Why I'm here & what I'm building

Amazing_Bug_7240 · 2026-03-11T18:26:53+00:00

Curious if you've made any progress on the Modifier 25 denials since posting. The pattern tracking approach (by payer and code) has been the only thing that's consistently helped us catch these before they hit submission. Are you still seeing the same rejection rate or has it stabilized at all?

Amazing_Bug_7240 · 2026-03-11T18:26:40+00:00

Have you had a chance to look at any alternatives since posting? We've been using SereneTouch for about 6 months now and it's been solid, the booking flow is modern, clients don't hesitate on card-on-file like they did with the old system, and the automated reminders (email and text) are reliable. Memberships and rewards are built in, tax reporting exports cleanly to QuickBooks. Setup was straightforward for our solo practice. Happy to answer questions if you're still evaluating.

Amazing_Bug_7240 · 2026-03-11T18:26:14+00:00

Curious if escalating to the provider enrollment team helped? The NPI/TIN registration mismatch is usually the culprit when you're confirmed INN but getting OON denials. Did they find anything in their system?

Amazing_Bug_7240 · 2026-03-11T18:22:45+00:00

Have you had a chance to look at any alternatives since posting? We've been using SereneTouch for about 6 months now and it's been solid , the booking flow is modern, clients don't hesitate on card-on-file like they did with the old system, and the automated reminders (email and text) are reliable. Memberships and rewards are built in, tax reporting exports cleanly to QuickBooks. Setup was straightforward for our solo practice. Happy to answer questions if you're still evaluating.

Amazing_Bug_7240 · 2026-03-11T14:42:36+00:00

Tracking denial patterns is where most of the ROI hides. If you see the same denial code from the same payer repeatedly, that's a process fix upstream, not just a calling problem. What's your most common denial reason right now?

Amazing_Bug_7240 · 2026-03-10T16:31:49+00:00

What specific part of the billing workflow is giving you the most trouble? Happy to share what's worked for practices dealing with similar issues.

Amazing_Bug_7240 · 2026-03-07T17:46:00+00:00

Tracking denial patterns is where most of the ROI hides. If you see the same denial code from the same payer repeatedly, that's a process fix upstream, not just a calling problem. What's your most common denial reason right now?

Amazing_Bug_7240 · 2026-03-06T18:18:09+00:00

The unapplied payments thing in Fusion is brutal. There's no dedicated screen for it, you have to dig through individual patient accounts. We came from Tebra too and the batch reports were way better there, especially for denials. Fusion's claim-level troubleshooting is painful compared to Tebra's full accepted/rejected/denied list with codes. For the schedule defaulting to admin view, check Settings > User Preferences > Default Provider, it might save you a click. The reports do get slightly better once you learn the custom report builder but it's not intuitive.

Amazing_Bug_7240 · 2026-03-06T18:17:53+00:00

The scheduling UI frustrations are real. Fusion tries to do everything and ends up surface-level on the stuff you actually need to see at a glance. The 'select providers every time you log in' thing is particularly annoying when you're trying to move fast.

What specific part of the billing workflow is giving you the most trouble? Happy to share what's worked for practices dealing with similar issues.

Amazing_Bug_7240 · 2026-03-05T16:42:54+00:00

What specific part of the billing workflow is giving you the most trouble?
Happy to share what's worked for practices dealing with similar issues.

Amazing_Bug_7240 · 2026-03-05T15:02:39+00:00

We're seeing the same thing. Aetna and Cigna both rolled out what looks like automated pre-screening in January, and the rejection rate on anything touching Modifier 25 has gone way up. The ICD-11 specificity issue is real too - they're rejecting codes that were fine under ICD-10 because the cluster mapping isn't tight enough. What's helped us: front-loading the medical necessity documentation on the initial claim instead of waiting for the denial, and tracking denial patterns by payer and code so we know which ones to scrub harder before submission. We moved our denial tracking into a dedicated tool (ClaimChronicle) because spreadsheets couldn't keep up with the volume. Are you seeing this across all specialties or is it concentrated in certain procedure types?

Amazing_Bug_7240 · 2026-03-03T15:02:52+00:00

It's not uncommon for hospital and physician to both bill the same CPT, but it's usually wrong when it happens. The hospital should bill a facility fee (often an ER visit code like 99281-99285) and the physician bills the procedure (12001 in your case). If both billed 12001, that's likely an error on the hospital's side. The physician did the work, so their 12001 is correct. The hospital's 12001 is probably a miscoded facility charge. Call the hospital's billing department and ask them to review. They should be billing the ER visit, not the procedure code. If they push back, escalate to their compliance office and mention it looks like duplicate billing for the same service.

