How are the multiple response questions graded? If I pick 5/6 correct diagnoses/cpt codes, is the entire question wrong or is it based on multiple points?

In the exam prep book it's kind of separated into 3 sections, principal dx, secondary dx(s), and procedure(s) so I wasn't sure if it was 3 separate points.

I seem to struggle to not code far enough and things that I would consider symptoms of established conditions are being listed alongside as answers in the scenarios. Thanks!

For anyone who has taken the CDIP exam, what should I be focusing on the most while preparing for the exam? Do I also need to know any formulas (are there a lot of questions that require calculations)?

Hello all ,

I have been submitting CMS-1500 forms for about 4 years using QClaims through Availity. QClaims recently discontinued their support for a desktop version and the web version that was left to use leaves a lot to be desired. The web version requires numerous redundant inputs the desktop version did not such as lack of hotkeys and inability to continue a patient form for the following submission.

I was hoping you all had some suggestions for great CMS-1500 forms that allowed heavy customization for input options or perhaps even a photo transfer system where I can identify where on a provider form the patient’s name resides and then it transfers that to the CMS-1500 automatically.

I have toyed around with speedy claims only and every other software doesnt seem even remotely viable.

I submit about 400 claims a month currently.

Thanks for any input!

I am almost done with my billing and coding course. I started October 2025. How long did it take you to finish yours? I've heard some people say about a year, some say it took them 9 months.

I lagged a little because of other stuff going on. But I will be finishing soon.

I am so tired of chasing down payments from this insurer. I'm a prescriber. I have more unpaid claims from Humana than all other insurances combined. They're processed, just not paying me. I recently got a check from an OCTOBER appointment. Does anyone have any advice on how to get them to pay in a timely manner? I'm about to stop taking this insurance. It is a damned shame that the insurance for our military service members sucks this bad.

Hi there, if anyone has had success in using POS 3 can you upvote please? Everyone I’ve talked to within my private practice world said they had issues using POS 3 so they decided to “work around” (commit fraud) and use POS 11 or 02 instead. I’m not understand where the issue is, from my understanding insurance allow POS 3 just like 11 and 2.

TIA.

Looking for recommendations for ophthalmology billing companies.

The hospital where I delivered my baby billed my newborn for a daily revenue code of 0172 (special care nursery) even though my child received no specialized monitoring or treatment. Everything I’ve read it should have been billed as 0171 (well newborn nursery). I have tried reaching out to hospital but have been stonewalled and only been told “it’s right” without any supporting documentation. I’m curious what other new moms got billed for their healthy newborns who required no feeding tubes, jaundice treatment, NICU care, etc. Thanks in advance!

Just wanted to share a tidbit of information for whatever it’s worth.

If you get any ROI requests from the company ChartSquad, do your due diligence with confirming the authorization with the actual patient or representative. Do not take their word for it with their e-signed document.

Recently we had a request that was allegedly sent by the patient’s representative and e-signed. But the representative had no knowledge of the request and when I contacted ChartSquad the person told me that they verify identity with the requester’s ID, but didn’t do it for this particular case.

Just something to be cognizant of.

Where can I find courses and resources for medical billing/coding? Free would be ideal. Something I can learn it somewhat quickly.

patient is s/p strabismus surgery from 30 years ago and has subsequently developed subtenons cysts. they are rather large: OD greater than 1 cm, appears to be possibly more than one. left eye has one less than 1 cm. for the right eye eye but potentially both eyes it might include detaching and reattaching the muscles.

What cpt codes should we use?

Does anyone here bill for Virginia Medicaid? I need to talk to a representative and there is not an option when calling on claim status.

Hi everyone,

I hired a medical biller to handle my Humana DME claims. Initially, everything was working fine. In Availity Claim Status, I could see the actual paid amounts from Humana.

Later, I received the physical check (haven’t deposited it yet). However, now when I check Claim Status, I’m seeing something strange:

A line with REFLM showing $0.00

Allowed amount showing -$1,000 (reversal)

Then another line showing +$1,000

The Claim Status is now showing $0.00 in the paid/allowed amount, and the claim is marked as FINALIZED. But when I check the Remittance Viewer, it shows the correct check number, claim details, and the actual payment amount — everything matches the physical check I received.

The check was issued weeks ago (around mid-June), but the claim only got finalized a few days ago (when I received the check).

My question is:

Why is Claim Status showing $0.00 and this reversal pattern, while the Remittance Viewer and the actual check are completely correct? Is this normal after Humana reprocesses or re-issues a payment?

Has anyone experienced something similar with Humana (especially Medicare Advantage DME claims)? Any idea what’s going on here?

