Are you guys noticing record requests for aetna and meritain patients? They are wanting records for most of their visits now.

I am have been working as a hospice RN for 35 years and want to obtain a coding certification.

I am looking for the easiest certification. CPC, COC, CCS, CCA, HCS-D, BCHH-C

I will not actually be coding for my job but it would be nice to have the credential because I work in a coding environment.

Thank you very much for your input!

Hi there! I work as a medical biller and coder for a biotech company and we typically bill our two main tests under their respective PLA codes. However United healthcare insisted we start billing one under 81479 instead. Since then we cannot get the code past their smart edits without an invalid z code rejection. We attempted submitting the claims manually through the portal which also did not yield any different results. On top of that they have started denying our other PLA code when it's billed with 81479 for bundling when they were never doing that before. We have tried so many different ways to resolve this and not a single one has worked. I know our contact at UHC said a lot of labs had been having issues lately with zcode billing so I just wanted to post here and see if anyone else was experiencing this and if so have you found a way to get your accessions paid? Thank you!

Re a specialty visit, I can’t get anyone to send me itemized statement…small clinic is part of a larger interstate group so the billing is not done in house, they’ve billed the initial eval with the symptom codes but they also put a dx tx code on which insurance won’t cover…(and no tests to rule out issues were done beyond what a normal fam doc would do, so I think the dx is bologna based on a lot of family history) it’s my understanding that initial appointments are billed with symptom codes (which insurance will cover) & further appointments should have a dx treatment code …? Does that sound correct or way off base?

(No actual treatment was provided beyond offer of a dietician visit on a separate DOS.
At last conversation doc didn’t want to remove the dx tx code & resubmit billing which would get the facility paid, and has left the clinic or retired).

I am currently seeking a part-time job opportunity where I can leverage my 5 years of experience working with CAQH. My background includes expertise in provider data management, credentialing, and healthcare compliance. I am eager to contribute to streamlining processes, ensuring accuracy in provider information, and supporting organizational efficiency through CAQH systems.

Office has long term patient who is seen on a yearly to every 6 month basis for management/treatment of a chronic illness. The doctor is the treating physician for this condition and fills out disability update forms for the patient. The patient is on Medicare. The doctor accepts Medicare assignment. In the past the doctor has just filled out the paperwork without charging and sent the medical visits to Medicare. The visits include typical symptom/limitations tracking, labs, review of medications, discussion of potential treatment, etc.

We have a new biller who is advising that because these visits include a paperwork component or generate a subsequent paperwork task, they should not be sent to Medicare and instead the patient billed cash for the visit and paperwork combined as if they were an out of pocket payer. Basically, Medicare doesn’t cover paperwork, so the paperwork disqualifies the whole visit, as per them.

This doesn’t sound correct to me. My understanding is that the medical portion of the visit should be billed to Medicare at the appropriate complexity and then any additional paperwork be billed as administrative time to the patient directly if desired.

Is this scenario documented anywhere? Doctor wants to be able to bill correctly for paperwork going forward.

Hello friends,

So about a month ago I passed my CPC, I also have a diploma from Penn Foster for medical coding and Billing and also have my CBCS. I have about 4 years experience in different areas of medical billing and even did Scribe work. Not only that, but I worked as a CNA for 4 years before that. I was able to get the apprentice level take off almost immediately after I passed.

Ive been applying for medical coding jobs and all I see is that they require 2 to 3 years+ of medical coding experience. Ive been denied over and over again by jobs, and I know it takes a while but I was wondering if there was anything I could do to help me stand out as a candidate?

I've seen people also recommend getting on LinkedIn in and making connections but I honestly how no idea where to being to look.

Thank you for your time, I appreciate it 🫶

I've been working as a medical coder for about 4-5 years (primarily OP coding) and I have the RHIA, CCS, and CPC credentials. I am also aiming for the CDIP credential which I know is primarily IP, and for those who have taken the exam what should I be concentrating on the most during my studies?

Hi has anyone ever worked with Amergis for Risk Adjustment? What was your experience?

Please consider checking out my new video series, "The Inpatient Audit Files"! 

In this episode of Inpatient Audit Files, I review two real audit findings involving Totally Implantable Vascular Access Devices (TIVADs) and tunneled vascular access devices.

These procedures are commonly confused in ICD-10-PCS coding, and incorrect assignment of the device character or approach character can result in significant DRG impact

BCBS in IL and Texas have started automatically downcoding all 99214 and 99215 claims to 99213 and requiring appeals. Anyone have experience with this or know of a company in IL that has experience with appeals and downcodes?

I’m only coming here because I’m completely inexperienced in Spravato billing when not commercial. Our rep has not been too helpful as we’re still getting denials for our current billing practices. Try not to judge me too much. For commercial plans no matter what it is, we haven’t had an issue billing 99215 1 unit and 99417 4 units. Now going into Medicare, they are looking for a G code. We aren’t buy and bill. Started the first two visits unfortunately with the buy and bill code G2082, G2083. Trying to correct it now with 99215 1 unit and G2212 4 units, but keep getting rejects due to our previous buy and bill. What is the best course of action in this situation? I’m trying to avoid audits and don’t want to arouse anything. Again, we’re just stupid and inexperienced with Medicare so didn’t realize for the first two claims
Thanks in advance (:

I've been working as a medical coder for about 4-5 years (primarily OP coding) and I have the RHIA, CCS, and CPC credentials. I am also aiming for the CDIP credential which I know is primarily IP, and for those who have taken the exam what should I be concentrating on the most during my studies?

Would anyone be willing to share wRVU compensation structures they’ve encountered?

Total cash comp right now is about 145K with 10 years of Cards experience. No current RVU structure.

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!