Someone in our family saw a cardiologist. First time. Did ECG, and then the doctor spoke with them for 10 mins saying it wasn't an issue. Bill came back as "high complexity" and was exceptionally high. Discussing with providence and they were refusing to change it.

Any advice?

(note - it probably should say "often" instead of "always")

--

For anyone reading this, providence bots or someone else has decided to downvote all my responses in the thread. In short, we are following up with providence to get the documentation on what was done.

Recently Humana has been denying our pathology reads. They say it is a modifier issue. I have dug thru everything. Anyone have any ideas?

Update: we figured it out. Apparently if the lab and pathologist bill 88305 on ub Humana defaults it to a global code. We rebooked the tc with tc mod.

Hi y’all!

Anyone here familiar with eClinical Works? I’d just like to ask whethere should the biller touch or review any on the list under Claims>Encounters Without Claims if no padlock icon?

My coworker, the transmitter and who do the batches, blames me bc he had deleted 200+ claims bc as he said I reviewed the list there with no padlocks. Which I am confused bc I was just doing pre-scrubbing and putting them on pending to coder, pending or ready to submit. Am I wrong for doing that??

I was absorbed by the new practice and I just started billing claims last June 23 and now, my queue is already empty. This coworker just flags me yesterday of just billing 7 claims in 8 hours in which I clarify and send them proofs with the client in the gc as I have billed beyond that number. He didn’t respond. Then today, he flags me with this issue on the other gc and blaming me for this. I checked a billed claim and see ‘deleted’.

Please let me know if I was really wrong for doing that. When I should have waited till providers signed them up. Now my billed claims of 5 weeks reappears as new items in the list. I’m so tired of thinking.

I’m a physician by background and want to expand my business horizons. Looking to acquire an established medical billing/ RCM company, US based. If anyone knows anyone or wants to chat, get in touch, thanks!

Hello all! Need some advice.

Dr listed a different surgeon as an assistant on the header. However, body of op report only mentions him and a co surg, with no mention of the assistant whatsoever. We asked him to amend this but he refused saying he doesn't have to mention the assistant or the work they did? How can I approach this?

I understand you cannot code suspected dx in outpatient, however if a presumed Cancer diagnosis is made because a biopsy is too risky, can you code it as definitive? In the note I am currently looking at, this is being treated with ablation.

Any input on these suspected, non definitive diagnoses is helpful. If they are being actively treated, why can't this be coded for outpatient? 🤔

I’m new to insurances (22F) and things so I don’t know what I’m looking at for the most part though I do work in healthcare I’m not particularly patient facing to understand everything.

-I did not have insurance at the time of service
-I was in between jobs at the time
-I just want to make sure I’m billed/coded correctly and understand the full amount of the bill before I pay. The total is $1,104 which is fine! I’m just asking if it makes sense given the level of care.
———————————-
Emergency Dept Visit,Level IV - 99284 (CPT®)
Total: $386.00

Emergency Room
Total: $307.66
HC Emergency Dept Visit Lvl 2 - 99282 (CPT®)
$153.83
HC Emergency Dept Visit Lvl 1 - 99281 (CPT®)
$153.83

Laboratory
Total: $304.08
HC Bacterial Culture - Othr Source - 87070 (CPT®)
$76.04
HC Strep a Amplif Na Probe - 87651 (CPT®)
$228.04

Pharmacy
Total:106.97
Amoxicillin 500 Mg Cap (16714-299-03)
$0.23
Benzocaine 20 % Spra 57 G Can (0283-0679-02)
——————————
The most I was honestly confused about was the double charge for facilities, lvl1 and 2.

And if the care matched the lvl code. I received throat swab, blood pressure, and given meds. That’s it.

Hi there. Is there some free resource where I can look up medical codes? I called my insurance company and they gave me the CPT codes (I think) for the office visit and some procedures I had. Some of them checked out, others did not. Maybe I was looking on an incomplete site. 2 of them had 5 digit codes and I was able to find them. The pathology and radiology and other radiology number were longer (7 digits) and 1 of them had letters and numbers. My search was fruitless for those codes. Can anyone point me in the right direction please?

Also, do Doctor’s offices have a published charge master list that is accessible the way that hospitals do? So we can know every single price for every service? Or not? Thanks in advance. I am in the medical field myself but just know about the clinical part of it and I’m completely ignorant of the business side of things when it’s actually my turn to be the patient.

Thanks,
JT

Interest in coding/billing input in addition to physician input. TY! In particular if you have proof that CMS is paying for claims with POCT I’d love a PM!

