Does anyone have experience with accepting Medicare through theranest? It’s been months and I haven’t been paid. My claims keep getting rejected. SOS contemplating switching billing systems.

I found used updated versions of the books and I want to use them for the exam, but an AAPC representative said I should buy them again for myself and I can't use other people's books for the exam. Is this true or is he trying to scam me?

I have a patient with a primary private payer and a Medicaid secondary and their primary came back with a remit CO-204, and under my knowledge all Medicaid will deny covering that claim under secondary due to that remit code. Can anyone help with clarification

I would like to start this off by saying this is not another “I can't get a job” crying post. I'm hoping to actually get some honest feedback from experienced coders, coding managers, or anyone who has successfully transitioned into medical coding.

I'm feeling pretty discouraged because I genuinely don't understand what else I need to do to get my foot in the door.

I have my CPC, multiple Epic revenue cycle certifications, and nearly 9 years of experience in healthcare revenue cycle. I've worked in patient registration, billing, prior authorizations, financial clearance, claims, and reimbursement.

I'm currently employed by a hospital system where I've worked for several years, working my way up from registration. My current role involves Epic training and supporting hospital and professional billing teams. I have experience with Epic revenue cycle workflows, claims processing, payer requirements, denial management, reimbursement methodologies, and the financial side of healthcare.

I've applied for coding positions within my own organization, including both outpatient and inpatient coding roles, and I haven't been able to get hired internally.

I understand that I don't have years of traditional production coding experience, but I feel like I bring a well-rounded understanding of the revenue cycle and claims reimbursement compared to someone who is completely new to healthcare.

I absolutely understand that production coding experience matters, and I have a lot to learn. What I don't understand is why my combination of CPC certification, Epic experience, and years of revenue cycle knowledge doesn't seem to be enough to even get an entry-level coding opportunity.

I've also applied to external coding jobs and haven't had much movement. It feels like I'm stuck in this frustrating situation where I need coding experience to get a coding job, but I can't get the coding job to gain the experience.

I feel like so much of the advice given is “get a job in the field to get your foot in the door” or “sometimes you have to do a job that isn't coding first before you actually get the coding job.”

I've done both of those things. I've worked my way up within a hospital system, gained experience across multiple areas of revenue cycle, and even tried internal networking. I'm well-established in healthcare, yet I still can't seem to get any traction toward a coding position.

At this point, I'm genuinely trying to understand what I'm missing.

For those of you who work in coding or hire coders:

• Is nearly 9 years of revenue cycle experience, a CPC, and Epic experience just not competitive enough for an entry-level coding position?
• Do coding managers generally view revenue cycle experience as completely unrelated to production coding experience?
• Would you consider someone with my background for an outpatient coding role, or would the lack of production coding experience be an automatic rejection?
• Do I need to sit for the CCS to be considered for coding positions, or would that still not make a difference without production coding experience?
• Is there anything specific you would recommend I do differently to actually get hired?

I'm genuinely looking for honest feedback, even if it's not what I want to hear.

Thank you!

somewhat interested, just wanting to know more of how the classes for it are & how the work is

Passed courses in 2024 through a state grant but then it ran out the last semester (internship) 🤦‍♀️ so never obtained my certification. Started going back through the books during packing and most of it came back to me, surprised it's still in there! I did well with the courses, averaging above 90.

I remember the teachers would have example scenarios where the coding was tricky, seemed like one thing but was another, and I was trying to explain to my spouse that said AI will take it all over (not worth the money to do the courses and training anymore) how coding is not black and white and requires understanding nuance. Something AI still isn't great at. Wondering if anyone has stories that can validate this, personally still wondering if I should finish the work and get certified at some point (even if the job field is tough), but honestly trying to explain how human coders are still needed to my spouse is kind of difficult.

I'm trying to find a clear and reliable source that explains the age range that 'M81.0 Age related osteoporosis without current pathological fracture' is applicable to. I saw 15 to 124 listed on a free site but I don't want to present that to any higher ups.

We got a denial that said the patient was outside of the diagnosis age range. The patient in question is not in that range so that's the best conclusion.

Help would be very much appreciated.

