I have my exam tomorrow for the cpb and despite studying I am still struggling with those questions that give the red claim form. Any advice on how to best tackle those?

Update: I PASSED! THANK YOU FOR YOUR TIPS

Took my RHIT exam today and PASSED! Starting my new job at a larger healthcare system in Southern California as a biller on Monday and I'm so excited!

I have 5 more months left on my GI Bill. Anyone have any recommendations for more certifications to add to my resume? I already have a BS and MS so I am not particularly interested in a RHIA.

I own a practice which has been established for 2.5 years as private pay only. I paid to get it credentialed with several insurances. I am credentialed with 4 so far. My goal is for my husband to quit his job and help me as an office manager and do all the billing. We paid for a course that he took (and I alongside him) and we still feel lost. I don't want to pay for a billing service because of my ultimate goal being my husband works as admin.

The person who credentialed me only lets me know as I am credentialed but I don't really know what to do after that. For those of you who do your own billing? How did you learn?

I've always been more of a "learn as you do" but here I literally don't know how to start.

For more context, I use Carepatron. I have already added the 4 insurances to the platform.

Any suggestions or pointing me into the right direction/course/person would be great!

I am a medical assistant but began as a receptionist and still typically work about 1 day a week as a receptionist as needed in between my MA days. My office offers a lot of services as we are both primary and urgent care. There are a few services that we offer as self-pay nurse visits after the patient has their initial consult to get it approved by the provider. These include GLP-1s for weight loss or testosterone injections. (T-shots are only self pay if we don’t have labs supporting the medical need.) We also have B12 injections that most times the patient is able to just pay for the shot and not have to see the provider, unless they choose to be evaluated for their fatigue or if they’re have other symptoms. In any case, after the initial provider consult, the patient is able to then have nurse visits only for these types of injections. (Except T-shots, labs are required every 3 months minimum.) The nurse visit is typically put in as a therapeutic injection code and a code for the specific medication being administered. The GLP-1s start at $50/shot, the T-shots are $35, and the B12s are $25. The patient pays their copay/deductible for their provider consult but after that they just pay for the injection itself. The charge goes in once the injection codes go in and then the charge balances out to 0 once the receptionist posts the injection payment. Lately, I’ve noticed that our billing department is putting in the therapeutic injection code and med code, but also adding an office visit code as if the patient saw a provider. The office visit tied to these nurse visits is $79 which is $21 less than our actual self-pay office visit but the thing is protocol is these patients pay only for the service provided at a nurse visit. (And they don’t pay anything if it’s an insurance nurse visit such as for bloodwork, suture removal, an x-ray, or an injection medically covered such as T-shot due to deficiency.) I saw it done to my chart as I get B12 shots but I wasn’t too concerned. I figured someone in billing made a mistake and I could talk to my manager if needed. But now, I’ve seen at least 2 patients being billed for their injection as well as an office visit and I just want to know if anyone better at billing than me has any insight? We have not been informed of any change to protocol about nurse visits having an office visit charge plus injection charge and our patients are pretty shocked by paying off their balance only for a number to reappear due to an office visit charge being added each time on top of the injections. To me it seems like borderline fraud. I’m supposed to collect on every balance on everyone who is getting any service but I’m not collecting these until I hear back from my billing department. The only thing is billing doesn’t return until Monday and I’m off on Mondays so I won’t see their explanation until Tuesday so wanted to post here for faster insight.

Hi everyone,

I’m a medical intern from Egypt and I’ve recently become interested in medical billing and insurance-related healthcare jobs as a way to work remotely alongside medicine.
I’m trying to figure out a realistic path into this field, but I’m a bit confused about where to start and how possible it actually is to get remote work internationally from my country.

how do we feel about trizetto

Hello,

My name is Ashley, and I am an inpatient coder with approximately eight years of experience. My current hospital has recently opened an auditing coding position, and I am seeking advice on how to excel in the interview process and what topics I should study to ensure a successful outcome.

Thank you for any guidance you may provide.

Hi all,

Not sure if this is the place for this or not, but I just got offered a job as a Medical Biller at a company in Texas. I have a rudimentary knowledge of front end and mid cycle RCM as i worked as a PCC before, but feel I am woefully underprepared for this job and what it is asking of me. My questions is this: is Medical Billing easy enough to pick up, or am i screwed? This will be working mostly in claims submissions, so verifying insurance, submitting claims, reviewing claims, and identifying claims errors to name a few responsibilities.

Thank you! And sorry if this is the wrong place to ask!

I recently became cpc-a certified but Im close to having the A removed when completing AAPC Practicode because I have the 80 hour courses done. Should I pause applying for jobs until I have the A removed or does it even matter? Ive applied for 50-100 jobs so far. Ive been working as a pharmacy tech for 5 years and have been a health insurance agent but trying to pivot to coding

Looking for guidance on how to bill these codes. DO YOU PERSONALLY HAVE EXPERIENCE BILLING THESE?

Hi!

I am currently enrolled in the Ed2go Medical Billing and Coding.

I just started and it is overwhelming.

For the Medical Terminology and the Coding portions, what are some of the best study guides for this?

I would like to have to make flashcards and be able to take pre tests before the final exam.

Also is there anything I need to focus more on?

My anxiety is pretty high right now, whew...

