r/CodingandBilling

I'm an Oregon birth doula, newly credentialed with Regencee BCBS. I've tried billing with the codes that the Medicaid system uses (T1033 & T1032) but they're both listed in the Clinical Edits list as non-payable through Regence. I'm trying to figure out what codes to use for Prenatal visits and Day-of-delivery labor support and I feel like my next choice is to break out the Ouiji board and ask the spirits because I can't find this information anywhere. I have the fee schedules from Availity but none of the codes have descriptions there and I feel like I'm running in circles. Anyone have any insights about this?!

Hey guys!

My team that usually bills WC visits out to insurance for Illinois and Indiana is talking over billing for our New York clinics. NY is also very new to me.

We submit billing through Ziramed Waystar. I know about the rule for NY that all WC medical bills must be submitted electronically. However, recently, we have been getting denial of payments from a series of payers. EOBs stating that "Medical bills should be billed through the board".

I researched a bit and have come across nothing helpful. I need some insight into how I work on this.

Thanks in advance! ☺️

So on 5/18/26 9 claims were sent for BCBS NC through TriZetto, 2 of those were federal BCBS and those went through to the payer. The other 7 were rejected stating " Human Readable Rejection Report. Received - Pending Validation." There's no other rejection details and all NPI/Taxonomy/Subscriber ID's are correct.... Has anyone else had this issue?

I work in the callcenter for a billing company.. im not a biller, I just a verbal punching bag. We have this constant issue where patients are being billed specialist copays for their PCP's. The patients call their insurance and the insurance tells that we are submitting claims incorrectly. From my research it seems the issue is with how the provider is credentials. I've explained this to patients and ​I basically get called a liar who doesnt know what they are doing. Im stuck in the middle and its getting frustrating. Ive had 4 patients yell at me today. thanks for reading

I just completed the class for my certificate, and I wont be talking the AAPC CPC test so does anyone know jobs I can get with just the "completion of the class" certificate? Iv tried looking it up but it hasn't been very helpful. I live in a small town and cant really afford to relocate so I kinda got slim picking :/

I graduated with an Associate of Applied Science in Information Technology with a concentration in Networking a few years ago and have been struggling to find an IT job since. I've been working fast food jobs instead. My Mom brought up switching to medical coding and I really clicked with the day-to-day operations of the job when reading up on it. There's also way more job offers in coding compared to IT where I live. She offered to pay $3,000 for me to take an online certification course through my local community college and get a CPC. However, I've got cold feet now reading what people are saying on this subreddit (The field is too oversaturated, AI will take over, etc...). I don't want to spend months studying to end up in the exact same position, but coding as a career sounds perfect for my personality and work preferences. Is it a bad idea to get into coding?

Hi all. Got my CPC-A in January 2025. Been working since February 2025. Had a 1 year meeting with my boss in February where we discussed that I “graduated” my apprenticeship since I now have 1 year experience- yay!
However, it is now almost June and the Apprentice title is still showing on my certification. Any time I’ve asked her about my recommendation letter since February, she said she’ll “mail it in soon”, and as of the last month or so she keeps saying she already has mailed it in. However, she also mentioned something about how she thinks the rules have changed and you now need 2 years experience to get the A removed.
What can/should I do? Is it 1 or 2 years of experience that I need, if I got my certification in 2025 when they only required 1 year?
TIA

Just wanted to share my experience for any RCM or medical billing companies thinking about buying leads from Billing Service Leads / 7Connects LLC.

I was looking into purchasing leads for my RCM company and was told by the salesperson that the leads would be exclusive to us.

But when I reviewed the contract, I did not see anything that clearly said the leads were exclusive. That was my first red flag.

The contract also says something along the lines that many leads may have requested information from other competitors. To me, that sounds like the leads may not actually be exclusive. And when I spoke to the sales rep, he said I can't guarantee anything cause of "blah blah blah" was just speaking quickly and trying to do what sales people do - talk a lot and sound like he knows what he's saying until I just said "oh ok, that makes sense." Basically he said that he sees it's exclusive from his side, but can't show it to us and can't make any promises either that the lead is exclusive but trust him.