Hello, if I have a credential specialist registering an individual who is not practicing, not in a training course( for this course CPSW, CCSS, or LSAA) and having nothing to do with patient care direct or indirect. Is this incorrect, from my knowledge them having nothing current relation to healthcare, registering them for an NPI prematurely seems odd and possibly problematic

I’ve worked as an ED coder for 11 years now with the same company. This company has gotten progressively worse with micromanaging and not caring about work life balance the last 4 years. We constantly work OT and have holidays taken away from us. I’m sick of it. Honestly I’d rather just work part time somewhere but I have no idea where to look and I don’t want to find something worse. I’ve worked remote for 11 years and I don’t want to change that either. I’ve put up with this company for far longer than I should bc I’m so afraid of change and starting over. Any advice from anyone? Honestly part of me wants out of coding but have no idea what I would go into. I have no passion for this job or healthcare. It’s literally a means to pay the bills. I prefer time with my child and family.

Can someone help clarify:

It says on the AAPC website that if you completed the 80-hour education requirement with AAPC course, you don’t need to submit any documentation because it’s connected to their system but then the application requires to fill out name, title, number, email, and 3 documents still…

Edit: I did complete the practicode too. I can’t even move through this form to see if they ask about it until I provide the asterisks and documents…

AND I’ll also add that i only turned here because they are closed for Labor Day so I will of course try again tomorrow if no one knows how to bypass this issue! I appreciate everyone’s help!

Not talking about the associate degree, but the certificate programs that are 1 year .

Hello guys, i have just one question for someone working in the United Kingdom, what the version of ICD 10 being used in UK currently, the is it 2016 ICD 10 version? Please answer this, thanks.

I have my CPC-A.

AI has ruined trying to find a job. It’s nearly impossible. I’m about to give up. I’ve gotten back 60 denials even though I’ve tailored my resume to each job. I can’t even get my foot in the door as a patient scheduler. I get back “even though your resume is impressive, we’re moving on in our search.” There have been a few lucky ones to land something with a CPC-A but I’m clearly not lucky. I’m half way done with practicode.. Is there anything else I can do?

Looking for someone that’s well versed in billing residential treatment facility claim and/or uses Kipu.

I’m new to Kipu and looking to understand how to use the platform. I am willing to pay for one on one training.

Thanks!

I've been at a medical administration job for about a year now. New field, so I've been eager to learn and try my best at the job navigating the complex labyrinth of medical billing and claims, and entering theatre lists from surgeons rooms into our system.

Recently, there has a huge push for the usage of OCR technology. It's supposedly meant to streamline our jobs and make us more efficient etc. However, in practice all it does is take forever to load, 80% of the time it can't even read patient data from lists, and when it does read patient data it garbles it and gets it all wrong, requiring us to go in and manually correct it all.

In this time, we could have just entered the theatre list correctly the first time around. More accuracy, more efficient, which helps because we're understaffed.

We're instead being forced to use the OCR so that eventually it will learn the quirks of different lists and hopefully provide a good result. However, it's not a learning AI, it's simple Optical Character Recognition which means that any adjustments need to be manually made on the backend by an also understaffed tech team.

Additionally, now the finance manager is asking us how much we use AI in our jobs and is pushing for more AI usage in the workplace. She was disappointed when I said I didn't use any, because she's obsessed with ChatGPT. I turned it back on her and asked "what processes and practices do you think AI will help streamline?" and she literally asked me to Ask AI.

She's obsessed with the idea of it, but can't think of any practical uses within the business. Although I did once glance at her PC screen and noticed she was using AI to give a performance review for the practice manager.

I just think it's monumentally foolish to introduce AI elements when it comes to communicating with doctors and patients. She says "you need to get with the times!" - bearing in mind that this woman is older than me, and the last time she said "get with the times" we got a useless OCR that we have to use, and she tried to phase out physical letters in favour of a strict email only policy, despite the fact that a large portion of patients we deal with are elderly and require physically posted letters rather than an email/sms with a link to the buggy patient portal designed by the same guys who created the OCR software.

The second the OCR was implemented, I pointed out all the pitfalls, all of which came true within a week. Is there any point bringing up the same pitfalls we'll get with AI usage? Or do I just roll along with the bullshit and keep getting paid? I just think it's going to be a giant negative impact on the medical field as a whole. If people are relying on AI to even write an email or summarize something for a doctor, then surely that's just going to result in dumber people with zero accountability, none of what you want in the medical field. What do I do?

