Behavioral Health Billing
Revenue Cycle Management For Behavioral Health Practices
Behavioral health revenue cycle management means we check every claim before it goes out, work every denial back to its cause and post every payment against the deposit.
See PricingKnow What Changed In Your Revenue Cycle
A useful owner report explains the work behind the balance. It should separate new charges from old A/R, clearinghouse rejections from payer denials, and money received from payments that haven’t been posted or reconciled.
- Check the starting position. We look at open claims, aging by payer and provider, unposted payments, who has access to what, and which parts your current team handles.
- Agree on the recurring work. Claim submission, denial handling, follow up, posting, patient billing and reporting each get a named owner in writing, and so does the work that stays with your staff.
- Review exceptions every week. Look at rejected claims, filing deadlines, unusual adjustments, unpaid balances with no recent action, and deposits that don’t match posted payments.
- Close the loop. Every claim keeps a dated next action until it’s paid, corrected, appealed or closed with an adjustment you approved.
For a practical owner agenda, use the weekly behavioral health A/R review. It’ll help you ask better questions whether your billing’s handled in-house or by an outside team.
Built For Behavioral Health Practices
We bill for psychiatrists, PMHNPs, psychologists, group practices and interventional programs.
Solo therapist or counselor? Ongoing Billing is 7% of collections with a $300 monthly minimum, and you can start online. Start Billing Online
Command Suite
Know Where Collections Stand
Aging buckets, denials to work and payer friction, all in one command center, so your team isn’t guessing from a spreadsheet nobody can read.
Ask Practice ConciergeVisibility
What Practice Owners Can See
A working revenue cycle answers these on any given Tuesday. If yours can’t, that gap is where revenue leaks.
Aging Claims, With The Reason
What’s aging, and whether it’s a payer, documentation, credentialing or unworked-queue problem.
Repeating Denials
Which denial reasons keep coming back in volume, and whether a systematic fix exists.
Payers To Escalate
Which payers keep causing the same problems, and which of those are worth raising with a provider rep.
Work With No Assigned Owner
Work that’s sitting in the EHR, the clearinghouse, the practice management system or someone’s inbox with nobody’s name on it.
Problems Before Claim Submission
Where a note that doesn’t support the code, a provider who isn’t enrolled yet or a scheduling miss is holding up what you can bill.
What To Work First
A prioritized view of what moves cash flow most this week, not everything at once.
How It Works
Focus On The Problems Holding Up Payment
Review
We map how your practice submits and tracks claims, then hand you a prioritized list covering aging, denials, queue ownership and the upstream problems slowing everything down.
Scope The Fix
We start where the drag’s worst, whether that’s billing oversight, an audit of how your outsourced biller is performing, or fixing the claim workflow directly.
Track The Work And Results
After that, ongoing support keeps denials worked and documentation holds flagged, and leadership gets a clear written status every month.
Billing Priced By The Size Of Your Practice
Your rate drops as you grow: 7% of collections for a solo provider with a $300 monthly minimum, down to 4.5% at 26 to 50 providers. You get whichever rate is lower, by provider count or by monthly collections. There's no setup fee.
Ongoing Billing
Claims, denials, payment posting, A/R follow-up, reconciliation and a monthly report.
7% of collections, 1 provider
$300 monthly minimum. No setup fee.
Start Billing OnlineBuy online
- When we handle your credentialing too, the rate is 0.5 point lower.
- We also work unpaid claims older than 90 days for 20% of what we collect on them. Nothing is owed on claims we don't collect.
Rate By Practice Size
A practice with a few busy prescribers often qualifies on collections.
| Practice Size | Rate | Minimum Per Provider |
|---|---|---|
| 1 providerUnder $25,000 a month | 7% | $300 |
| 2 to 5 providers$25,000 to $75,000 | 6.5% | $275 |
| 6 to 10 providers$75,000 to $150,000 | 6% | $250 |
| 11 to 25 providers$150,000 to $300,000 | 5% | $200 |
| 26 to 50 providersOver $300,000 | 4.5% | $175 |
- Each month you get a written report on what was billed, collected and denied, and what we did about it.