A few other red flags I noticed:

• No clear exclusivity language
• No real guarantee that the leads are qualified
• No guarantee that you will reach the person
• No guarantee that the lead is actually a good fit
• Very limited refund/replacement protection
• Strong chargeback penalty language
• They ask for ACH/bank authorization
• The agreement seems very one-sided in their favor

I’m not saying they are a scam because I did not move forward, but the contract gave me enough concern to pause.

If you're an RCM company or medical billing company thinking about buying leads from them, make sure you read the agreement carefully and get everything in writing before paying.

The sales person told me a lot of things I wanted to hear on the phone and then in the contract, none of that was mentioned. Just be careful.

Especially if they tell you the leads are exclusive, make sure the contract says that clearly.

Do not rely on what a salesperson tells you over the phone.

Probably a genuine question for people working in U.S. healthcare operations —

Which states in the USA are generally more open toward offshoring or outsourcing support services for solo practitioners, small clinics, and mid-sized healthcare facilities?

I’ve noticed some practices are very comfortable outsourcing functions like RCM, billing, admin support, and back-office operations to scale faster and reduce operational burden, while others still hesitate despite increasing costs and staffing challenges.

Would love to know your thoughts and experiences on which regions are the most outsourcing-friendly and growth-oriented.

Hi! I am studying for my CPC and want to ask how the job market is for medical coders in the Phoenix area? I want to know the good and the bad!

I have a lot of medical experience. I’m an OTA (8 years) and prior to that I was CNA for banner. I have been working in medical since 19, but all patient care. I’m now 32, so this is a big change but ready for a more routine career. Im unsure how hard it is as a CPC-A to find a job in the area. I see a lot of medical coding jobs but all want 2-5 years of experience. Any entry level friendly companies around?

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Hello everyone!

I am new to this subreddit as well as medical coding/billing. I operate a behavioral health practice and recently began the process of contracting with Tri-West. I have heard that Vets must get a referral for Detox and Residential levels of care but cannot find additional information as it pertains to PHP and IOP. I have emailed our contracting representative and have been unable to get a response.

Does anyone have experience billing Tri-West for these services (H0015,H0016,S9480)? It would be very helpful to gain some more insight into the authorization process as well as reimbursement. Our contract simply states that we will be reimbursed 75% of billed charges.

Hey, I’m wondering if someone can help me with maybe wording my resume better. I recently got my CPC certification, I have spent the last six years working in credits resolution for a dialysis provider. I review claims, I process claim adjustments, I use Medicaid web portals for both my state and multiple others.
I would love any advice anyone can give me. Thanks!

If anyone is looking for training for certifications like cpc,ccs, basic to advance medical coding, ipdrg, surgery, e/m cross specilaity training, then reach me out, my friend does it at very cheap cost

I currently work remotely M–F 8:00–4:30 and make about $37/hour. I was just offered another remote position at $35/hour, so about a $2/hour pay cut. The big difference is the flexibility. The new job allows you to clock in anytime between 4am–9am as long as you work your full shift.

My kids are elementary school age and this would be super helpful. In the summer, I could work 4–12 while they sleep in and then still have most of the day with them. The pay cut would obviously still matter, but the flexibility sounds amazing after years of a fixed schedule. My boss is also a bit of a micromanager but I do what I’m supposed to do so I don’t really have any issues. Would you take the pay cut for this level of flexibility?

Mid-sized Texas town here and wages are low. Office based billers in a clinic are getting between $16 and $19 an hour. What towns are similar? Save me your big-city $30 an hour brag - this ain’t it! I am curious what areas have similar wages.

I am finishing up my medical billing and coding certificate, and I keep wondering whether I am going to like this or if I am doing it because it seemed like a stable remote job. Everyone talks about the pay and the flexibility but nobody really talks about what it feels like to sit and code charts for eight hours.

I shadowed a friend's mom who does this and she was really honest about it being repetitive. She said some days she puts on headphones and just goes into a flow state and other days she feels like her brain is turning to mush. That scared me a little.

I am someone who needs variety or at least some kind of human interaction during the day. I am not sure if I am built for something this solitary.

Do you enjoy the work itself or has it become something you tolerate because the lifestyle works? And if you do enjoy it, what keeps it interesting for you?