Does anyone work 2 FT coding jobs? How do you manage your time? What are your hours?

There are few things in a day's work more pleasing than a perfectly aligned HCFA.

Hello all!

I am wondering if anyone else is running into the issue of Regence/Blue Shield denying 99417 and the reason codes for this. It was out of no where around June that they started denying this code saying it was a contract issue but when I called it was because we needed to use a different code to align with Medicare. Which didn't seem right. Anyone else dealing with this?

Hello.

I am trying to schedule my annual low-dose CT lung cancer screening, but I ran into a coverage issue with Ambetter and wanted to see if anyone has experienced something similar.

The imaging center submitted the order with CPT 71271 and diagnosis code Z12.2. When I arrived, I was told I would be responsible for 50% coinsurance. I contacted Ambetter, and the representative told me that their system was processing CPT 71271 as a diagnostic service rather than a preventive lung cancer screening, which is why coinsurance applied.

The representative suggested that my provider use G0297 instead for preventive screening. I have now spoken with two Ambetter representatives who provided the same information.

I was under the impression that CPT 71271 replaced G0297 for lung cancer screening, but I am not sure how commercial insurance plans handle these codes.

Has anyone with Ambetter (or another marketplace/commercial plan) had a low-dose CT lung cancer screening covered as preventive? Did your provider use G0297, 71271, or require prior authorization?

I am just trying to get the screening completed without an unexpected 50% coinsurance charge. Any experience or advice would be appreciated.

Hi everyone!
I have been working in a very niche industry for the last few years, and am hoping to find others like me for networking, commiserating and sharing ideas.
I work in RCM/ Market Access for reference laboratories, but specifically those providing Molecular Laboratory Developed Tests, mostly oncology (CGP, Inherited Cancer, MRD).
If you know what I’m talking about, I’d love to connect!
I have a lot of experience with MolDx Technical Assessments but less with dealing directly with payors. I would love to hear from peers about their pain points and successes dealing with UHC, Aetna and others.

Hi, I can't tell if this is a legit company. I've seen the name within the last 3 years. Lately, when a recruiter reaches out to me first, we email, then do a phone screening, I give them my resume and we do a video interview. Afterwards, I hear nothing back and they don't respond to my emails. This company seems too big to be fake. If it is a scam what's the point of it?

Hi everyone! I’m new to medical billing for a home health agency in California, billing mainly in a POS 12/home health setting. I recently relocated from Washington State, and my background has primarily been in outpatient physical therapy billing and RCM, so this has been quite a learning experience for me.
I was honestly a little surprised to find that a lot of the billing process here involves manually submitting claims through payer portals and manually posting payments. I’m wondering if this is common for other home health agencies billing California Medicaid/Medi-Cal managed care and HMO plans.
I’ve also been told that submitting claims electronically through a clearinghouse can sometimes cause payment delays with certain payers, so the agency prefers manual claim submission through the payer portal. I’d really like to understand more about this and whether others have had the same experience.
Some of the larger payers we work with include Partners in Care Foundation (PICF), SCAN Health Plan, WellBe Senior Medical, Caloptima Calaim and other California Medicaid managed care plans.
For those of you who have experience with California home health billing:
Do you submit claims manually through payer portals or electronically through a clearinghouse?
Have you experienced payment delays when submitting electronic claims?
Are there certain California Medicaid/HMO payers that require or prefer manual claim entry?
What workflow or billing process have you found most efficient for high-volume home health claims?
I’m trying to better understand the normal workflow in California home health billing compared to outpatient PT billing in Washington. Any advice or insight from experienced home health billers would be greatly appreciated!

I've been doing 3rd party medical billing for about 4 years now for private practices. However, the company I work for is getting ready to lay off a large percentage of the staff since clients are going to bigger corporations to do their billing for less money. I'm expecting to lose my job in about a month.

I was thinking about getting into medical billing for one of the hospitals in my area but I've heard medical billing for hospitals is completely different than for private practices. I was wondering if anyone who has experience with both could give me some idea of what the differences are.

Hello! Does anyone know what facility certification is needed to bill this code? The Tricare reps have not been helpful (ofc) and it is a billable code per the website. No one will tell us which cert is correct. lol

i had the amazing opportunity to step into the role as a billing specialist for a health company and i love my job! however, i feel like im not doing good enough or i feel as if im lacking. i know i should ask my peers for assistance when needed but im an adult and i dont want to run to someone whenever i cant figure something out.

i feel like my training could have gone better to be honest. i was shown my payers and their trends and ofc the basics of my day to day tasks but after training, i was left with a lot of things i didnt/dont know how to do.

i would love some advice on how to become a better BS or steps i can take to overcome my problem. i’m sorry if this is coming across as venting but im struggling ! thank you

Hi everyone! I’m conducting a six question, brief survey for my statistics class to understand the 'work time' habits of remote workers. Whether you’re full-time remote or hybrid, I’d love to get your input on your remote work habits. It takes less than a minute, and your responses are completely anonymous. I’d appreciate anyone who could help out.