- Groups of six or more can bill psychiatrists and PMHNPs at $7 per paid visit instead of the percentage. Therapists stay on the percentage.
- A provider you add later has no minimum for their first 90 days, while they build a caseload.
- Practices with more than 50 providers, or very high claim volume, can ask us for a per-claim price.
Want the rates in writing first? We’ll email you the Ongoing Billing Order Form with every tier, minimum and term on it, so you can share it with your partners.
You’re billed on what actually comes in, so a slow month costs less. Your volume, payer mix, current A/R and provider count change what the work looks like, so we confirm the scope and the first month in writing before anything starts.
Monthly Billing Or Old Claims
Do You Need Ongoing Billing, Billing Cleanup Or Both?
There are two ways to buy billing help here, and they solve different problems. Ongoing Billing runs the recurring work every month. Billing Cleanup And A/R Recovery is for claims that are already old. We work the unpaid claims past 90 days, and you pay 20% of what we collect on them.
| Detail | Ongoing Billing | Billing Cleanup And A/R Recovery |
|---|---|---|
| Price | 7% down to 4.5% of collections, with a $300 monthly minimum for a solo provider | 20% of what we collect. Nothing is owed on claims we don’t collect. |
| Claims It Covers | The claims going out now, every month, under a written scope | Unpaid claims older than 90 days |
| Included Work | Claim scrubbing and submission, rejection and denial follow-up, payment posting and adjustments, A/R follow-up, reconciliation, and reporting | Working each unpaid claim older than 90 days that can still be collected |
| Outside The Price | Eligibility and benefits verification and prior authorization, which need a separate written scope | Claims we don’t collect on, which cost you nothing |
Credentialing and payer enrollment aren’t in either one. They’re priced per provider and per payer in the credentialing price builder.
If the backlog’s already there, run the cleanup next to the monthly billing. The old claims get worked for 20% of what they bring in, and the monthly work goes after the causes, so the same denials don’t build a new backlog.
Send us your aging totals by payer and by age, no patient names, and we’ll email you back within one business day with what we’d work and what it costs.
How The Work Runs
What Happens Each Month Once Ongoing Billing Starts
The recurring work runs in this order, inside the EHR and clearinghouse you already use. Each step feeds the next one, so a problem caught early doesn’t turn into aged A/R.
- Onboarding. We get authorized access to your EHR, clearinghouse and payer portals, pull open claims and aging by payer and provider, and put in writing which work stays with your staff. Before we bill for a provider, we confirm the enrollment is active and linked to the practice at each payer.
- Claim scrubbing and submission. Each claim is checked before it leaves, from member ID and rendering NPI to place of service, the telehealth modifier and codes that agree with the note. Then it goes out through your clearinghouse, whether that’s Office Ally, Waystar, TriZetto or Claim.MD.
- Rejection follow-up. A clearinghouse acceptance only means the file moved. When a claim is rejected, we fix the claim or the record behind it and resubmit, so it doesn’t sit until month-end.
- Denial follow-up. Denials are sorted by payer, code, provider and reason. We correct, resubmit or appeal the claims, then fix the cause, whether it’s a payer rule, a documentation gap or an enrollment record. If the same reason comes back next month, it goes on the weekly review.
- Payment posting and adjustments. Remittances are posted to the right patient, date of service and line, and every adjustment carries the payer’s reason. Contracted rates stored in an EHR are usually reference only, and a blanket write-off is how a short payment disappears.
- A/R follow-up. Open claims are worked in the order that moves cash and protects filing deadlines, with claim status checked in Availity or the payer’s portal. Every open claim keeps an owner, a next action and a date.
- Reconciliation. Remittances, posted payments, adjustments and bank deposits are compared before anyone relies on the totals. A deposit that doesn’t match what was posted gets traced back to the remittance.
- Reporting. You get a written report each month: what was billed, collected and denied, and what’s sitting in A/R, by provider and payer. It also shows what’s still unpaid, who’s working it and when the next action is due.
Eligibility checks before the visit stay with your front desk unless they’re in the signed scope. So does prior authorization. Keeping that line clear is how everyone knows who owns a denial when one comes back.