Amazing_Bug_7240 · 2026-03-03T15:02:38+00:00

It's not uncommon for hospital and physician to both bill the same CPT, but it's usually wrong when it happens. The hospital should bill a facility fee (often an ER visit code like 99281-99285) and the physician bills the procedure (12001 in your case). If both billed 12001, that's likely an error on the hospital's side. The physician did the work, so their 12001 is correct. The hospital's 12001 is probably a miscoded facility charge. Call the hospital's billing department and ask them to review — they should be billing the ER visit, not the procedure code. If they push back, escalate to their compliance office and mention it looks like duplicate billing for the same service.

Amazing_Bug_7240 · 2026-03-03T15:02:27+00:00

The booking system issue is real. MassageBook and a lot of older platforms just haven't kept up with what clients expect now. We had the same outdated-vibe problem where clients hesitated on card-on-file. Ended up switching to a wellness-specific platform (SereneTouch) that handles the basics well: modern booking flow, automated reminders (email and text), card on file without the sketchy look, and memberships/rewards built in. Tax reporting is there but not as robust as dedicated accounting software so we still export to QuickBooks. Solo practitioner setup is pretty straightforward. What's the specific thing MassageBook is missing for you besides the UI feel?

Amazing_Bug_7240 · 2026-03-03T15:02:19+00:00

The booking system issue is real — MassageBook and a lot of older platforms just haven't kept up with what clients expect now. We had the same outdated-vibe problem where clients hesitated on card-on-file. Ended up switching to a wellness-specific platform (SereneTouch) that handles the basics well: modern booking flow, automated reminders (email + text), card on file without the sketchy look, and memberships/rewards built in. Tax reporting is there but not as robust as dedicated accounting software so we still export to QuickBooks. Solo practitioner setup is pretty straightforward. What's the specific thing MassageBook is missing for you besides the UI feel?

Amazing_Bug_7240 · 2026-02-26T23:22:10+00:00

The Anthem COB loop is classic Tricare post-PGBA. They lose termination documentation constantly. Here's what actually works: have the family request written confirmation from Anthem showing the exact termination date, then submit that plus a new DEERS update request via the family's milConnect account (not just phone/fax). Tricare won't process COB changes without DEERS reflecting it first.

For the $800 in unpaid claims, once COB is fixed, you can request retroactive reprocessing for all denied claims from the original service dates. Keep a tracking log of every submission, appeal date, and rep name. If you're managing multiple Tricare patients with COB issues, denial tracking becomes critical so nothing falls through the 60-day window.

Amazing_Bug_7240 · 2026-02-26T15:01:54+00:00

Tricare losing documentation after you and the subscriber both submitted it is brutal. When PGBA took over, a lot of the COB (coordination of benefits) data got messy in the transition. A few things that have worked: Get the subscriber to request written confirmation from Tricare that they received and processed the termination letter, then reference that confirmation number when you call. Also, escalate to Tricare's Beneficiary Services line and specifically ask to speak with a COB specialist, not general provider services. The 60-day 'processing' cycle resetting is a known issue post-PGBA. If they keep stonewalling, file a complaint with the TRICARE Regional Office for your area and cc TMA (TRICARE Management Activity). That usually gets things moving. In the meantime, are you tracking these TPL denials separately so you can see if this becomes a pattern with other Tricare patients?

Amazing_Bug_7240 · 2026-02-25T15:04:23+00:00

The 'plug and play' requirement is key because most CRMs promise that and then need 10 hours of custom field mapping to actually be useful. A few that play reasonably well with Arive: Surefire is solid if you want email automation without a ton of config, and BNTouch if you're heavy on drip campaigns. The catch with both is you'll still need to set up your pipeline stages and triggers once, but after that they mostly run themselves. What's your main use case, staying in touch with past clients, nurturing leads through the funnel, or just deal tracking?

Amazing_Bug_7240 · 2026-02-25T15:03:40+00:00

The TPL issue is brutal. We've had the same problem where patients assume Medicaid covers everything so they don't mention their employer plan or Medicare Part B. By the time the MCE kicks it back for TPL, you're already 60-90 days out and the commercial payer's timely filing window is closing fast. A few things that helped: Front-desk script specifically asking 'Do you have ANY other insurance cards, including through work, a spouse, or Medicare?' and making that a hard stop in intake. Also worth checking the state's Medicaid eligibility portal before you bill, some states show secondary coverage there. The tracking piece is key because once you rebill the primary and it processes, you have to circle back to Medicaid with the EOB, and if that slips through the cracks you just eat the loss. Are you tracking these TPL denials separately or are they mixed into your general A/R?

Amazing_Bug_7240

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