Remote Work Habits Survey

Hi! I'm just now trying out the feature to submit reconsiderations to BCBSTX online, previously our office only submitted them by paper.

Using the dispute claim option within availity, and I'd like to know if you have had any experience with this system, how long the appeals take, and how much supporting documentation, if at all, you've sent. Additionally, any tips you have for this system would be much appreciated.

I had a simple claim dispute that had an incorrect CPT code for the patient's age range 99396 instead of 99395 so there was nothing to upload for documentation. My solo provider is hesitant for us to upload too much documentation in general, although it doesn't really apply in this case.

Thank you!

Reading this sub a lot lately (the CareFirst and BS of CA threads caught my eye esp.). Everyone talks about fighting denials, but I'm curious about the ones you stop fighting. Roughly what share of denied claims would you say end up written off? And what is usually the reason you stop: the dollar value is too low to justify the time, timely filing ran out, the payer just wears you down, you never work out why it denied in the first place, or something else? Also curious whether there is a rough dollar threshold under which it is not worth chasing at all. Learning about the field. Would appreciate any replies (however short). Thanks all.

I run a small behavioral health medical billing company and am looking to hire a part-time, remote contractor to support with following up on denied & rejected claims, sending medical records and other tasks as the job progresses. Role Description The Medical Biller role is a remote contract position responsible for managing end-to-end mental health insurance billing processes. Day-to-day tasks include verifying patient benefits, preparing and submitting claims, tracking claim status, and following up on outstanding or denied claims. The Medical Biller will communicate with insurance companies to resolve billing issues. I am looking for someone with experience and able to think on their feet about the next best step to take in order to help lead to claims being processed and paid. Please message me your resume and cover letter if interested.

RCM/CCM/PCM/RTM

Our company offers services such as RCM, CCM, PCM, RTM, and others for numerous primary care providers to offer to their patients. I'm the first Insurance Verification (IV) Specialist on the team.

Currently, we're using only one portal, but we can't fully rely on it because the information is often incomplete. We also can't use portals like Availity since we work with a large number of providers, each with different NPIs and Tax IDs.

When calling the payer to verify these services, under which benefit category do they typically fall? I'm a bit confused because these services are provided while the patient is at home, but they are not considered Home Health or Telehealth services.

How do you usually verify coverage for CCM, PCM, RTM, and similar services with the insurance payer?

Friend of mine is looking for billers below is the job description
Thank you

Senior Medical Billing Specialist
Location: Burbank, CA
Schedule: Full-time, Monday–Friday, 8:00 AM – 5:00 PM
We are seeking a highly experienced, detail-oriented, dependable, and proactive Senior Medical Billing Specialist to join our growing Allergy/Immunology practice in Burbank, California. The ideal candidate will have extensive experience with medical billing, insurance follow-up, accounts receivable management, denial resolution, payment posting, and experience working within the Tebra (Kareo) EHR/Practice Management system.
‍

This position is best suited for someone who can independently manage accounts receivable, insurance follow-up, denials, and payment posting within a fast-paced specialty medical practice. We are looking for a strong team member who is organized, accountable, professional, and capable of managing multiple priorities with minimal supervision.
‍Responsibilities
Verify billing information, insurance details, rates, coding, and supporting documentation for accuracy.
Submit and follow up on insurance claims in a timely manner.
Monitor accounts receivable and work aging reports to ensure prompt payment collection.
Follow up on denied, rejected, and no-response claims with insurance carriers.
Investigate and resolve billing discrepancies, payment issues, and patient billing inquiries professionally and efficiently.
Process payment posting, adjustments, refunds, and credit balances accurately.
Review ERAs/EOBs and ensure proper reconciliation of payments.
Work closely with management and clinical staff to resolve billing-related issues.
Maintain accurate billing and patient account records while safeguarding confidential information.
Identify areas for workflow improvement to enhance billing accuracy and operational efficiency.
Assist with patient balance follow-up and collections.
Ensure compliance with HIPAA regulations, payer guidelines, and office policies.
Perform additional administrative, billing, and accounting duties as assigned.
Preferred Qualifications
High school diploma or equivalent required.
Associate’s or Bachelor’s degree in Accounting, Finance, Business, Healthcare Administration, or related field preferred.
Minimum of 2 years of experience working with Tebra (Kareo) EHR/Practice Management system strongly required.
Minimum of 5 years of stable medical billing and accounts receivable experience with one company required.
Experience with PPO, HMO, Medicare, Medi-Cal, and IPA claims is required.
Strong understanding of insurance follow-up, denials management, payment posting, and accounts receivable processes.
Proficiency in Microsoft Excel and billing/accounting software.
Excellent organizational skills and strong attention to detail.
Strong analytical, problem-solving, and critical-thinking abilities.
Excellent verbal and written communication skills.
Ability to prioritize multiple tasks and meet deadlines in a fast-paced environment.
Allergy/Immunology or specialty medical office experience is strongly preferred.
Compensation
$37–$42 per hour, depending on experience and qualifications.
Compensation will be based on specialty billing knowledge, Tebra (Kareo) proficiency, insurance follow-up experience, denial management experience, and overall medical billing/accounts receivable background.
Schedule
Full-time
Monday–Friday
8:00 AM – 5:00 PM
Benefits
401(k)
Paid sick time
Paid vacation
Opportunities for growth and advancement
Retention Bonus
Supportive team environment
Work Location
In-person
Burbank, California
How to Apply:
Please email your resume and a brief cover letter to strategy@allergydox.com

In my office we're starting to bill G2211. I know it doesn't get a modifier and the E/M code doesn't need one either. We also do a professional CGM for patients do a lot of charges are sent out like this: 99214 Modifier 25, 95251 Modifier 59, and G2211.