Before You Sign
Questions Practices Ask Before A Billing Scope
Who Actually Does The Billing Work?
Experienced people do, and one expert owns follow-through and the monthly report. AdvanceAPractice was founded by Ryan Berg, who has 16+ years in revenue cycle. Software keeps the queues and next actions in front of us, but it doesn’t call payers, and it never decides what gets appealed.
What Do You Need From Us To Start?
Authorized access to your EHR, clearinghouse and payer portals, a few representative claims and remittances, your current billing workflow, and one owner who can approve corrections. You don’t have to switch systems. We work inside SimplePractice, TherapyNotes, Valant, Tebra (Kareo), AdvancedMD and others.
How Often Will We See Where Collections Stand?
You get a written report each month, and the dashboard shows what’s billed, collected, denied and sitting in A/R, by provider and payer. Routine messages get a response within one business day.
What’s The Difference Between A Rejection And A Denial?
A rejected claim never reached adjudication. The clearinghouse or the payer’s front end stopped it, for a subscriber mismatch or a provider the payer doesn’t have on file, so it gets fixed and resubmitted. A denied claim was processed and refused with a reason, which calls for a corrected claim, an appeal or a fix upstream.
How We Investigate Unpaid Claims
We compare claims, denials, payments, adjustments, and aging for the same dates and providers before telling the team where to start.
Check The Reports
We compare reports for the same dates, providers, and insurers, then investigate differences in payments, adjustments, and unpaid balances.
Separate The Work
Rejected claims, denials, claims with no response, underpayments, unposted payments, and patient balances receive different next actions.
Set The Priorities
We identify the corrections to make first, filing deadlines to protect, and claims that need an insurer's response.
Report What Moved Each Week
The owner sees what was resolved, what remains unpaid, the next action, and the person responsible.
FAQ
Revenue Cycle Management FAQs
What Does Revenue Cycle Management Include?
It covers claim scrubbing and submission, rejection and denial follow-up, payment posting and adjustments, A/R follow-up, reconciliation and reporting, all inside your EHR and clearinghouse. Eligibility checks and prior authorization are added only when a separate written scope includes them. You get a written report every month.
How Do You Reduce Claim Denials?
We sort every denial by payer, code, provider and the reason the payer gave, then fix what caused it, whether that’s a payer rule, a documentation gap or an enrollment record. Rejections get read, corrected and resubmitted instead of sitting until month-end. If the same reason comes back the next month, the fix didn’t hold, and it goes on the weekly review.
Can You Work Our Aged A/R Backlog?
Yes. That’s Billing Cleanup And A/R Recovery, and it’s separate from the monthly work. We take your unpaid claims older than 90 days, work the ones that can still be collected, and you pay 20% of what we collect on them. Nothing is owed on a claim we don’t collect, and we fix the upstream causes so the backlog doesn’t rebuild.
Do We Have To Switch EHRs To Work With You?
No. We work inside the EHR and clearinghouse you already have, whether that’s SimplePractice, TherapyNotes, Valant, Tebra (Kareo) or AdvancedMD, so there’s nothing to migrate. When a denial pattern traces back to how the EHR is set up, like insurance entered on an account with no effective date, we fix the setup where it lives.
For PMHNPs
Run A Psychiatric Nurse Practitioner Practice?
We keep a dedicated hub for PMHNPs, billing and coding, credentialing, and scope of practice by state. Explore the PMHNP hub or PMHNP billing and coding.
What This Looks Like
Problems That Look Like Billing And Are Not
At one practice, patients were calling about large balances. The billing was fine. Insurance plans had been entered on patient accounts with no effective date, so the EHR silently never sent those claims and the unbilled amounts surfaced as patient responsibility.
Separately, two payers had each paid as primary on the same accounts and both electronic payments had posted, which is a coordination of benefits problem wearing a billing costume.
Working the denial queue harder wouldn’t have fixed either one. That’s the argument for one person holding billing, credentialing and the systems at the same time.
What Would Fixing It Cost?
Ongoing Billing, Automation Programs and the Operations Partnership each have a published price and a written scope. Tell us what keeps going wrong, and we’ll point you to the right one.