The Denial Desk

A lot of new coders ask whether a remote coding offer is real. Usually the giveaway is money. The FTC's rule is short: "Never pay to get paid or get a job." Here's what the scams tend to look like. A text, WhatsApp or Telegram message offers remote work, sometimes with a pay rate but no real job details. The FTC says to ignore unexpected job texts, however professional they look. Someone sends you a check to deposit, then asks you to send part of it back for equipment or software. That's a fake check scam, and you're the one left owing the bank. A medical billing "business opportunity" sells you software and a client list up front. The FTC has warned about these since 2002. Some promise $20,000 to $45,000 a year, and the FTC says few people who pay ever find clients or make money. A real coding job looks boring by comparison. You apply on the employer's own careers site, a person interviews you, and you never pay anything to start. If a recr...

When employers are hiring coders, certification often matters. The Bureau of Labor Statistics says employers may prefer it, or require it ( BLS ), and they can look up whether yours is current. So it’s worth getting your credential line right. This is for coders, billers and health information (HIM) staff applying for jobs in the US. Where they go Put your credentials in two places: After your name at the top. Abbreviations only, for example Jordan Lee, CPC, CRC . In a Certifications section. Spell each one out, with who issued it and when you earned it. For example: Certified Professional Coder (CPC), AAPC, earned March 2023. Spelling it out helps when the job posting uses the full name instead of the letters, and when the first person reading your resume isn’t a coder. What order to use AHIMA’s guidance goes like this: academic degrees closest to your name, then the general credential like RHIA or RHIT, then specialty and coding credentials. ( AHIMA ) So it’s Jordan Lee,...

Right now, Medicaid can often pay medical bills from up to 3 months before the month you apply, as long as you would have qualified in those months. That's called retroactive coverage. It's why hospital staff tell people to apply even after a big bill. A federal law passed in 2025 shortens that window for applications made on or after January 1, 2027. ( California DHCS , Washington HCA ) Who Past months Medicaid can cover Adults 19 to 64 who qualify through Medicaid expansion 1 month before the month you apply Everyone else (children, parents who qualify through the parent group, pregnant people, older adults, people with disabilities) 2 months before the month you apply Applications made before January 1, 2027 still follow the old rule of up to 3 months. ( California DHCS ) Your state may be different Some states already had shorter windows before this law, through federal waivers. ( KFF ) Some may keep more months for a while using state money. Minnesota...

Most people expect prior authorization in Medicare Advantage plans, not in Original Medicare. But since January 2026, Original Medicare checks some services before it pays in six states: Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington. Your provider can ask for approval first (prior authorization), or skip that step, and then Medicare reviews the claim before paying it. It's a CMS test program called WISeR, and it's set to run through December 31, 2031. ( CMS ) If you have a Medigap (Medicare Supplement) policy, you are still in Original Medicare, so this applies to you too. People with Railroad Medicare are not included. It does not apply to Medicare Advantage plans, which have their own prior authorization rules. Which services are on the list The list is narrow. As of CMS's July 2026 guide, it includes: ( CMS WISeR guide ) Epidural steroid injections for pain Nerve stimulators, including vagus, sacral (for urinary incontinence), phrenic and hypoglossal (f...

If you have Medicare drug coverage and expensive prescriptions, you might pay a lot at the pharmacy early in the year. Starting January 1, 2027, the most you'll pay out of pocket for covered Part D drugs in a year is $2,400. That doesn't include your plan premium. ( Medicare.gov ) But you could hit most of that in the first few months. The Medicare Prescription Payment Plan lets you spread those costs into monthly bills across the year. It's free. But few people use it. In 2025, fewer than 4 in 100 people who reached the yearly drug cost cap had signed up, based on one industry analysis of Medicare claims. ( Avalere ) That count left out people with Extra Help and people in employer plans, and the analysis was paid for by a drug industry group. How it works You pay $0 at the pharmacy for covered drugs. Your plan sends you a monthly bill instead. There's no fee and no interest. It does not lower what you pay in total. It changes when you pay. Anyone with a Medica...

 New Medicaid work rules start by January 1, 2027. Here is who has to meet them, what counts toward the 80 hours, who is exempt, and how to keep your coverage. Who the rules are for The federal rule generally applies to adults ages 19 to 64 who get Medicaid through the expansion adult group or through certain state waiver programs that cover adults, and who aren't on Medicare. There are exemptions, and your state's notice will say if it applies to you. ( KFF ) If you got Medicaid because your state expanded it to adults with low incomes, this probably means you. States may start earlier than January 2027, and Nebraska started May 1, 2026. ( Nebraska DHHS ) Some states can get extra time, but no later than December 31, 2028. ( KFF ) What counts toward 80 hours You need 80 hours a month of work or community service activities, or you need to qualify for an exemption. ( KFF ) Under the federal law, that can be paid work, community service, a work program, school at least half time...