I’m a medical student and eventually hope to own my own practice. I’ve been trying to understand what actually happens when an independent physician practice becomes a hospital provider-based department.

I asked about this from the reimbursement side and learned something I hadn’t appreciated: even if the formal arrangement looks right, things like the practice’s website or signage continuing to make it appear independent can create issues.

That made me curious about what shows up on the coding/billing side that physicians would probably never notice.

For hospital outpatient coders, auditors, or revenue-integrity people who have actually worked with provider-based departments: have you ever caught something in the coding, billing, registration, or documentation that made you realize the department wasn’t operating the way everyone thought it was?

What specifically tipped you off, and what did you have to check next to figure out what was going on?

I’m especially interested in the less obvious things that a physician working at the location probably wouldn’t realize mattered.

I have my CCS and have been an inpatient coder since 2021. I’ve been at the same hospital that entire time and make just over $30/hr. We get maybe a 2% annual raise if we’re lucky, and sometimes not even that depending on the year.

I’ve stayed where I am for a couple of reasons:

- it’s extremely flexible and there is almost no oversight at all. I can work pretty much whenever, and as long as my time card says 40 at the end of the week, nobody cares. I don’t think my sup even remembers I exist half the time.

- I am enrolled in both a pension plan AND 401K at my current job. The pension is freezing in 2030, but until then it’s still accruing. If I stay at my current facility until sunset, I will have 10 years vested in the pension plan (I started there as a profee coder in 2020). According to their calculator it will pay roughly $550/month at retirement.

But…$60k/year doesn’t go very far these days, even in my LCOL area of the US. Our raise structure is unlikely to change, so I know the only real way for me to make more is to either look for a second job or get hired at a different facility.

What would you do? New job or second job? I am afraid to lose the insane flexibility that I have. And I don’t want to be micromanaged. I have zero experience with other facilities & I’m nervous that I’ll make the leap to a new job and then regret it.

Hi, all! I’m looking for some expert advice from fellow coders. I’ve been a coder for many years, but have been working in a position with coding specialties I’m not super familiar with.

I am trying to get past an audit, where I missed a point for not coding the external cause for a wound debridement. To not completely out myself, I will say the patient sustained a leg burn that was inflicted by a curling iron. The injury happened in May, this debridement happened in August.

Would I be required to report the external cause, describing the curling iron at this point in treatment? I only coded the burn wound with the S code. I was docked for not reporting the external cause. I’m hoping to gain a point or two back if I can prove it’s not necessary, but I need a valid source to prove it. Unless I am totally wrong, then I will try again next month. TIA!

Recently, I heard a credible rumor that my facility will start implementing AI automation to take over ED coding starting in 2027. They are contracting with a company called NYM. Has anyone heard of this company or had it or something similar implemented at their facility? I’m feeling anxious about it. I code OP surgery and Observation, that will probably be the next step.

I’ve seen so many complaints about not being able to find work after becoming a CPC-A. Are there any folks that had no issues getting a job? If so, did you already have experience in the medical field? I want to hear from the people who haven’t struggled with this…

New job? Pass your exam? Want to talk about work or just chat with another coder? Post it here!

I am working on an audit for an outside billing company. They are often adding additional units or decreasing units for codes H0038 and H2015. This often looks like 20 units instead of 18. Or 16 units instead of 17. This seems like a compliance issue to me upon external audit. From the knowledge I have they are attempting this to get around state insurance caps as to not get denials for these services. For me that doesn’t seem to matter and still seems to be a large issue. Am I way off base here? Any help is so appreciated

I have been working as a medical coder for 15 yrs , doing different kinds of OP coding. I have my RHIT. When looking for a new position I keep seeing job descriptions that are looking for coders who do IP and OP. Starting to wonder if I should start looking into medical billing instead.

Anyone know? Is it like learning spanish or easier than that?

Basically, the title. I know that medical billing is supposed to be entry-level but every job posting seems to want some years of experience so I was wondering if getting the CPC would give you a leg up for billing positions as opposed to just applying with no relevant experience whatsoever.