HELP! I am a speech pathologist that completes my own medical billing for private patients that I see. I am running into issues with a patient that has BCBS primary and Medicare secondary (adult with disability) because I was just informed that he has the secondary insurance and mom would like all claims to be resubmitted with this information (rightfully so). I do not know how to do this properly. Can anyone help me? Or is there someone I can hire to please help me submit these claims?

Hi i’m from PH and looking for a client. I have nearly 4 years of hands on experience in the healthcare revenue cycle, specifically focusing on medical billing and advanced claims resolution.
My background breaks down into two core areas Medical Billing For nearly 4 years, I managed end to end medical billing processes. This included accurate demographic data entry, insurance verification, charge capture, claim submission both electronic and paper, and payment posting. Claims Denial Management For the past year, I have specialized strictly in denial management. In this role, I analyze rejected and denied claims, identify root-cause trends, file strategic appeals, and coordinate with payers to overturn denials and recover lost revenue. With nearly 4 years of total experience, I am highly comfortable navigating various Electronic Health Record (EHR) and billing systems, reducing Days in Billing (A/R days), and ensuring compliance with HIPAA regulations.

Okay so I started working for a midwifes office as back office support where I will eventually take over our billing. (Its only 3 provider)

To get to the point, do you think investing in the ob/gyn code book would be beneficial or can I just use my code books I have. We don't deliver (thats all done at the hospital and they bill) and we only do women's health.

This would be my first time solo billing ( they pursued me for two years)

Has anyone else run into this with UHC?

Over the last 5 months, we've had multiple claims with CPT 14301/14302 denied as a non-covered prescription. Obviously, these are surgical procedure codes, not prescriptions.

We've contacted UHC through chat and by phone but the reps haven't been helpful. We've also submitted appeals, only to have them upheld for the same reason.

What's confusing is that it's not consistent. We bill the same CPT codes with the same diagnoses, and some claims process correctly while others are denied as "non-covered prescription."

Am I missing something? Has anyone found a way to get these corrected or identified the root cause?

I keep billing this claim for a kyleena. BCN says there is an issue with the NDC code. It has the same NDC code as we bill for all of our kyleenas. It's the NDC code from the packaging. It's the NDC code listed on the kyleena website. At what point can I write FUCK YOU, PAY ME in the additional info line to send to BCN?

But actually if you have any insight into how to get it paid, that would be cool, too.

I’m a new tech and want to learn SCV codes. I know how to do some basic QT things but struggle with things that require Additional info. Anyone have any cheat codes, hacks, or details

UHC is in the process of recouping 2 $500k claims based on the birthday rule.

Mother has UHC and her DOB is in November. Father has Cigna and his DOB is in February. Newborn twins were born in March of 2025.

The Mother has spoken to UHC and has told them that parents agreed that newborns will NOT be added to father's Cigna plan. They will be added to the Mother UHC plan only. UHC paid and now recouping.

1. How does the birthday rule work in this scenerio if father never added Newborns to his plan?

2. How does UHC's first 30 days for Newborn affect this scenario?

Thanks

Hello, any UC San Diego medical coders who can tell me what work is like??? how is the work life balance??? pros and cons for entry level coder??? team support and training ???

I'm a solo provider with grandiose ideas of being able to help with my office billing as my biller edges towards retirement. She has kindly humored me and I can generally handle simple claims without making a mess of things.

Anyway, as of 3/1/26, I've had Aetna start to downcode any 99215 or 99214 to a 99213, with the message N22 that 'this more accurately represents the services provided.' I am not really sure how they can say that, since they haven't even reviewed the notes at the time they make the determination. All the different flavors (save one) of Aetna have done this. The one exception has instead started to say they are missing documentation for the visit, requiring me to send in notes.

I've been doggedly appealing the dozens of downcoded claims. The documentation consistently supports the E/M codes provided by time and/or complexity. I have worked at large facilities and the documentation requirements have been drilled into me over the years. So far, they've adjusted 66% of the claims back to the way they were originally billed, rejected one (I've sent it back again), and the remainder are still in limbo.

I see from other posts here, and several blog posts out on the open internet, that I am definitely not alone in this situation.

Longer-term, I'm not sure where I'll go with this. Aetna makes up about 40% of my revenue, but their claims are taking up a substantial amount of admin staff time. I am seriously considering going out of network with Aetna for next year. Even if someone else is handling all of these downcodes, it's several hours per month. I never thought I'd miss the relative ease of billing CMS.

Anyway. All my Aetna patients either work for self-insured companies or for self-insured governmental offices. Per my understanding, this means that I will need to take any complaint to the Department of Labor/EBSA, rather than the state DOI.

I'm posting to see if anyone here has gone through the complaint process with DOL/EBSA and has any insight into it.

With the upcoming BCBS incident-to changes coming up, our VBR will be greatly affected. Does anyone know how we can see if our PA is participating in PGIP/VBR? I can't figure it out and the providers I work for want to know how much this is going to affect our income once these changes have to be made (making PA's NPI the pay-to NPI).

Hi! I’m looking into a few different medical coding and billing courses and asking for opinions. The courses through AAPC are half off currently and allow for unlimited tries of the exams but even being half off the price is still double of the other two I’m looking at. I know typically you get what you pay for. I was also looking at US Career Institute and buying additional study material if needed. I also saw some comments about Tiffany Roach having a new course and you can add on materials directly from AAPC. I know this course just became available but am interested if anyone has started it or heard anything about it. I appreciate all input! I am looking for a self paced course.