r/CodingandBilling

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!

Title is fairly self explanatory, as an attorney specializing in representing out of network doctors, I’m finding it extremely difficult to bring in new Doctors / billing companies. Does anyone have any advice for someone on the legal side of State and Federal reimbursement actions as to how to network in the field? I am surprised at the difficulty because I imagine so many practices are leaving huge amounts of money on the table when it comes to OON.

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.

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!

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.

Hello, folks! We’re looking for our next INTERN CPC or CRC coder. If you’re looking for some practice and experience to help with your apprentice designation, you may be the right fit.

This is a subcontract opportunity, paid on a 1099 basis. It would be perfect for someone who is currently working toward or already has their initial AAPC certification.

There will be a requirement to sign a BAA, as well as a noncompete agreement.

This is an excellent opportunity to learn the RCM business with a strong emphasis on the coding perspective. Duties will include the entry of new patients, including correct application of insurance and insurance order for coordination of benefits, followed by reviewing provider charts and recording appropriate diagnoses as documented by the provider.

Interested parties MUST be physically located and eligible to work in the United States.

You must have an appropriate, dedicated computer on which you can perform work, a private space that allows for HIPAA compliance while working, and a reliable high speed internet connection.

This is a 100% remote opportunity. We don’t even have a physical office to make you RTO. The work is based on volume and getting it done - meaning you choose your hours, as long as deadlines are met.

We do not sponsor work visas.

You may inquire via DM, where I will share our website address so that you can further review our company.

Been reading about autonomous medical coding lately and wanted some real opinions from people who deal with it.

Quick bit of context on how it got here. Coding used to be fully manual, someone reading physician notes and assigning the codes by hand. Then came computer-assisted coding, where the software suggests codes and a human signs off. Autonomous is the next step, where the AI reads the documentation, assigns the codes, and processes the straightforward encounters on its own. Anything complex or low-confidence still gets routed to a human.

It works well for high-volume, low-complexity stuff. Faster turnaround, better consistency, less admin load. Where it still struggles is messy inpatient cases, ambiguous notes, and compliance-sensitive calls that need actual clinical judgment.

So honestly it doesn't feel like replacement to me. Most places seem to be going hybrid, letting AI handle the routine encounters while humans focus on audits, compliance, and the hard cases. The job just shifts more toward oversight.

The part I think people underestimate (I build healthcare software, so that's my bias) is the audit side. Auto-assigning a code is the easy bit. Proving why it was assigned, and logging it in a way that holds up in an audit, is where it gets hard.

Anyone seeing this in production, is the hybrid model actually holding up, or is autonomous creeping into more complex cases than you expected?

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.

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?

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????

I’m currently seen an in-network physical therapist with my PPO insurance. The PT clinic bills my insurance for all the services, except dry needling, which I pay the cash price for.

My insurance does cover dry needling as an approved procedure, but the PT clinic will only offer it as a cash service. Is this generally allowed? Are they doing it since their reimbursement through insurance would be lower than what I’m paying out of pocket?

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 recently went to an Urgent Care clinic that is in the same health organization I usually go to for primary care, but I have not been to this specific clinic or provider before. I was confused upon seeing the cost of my appointment, so I googled the code. It seems that 99215 is the code for establish patient visits that are 45+ mins long and/or deals with life threatening illnesses.

I called patient billing to ask about this and said I feel this code was not right as I was in the doctors office for less than 5 minutes, but the representative just said 'well that includes the entire time they spent, not just the time in the room'. Which I understand.... but idk, I was there for 5 mins for one symptom and a completed chart was posted on my patient portal in the time it took for me to walk to my car. The doc didn't even examine me or talk to me, he just told me they did not have the equipment necessary to help me there (which I assume he based on my intake info).

The patient rep made it sound like it is hard to get this changed based off time as it's kind of my word against theirs, but then I read something that makes it seem like "established patient" would also not apply as I had not been to that specific clinic before?

Honestly idk exactly what info is relevant to include, but I'm trying to figure out 1. if this billing likely is in fact wrong, and 2. what things would actually be provable / usable in getting something changed? Thanks in advance.

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!

My pediatrician requires a monthly medication check for our ADHD child. She doesn’t spend more than 10-15 minutes and hasn’t had to change the dosage. It seems outrageous for this to be billed at Level 4 and charge $335 per visit every month! Anyone have some insight into this? Am I able to appeal?