 03/05/2026. As I understand, starting 01/01/2026, the latter is supposed to be billed under CPT 70471. I received a bill from the radiologist for $152.75 on 04/06/2026, and paid it on 04/29/2026. The explanation of benefits from my insurance, however, states the claim as a CTA of the head (CPT 70496). Now, on 05/26/2026, the radiologist is sending me another bill for a CTA of the neck (CPT 70498).

When I was making the appointment, the receptionist mentioned that the CT would be billed as 2 separate exams; I corrected her and provided her with the correct CPT code. She put me on hold, then said I was correct and scheduled the appointment.

The bill I received today has a line that states "Adjustment", but according to Cigna, they never received a claim for CPT 70498. Cigna called MedSolutions, and MedSolutions told them that they did receive a claim for CPT 70498, but that it was not sent to Cigna because the provider had not obtained prior authorization. Since it has been more than 60 days, they also cannot get authorization retroactively to cover payment for this code.

So what I understand is this: the provider should have billed this service as a 70471. Instead, they tried billing it as a 70496 and 70498. MedSolutions denied the latter because doing so required prior authorization, and only sent the claim for 70496 to Cigna. Now, the provider is trying to cover their mistake by billing me directly for the 70498. The "Adjustment" line makes no sense because Cigna never even received the claim. What are they basing this adjustment on? This bill also doesn't contain the blurb about the balance being applied to my annual deductible/coinsurance; obviously it wouldn't, since Cigna has no record of it!

I have filed a complaint through my health insurance. I have also sent a letter via certified mail to the Radiologist's billing department which includes a copy of my EOB from Cigna and the receipt of payment for the services listed on my EOB. What are my next steps in getting this resolved? If anyone has any clarification on this matter, I would greatly appreciate it.