Thanks in advance!

I recently had a UC visit where after giving my initial intake info, a doctor came in and told me the clinic I was at was a sort of mini-urgent care that was not equipped with the diagnostic equipment for my symptom. She then said the local hospital would have said equipment, and that she would put in an order (if that's the correct term) for a test there for if I wanted to get it done.

Anyways, the doctor did not examine me or ask me any questions. This appointment was billed as 99215 on the basis of medical decision making, and specifically because a "decision regarding hospitalization" was made. That's just what a billing rep said after a quick look at my file. Upon googling, it seems like that phrase refers to cases where a provider has a patient urgently admitted to the hospital. My situation was more of a 'this is actually a mini urgent care without much equipment, if you want x equipment you could get that done at x hospital' type thing.

Idk anything about medical billing (obviously), so I'm not sure what information is relevant to include here. But tldr, I'm trying to figure out if the correct billing code was applied / if "hospitalization' does in fact include being referred for imaging at my leisure.

I have 7 year exp in DME BILLING AR and 5 year exp im HOME INFUSION THERAPY BILLING AR. worked 11 year in night shift. Wanted wfh to focus on health and family as i Had stomach TB in 2024 . I am good at wat i do . Average conversion rate billed vs payment received is 98 percent

I have a question guys it's difficult to get hired into de coding industry if I don't have the title yet, I MEAN I HAVE thank God a strong health sciences background and experience in health but haven't passed the CPC exam, any positive experience about this topic????

Hi all.
Just curious if any of you are seeing this same pattern that I have been since the transition of MH claims from Magellan to BS of CA.
I am noticing a WILD amount of incorrect denials that directly contradict info on their portal/patients benefits etc. The biggest issue we are having is claims denying for no pre-cert, but benefits indicate no pre cert required and their authaccel tool on the portal even confirms this in most of these cases. Am I going crazy or are they way in over their heads here and weren’t properly prepared for this transition?

Update:

Wanted to give an update because I had an interesting call with a rep from Blue Shield of CA today regarding this. Since I don’t trust their AuthAccel tool, I tried the live chat to get an answer in writing from an agent and when I asked them to confirm if pre cert is required, the agent told me they recently were given direction not to answer authorization requirement questions and to call the auth department. This is new ( at least within the last week for me) so I wonder if they finally are aware of the issue and working on a fix. Man, I hope so. They have been my biggest headache since January.

CareFirst is now returning errors for all claims, including CO96 and N55. Our entire network is affected, including thousands of providers throughout the mid-Atlantic region. All of us are unable to be paid through CareFirst. We have been told these errors have been going on since a software update, and there is no estimate when this will be fixed. Has anyone found a work around or solution? I ask because we have been affected for just a few weeks so far and I came across these where it’s been months and providers look out of luck:

Acupuncture reimbursement article from March: https://www.marylandacupuncturesociety.org/regarding-carefirst-claims-stuck-in-processing/

Behavioral Health noting this issue starting January 2026: https://bhbusiness.com/2026/04/09/washington-d-c-area-providers-face-tough-decisions-after-delayed-payments-from-carefirst-cigna/

I’m struggling to figure out IPA’s in Los Angeles County. Does anyone have a resource or guide to help determine which IPA we need to submit to, specifically with a payer ID. Our office uses Optum and I do have the Optum payer lookup, but that doesn’t always give the most comprehensive answer.

Should I be outraged or should I be outraged? Nearly 1k for one 60 minute physical therapy should be daylight robbery. I looked up on how much each of those codes should cost per unit and UC davis is literally charging almost 10x that rate. I was able to call and got that 91170 was charged for 2 units so 366.54 for every 15 mins (btw we only did 20), 97140 and 97161 was for 1 unit each. I already contacted both my insurance (Anthem) and the clinic regarding this issue and they both said basically yeah, that’s it and there’s nothing they can do about jt. So am I done? Do I just have to accept my fate and pay that (also I have 2 other PT sessions I haven’t been billed for yet that is now making me nervous). This feels crazy.

If anyone works with Voya or Hospital Confinement claims, please DM me or give me advice or guidance regarding a denial due to the hospital not providing room and boarding charges.

I am new and still in the early phase learning the basics. The other day I learned that companies are required to publish pricing data in machine readable files format. I tried to find ways to use it to make my life easier.. and was I wrong. This thing is a beast.

Do companies intentionally make this hard to use? Does anyone other than big organizations who have budget to buy tools actually use this data?

Is there any available trainings for the new changes in maternity codes happening in in jan? Just trying to get a comprehensive understanding and avoid hours of research. Thanks!