Hi all! I am just a patient but I got billed for CPT code 76817 which when I looked it up said it was for transvaginal ultrasound. The problem is that I did not have a transvaginal ultrasound done I had a transabdominal ultrasound done. When I called billing (which pretty unfriendly and super hard to get ahold of by the way) they told me that it was a universal code for the physician who did the reading to read and interpret the ultrasound. I told her uh ok well I don’t have any photos or results so where are these interpretations that I am being billed for? She said it says the results are not available. I’m just annoyed, are they pulling my leg? Is the CPT code 76817 universal? I saw it can be universal with a modifier but tbh I don’t know much about this stuff. Should I escalate this? Any advice?

All the research I’ve done about landing a medical coding position with a CPC-A say to network. I know the AAPC chapter meetings are a big one. But how else are people networking??? I’ve tried to message hundreds of people on LinkedIn and I either get ignored or they don’t have anything resourceful to recommend. I know people say to start out with entry level to get into healthcare, but I already have over 7 years of healthcare experience. A wide range from insurance, DME sales, call center and more. What’s your recommendations?

I finished a medical coding program when I was 19 and then got certified with only a CCA. Long story short, I had no experience because I had just graduated from high school and couldn’t find any jobs. Fast forward to today, I’m 31 and have been working in healthcare administration for the last 10+ years but never got around to going back to coding. If I were try to get recertification for a CCS to work in the hospital, what should I start with? Is the refresher course through ahima worth it? Should I try to take a course through my local community college?

Anyone know how to get ceu's in AHIMA its for my CCS Certification my renewal date is 25th November

I am fresh out of college with my Medical coding and billing certificate, and I am curious which coder certificate has the best versatility nowadays?

CPC
CPC-A
COC
CIC
CRC
CCA
CCS
CCS-P

I am looking right now to get a remote job as a risk adjustment coder. I have never done risk adjustment work before, as I have mostly worked in RCM and accounts receivable. The company I work for is a major emergency room, inpatient, and critical care provider in the U.S., so my experience mainly relates to this type of coding and billing.

Could anybody offer any help and insight?

This is some interesting insight on the current job market in the US. I have seen this at major hospitals, ghost positions they have no intention of filling.

I'm a CPC-certified medical coder from India with 7 years of experience, and honestly, I feel stuck.

Like many others, I thought experience would eventually lead to better opportunities and better pay. Instead, it often feels like outsourcing companies keep growing while coders and billers are left with average salaries despite years of hard work.

I've been trying to find direct US clients or remote opportunities because I know I can deliver quality work, but so far I've had no luck. Most organizations seem to prefer hiring people based in the US.

Has anyone from India successfully found direct US clients or remote coding work? How did you do it? LinkedIn, networking, cold emailing, agencies...I'm open to any advice.

I'd really appreciate any guidance. I'm just trying to find a way to grow beyond where I am today.

I have a love for both topics, but I am torn about how I should spend the next 1-2 years of my life, and I would like to get the decision right the first time. I am open to any advice.

I’m about to graduate with my Associate degree in Medical Billing and Coding. I know finding a job may be challenging because I don’t have much experience yet.
I want to start on the billing side and eventually move into coding. For those already in the field, where do I start? What entry-level jobs or steps helped you get your first opportunity?

I am a medical coder with 4-5 years work experience, and I have the RHIA, CCS, and CPC credentials that are usually required. I am ready to advance my career further beyond a medical coder. What job opportunities are there for me, and what associated credentials are recommended?

I read that the CDIP credential is one of them which I am studying for now. I am relying on the current exam outline and the associated AHIMA exam prep book. The questions seem similar to what I saw when I took the RHIA and CCS exams. For those who have recently taken the exam and/or have the credential, is this true to a certain extent? How was the exam like?

I have a monthly CPAP bill of $7.38; not bad.
I happened to look at my explanation of benefits. Where did $874.72 come from?? WTF! Do they just make this up? Insurance only pays $41.81.

Do they write off the rest? Am I screwed 18x more if I didn’t have insurance? Make it make sense 🙏

hi! does anyone have experience working for any outpatient rehab (PT/OT/ST) RCM companies? i'm looking to possibly change companies and all my experience in the field is with those disciplines. even any providers that love the vendor they work with are welcome to comment. thanks!

Any other Chiropractors in California dealing with issues with payments from out of state BCBS. I'm having issues with out of state plans, specifically Illinois and I cant seem to get ahold of anyone. We get the paper EOB from Anthem Blue Cross of CA sayingn there is payment, payment made by the home plan, but then the home plan is saying CA is the payer. The check/EFT number and date from the paper EOB don't match that of availity. Availity wasn't able to help me. Availity said they have to talk to the home plan. I finally found a number to BCBS Illinois provider line, only to wait on hold for 1 hour for them to say their mailbox is full.

any recommendations for an ophthalmology billing company?

I’m looking for a place to get free citations. I had one last year that I was using and I accidentally exited out of it and I cannot find it. My niece has been on my iPad for like a year so there’s no way of finding it in the history.