 Got a big bill from a doctor or hospital you didn't choose? A federal law called the No Surprises Act may mean you don't owe it. Here's when it applies and what to do. What the law covers The No Surprises Act protects people with job-based, Marketplace, and other private health plans. Medicare and Medicaid have their own billing protections. These are the main protections, according to CMS ( CMS: No Surprises Act protections ): Emergency care. Out-of-network emergency care generally can't be billed above what you'd pay in network. Your plan also can't make you get approval first for emergency care. Out-of-network doctors at an in-network hospital. For most non-emergency care at an in-network hospital or surgery center, an out-of-network doctor, like an anesthesiologist, generally can't bill you more than your in-network share. For some planned care, a provider can ask you to sign a consent form giving up this protection. That's never allowed for emergen...

 That one-line hospital bill doesn't show you what you're paying for. Here is how to ask for an itemized bill and what to look for once you have it. What an itemized bill is The summary bill shows a total. An itemized bill lists every charge, line by line, with codes, dates, and quantities. That's where mistakes show up. Ask the hospital billing office for one, and ask separately for bills from outside doctors, like the radiologist or the anesthesiologist, since they often bill on their own. ( AARP ) Wait for your insurance first If you have insurance and your plan hasn't processed the claim yet, call the billing office and ask them to hold the bill until it does. Write down the date, who you talked to and the new due date. Then compare the bill to your Explanation of Benefits (EOB). For in-network care, what the hospital says you owe shouldn't be more than the patient responsibility on your EOB for the same dates and services, minus anything you already paid, like ...

 Your doctor ordered an MRI and your insurance said no. Here is why MRI requests get denied and what you and your doctor's office can do about it. Many plans need approval before an MRI. This is called prior authorization. ( Triage Cancer ) If it's denied, you usually haven't had the scan yet. The insurer has to decide an appeal for care you haven't had within 30 days, and an urgent one generally within 72 hours. ( HealthCare.gov , Department of Labor ) Who said no The letter might come from a company you've never heard of. Many insurers hire outside companies to review imaging requests. One of the biggest, EviCore, makes these decisions for more than 100 insurers, including UnitedHealthcare and Aetna. ( ProPublica ) Your appeal still goes where your letter tells you to send it. Why MRIs get denied Look for the reason on your letter. Two to know about with MRIs: Try something else first. The American College of Radiology says imaging is generally not needed for plai...

 Got a denial letter from your health insurance? You can appeal it, and here is how to do it step by step, with the deadlines that matter. Most people never appeal. In HealthCare.gov plans in 2024, insurers denied 19% of in-network claims, and fewer than 1% of those denials were appealed. ( KFF ) Some people don't know they can appeal. Others are sick, worn out, or out of time. These steps are meant to make it shorter. Who these steps are for: job-based plans and plans you buy yourself, like HealthCare.gov or state marketplace plans. Medicare, Medicare Advantage and Medicaid have their own appeal steps and deadlines. If you have one of those, follow the deadline on your notice, and see Who will help me for free? for the right place to call. A few older "grandfathered" plans may follow different rules too. Step 1: Read the letter for three things Find the reason for the denial, the claim or service it is about, and your appeal deadline. The reason is the part you will ans...

If you have a Marketplace plan and do nothing during open enrollment, HealthCare.gov will re-enroll you automatically so you don't have a gap. If your plan is discontinued, you may be moved to a similar plan, sometimes with a different insurance company. Plan costs can change. ( HealthCare.gov ) That matters more this year. The median proposed premium increase for 2027 individual plans is about 15%, and more insurers are leaving than joining. ( healthinsurance.org ) Dates for HealthCare.gov states November 1: Open enrollment starts. December 15: Pick a plan by this date for coverage starting January 1. December 31: If you were auto-enrolled and don't want the coverage, stop it by this date. January 15: Open enrollment ends. Changes after your auto-enrolled coverage starts take effect February 1. ( HealthCare.gov ) States that run their own marketplace can have different dates. What to check in your renewal letter Is it the same plan, or a new one? Is your doct...

Not every denial is the insurance company saying your care wasn't needed. A lot of them are paperwork. If the problem is a billing or coding mistake, the fastest fix is usually the doctor's office sending a corrected claim, not you writing an appeal. In HealthCare.gov plans in 2024, only 5% of denied in-network claims were denied for medical necessity. Another 25% were denied for administrative reasons, and 36% for "other" reasons. ( KFF ) Insurers don't report much detail beyond that, so we can't say how many were simple mistakes. But it's worth ruling out before you start an appeal. Signs it might be a billing problem The denial says something is missing, invalid or doesn't match: a code, a modifier, a diagnosis, your member ID, your date of birth, a referral or an authorization number. The date of service, the provider's name or the service on the EOB doesn't match what happened. The plan says you had other insurance, or asks for ...

If you got a letter saying your Medicare Advantage plan is leaving Medicare or won't be offered in your area next year, you still have Medicare. You also have extra time and some extra rights. Here's what the letter means and what to do before the deadlines. A lot of people are getting this letter this fall. Humana alone is ending plans that cover about 600,000 members at the end of 2026, though it expects to move some of them into its other plans. ( Healthcare Finance News ) First, read which letter you got Plans send a Plan Non-Renewal Notice in October when the plan is leaving Medicare for the coming year. ( Medicare.gov ) Some companies move members into a different plan of their own instead, so check whether your letter says you've been moved, and to what. If you get Extra Help with drug costs, Medicare also sends a separate notice in late October or early November about the drug plan it will put you in if you don't choose one. ( Medicare.gov ) Your two window...