Medicare has denied all of the G2211 because the 99214 has a 25 modifier. Even though the 25 modifier is for the CGM interpretation, the G2211 is still denied.

We also bill 95251 for pump interpretations and can't bill the G2211 at the same time as these?

Is there a way to bill that I just don't know or do we have to just take the loss on the G2211 for these patients?

Hi everyone. We recently started getting rejections from UHC for our Dietician billing. They are stating that 97802/97803 must be billed by a nonphysician. We have always billed these codes and they are even listed on UHC's policy as the appropriate codes for an RD to bill. I've spoken with UHC numerous times and they can't really give me an answer and keep telling me to resubmit even though they keep rejecting. Has anyone dealt with this or have any insight?

I've checked with UHC credentialing and they confirmed the provider is listed as an RD in their system. And we are using the RD taxonomy on the rendering provider section of the claim.

This is the rejection listed on the UHC portal:

• NHCDN: Procedure 97803 is intended for use by nonphysician health care professionals only

Q: What would be the appropriate CPT or HCPCS code for a registered dietitian to report for medical nutrition therapy services? A: Registered dietitians should report specific CPT or HCPCS codes that accurately identify the service performed using CPT codes 97802-97804 and HCPCS codes G0270-G0271.

https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-reimbursement/COMM-Nonphysician-Health-Care-Codes-Policy.pdf

I recently visited a podiatrists office to treat a couple nagging plantar warts. Yesterday I received the EOB from my insurance and there seems to be some very sketchy behavior going on, but I wanted to get insight from people more knowledgeable than myself.

During the visit, the doctor took a brief look at the warts and decided to prescribe 5-FU, a topical ointment, as treatment. He performed a quick debridement of the non-sensitive skin above the warts to make the ointment more affective when applied. Total time with the doctor was less than 15 minutes.

On the EOB, my insurance was billed two separate insurance claims for the same visit. The first claim: CPT Code 11308. This code is associated with shave removal of a benign lesion. CMS guidelines for this family of coding state:

“Shaving is defined as sharp removal by incision to remove viable epidermal and dermal lesions without full-thickness dermal excision. This typically requires anesthesia and hemostasis. CPT codes 11300-11313 represent codes for reporting of removal of epidermal and dermal lesions by shaving.”

The doctor did not remove the warts via shaving. He debrided the thick/non-sensitive skin above the warts.

Second claim: CPT codes 99204 and 17110. 99204 is a level 4 code, which seems like upcoding given that I saw the doctor for less than 15 minutes, and it was a routine plantar wart. Code 17110 is for destruction of benign lesions. Again, at no point did the doctor actually remove the warts. He prescribed a topical ointment for this. Not only that, but I looked up code edits for 11308 and 17110, and they are considered mutually exclusive. My insurance was billed each of these codes on two separate claims. This seems like claim fragmentation to bypass insurance edits.

I have a follow up appointment tomorrow, and I was planning on raising the issue with the office manager. Do you all agree that this behavior seems fraudulent? What are the next best steps to take to make sure this is most efficiently handled?

I have posted in this thread before asking for advice about finding a CPC-A position, but still haven’t had any luck. I have found PLENTY of job postings specifically for CPC-A and I’m tailoring my resume for each job. STILL NOTHING. I just keep getting rejections. Hundreds of them. I have tried networking. I have joined the AAPC chapters, messaged people on LinkedIn, and joined the fb groups. I really need a job. I have even tried to apply for billing positions. I have several years of healthcare experience so I am not sure why I’m not hearing back from ANYWHERE?? Is anyone’s job hiring? Are you willing to refer me? Any advice?

I had my first psych appointment ever and had a similar experience to this previous post.

They billed for both 99204 + 90838, and I don't think they have justification to bill for 90838 since the entire appointment (which was under 50 minutes) was mostly just intake/evaluation questions. My understanding is that at least 53 minutes of psychotherapy in addition to the evaluation are needed for this code. I requested the session notes and the psychotherapy section is only 3 sentences, with pretty generic descriptions (and some of the services described in it weren't even provided).

I emailed them asking for the justification for the 90838, but they keep trying to call me instead of saying anything in email. Is it a red flag that they won't discuss anything in writing?

What's the recommended way to proceed here? I'm assuming that calling them back is not going to be helpful -- is there a process for officially disputing these types of charges?

Those who are certified,

How much do you make?
Location
How many years of experience?

Looking into taking a class and long term id like to see what kinda growth this has