AdvancedMD
AdvancedMD Services For Psychiatry, PMHNP, Psychology, And Behavioral Health Practices.
We work the billing side of AdvancedMD for behavioral health practices, from the master files and the claims your scrubber holds to remittance posting and the denials that come back. You don’t switch systems, and we don’t rebuild what you’ve already set up.
Why AdvanceAPractice
What We Bring To AdvancedMD Billing
Behavioral Health Billing Experience
We know psychiatry, PMHNP and psychology billing, where time-based therapy codes and add-ons billed with an E/M visit decide what you’re actually paid.
Schedule, Note, Code And Claim Have To Agree
A claim’s only as clean as the steps behind it. The schedule, the note, the code and the submission all have to agree, and when one of them is off, the payer notices before you do.
One Break Shows Up As Another Denial
We work denials, telehealth rules and credentialing together, since a break in one tends to show up as a denial in another.
Where Behavioral Health Billing Gets Complicated
Where Behavioral Health Claims Get Stuck
Benefit Rules Change Plan By Plan
Visit limits, covered services and telehealth rules change from one commercial plan to the next, and Medicaid and Medicare each have their own. Authorization mostly comes up with medications and Spravato, and even there it’s plan by plan.
Notes That Can’t Defend The Claim
When the diagnosis, the medical necessity language, the note’s timing and the billed service don’t match, the claim’s harder to send clean. Defending it later, when a payer asks for records, is harder still.
Credentialed Isn’t The Same As Set Up To Bill
You feel this most when you’re adding providers. Someone who’s credentialed but not enrolled, or on the panel but not set up to bill, can fill a schedule you can’t collect on.
What We Check
What We Check On Every AdvancedMD Claim
We work the parts of the revenue cycle that decide what you actually collect. We check eligibility and benefits before the visit, set telehealth place of service the way each payer wants it and make sure every signed note turns into a charge, then a claim. Denials, patient balances and the old aging accounts get a set schedule. They don’t wait for somebody’s spare afternoon.
- Eligibility and benefits checked by service type, before the visit
- Authorizations and concurrent reviews tracked by plan, so a visit doesn’t go out on an approval that’s already run out
- Telehealth place of service and modifiers set per payer
- Psychotherapy add-on codes billed with a med-management visit, checked against the note before the claim goes out
- Denials appealed while the appeal window’s still open, and aging A/R worked claim by claim
- Patient balances that match the remittance, so a patient doesn’t get a bill for what the plan should’ve paid
- Credentialing and payer enrollment tracked together, so a new provider doesn’t fill a schedule before they can bill for it
Beyond The Software
What’s Changing In Behavioral Health Billing
More Teams Touch Each Patient
More teams touch each patient now. Every handoff between offices is another chance for the insurance on file or the diagnosis to arrive wrong, and the claim carries that mistake straight to the payer.
Electronic Checks Need Someone Running Them
Electronic eligibility checks, claim status requests and provider data updates only save time if someone’s built a routine around them. Without one, they’re another screen nobody opens.
New Medicare Provider Types Mean New Enrollment
The rules on who can bill what keep moving. Medicare now enrolls marriage and family therapists and mental health counselors, for one. When a change like that hits your roster, enrollment, system setup and claim habits all have to catch up. If they don’t, that provider’s claims stall.
Best-Fit Practices
AdvancedMD Practices We Fit Best
We’re the best fit for psychiatry, PMHNP and psychology practices, and larger behavioral health groups, that already know denials, telehealth errors or uneven documentation are costing them collections.
- Practices where payer follow-up happens when someone remembers
- Psychiatry and PMHNP practices billing med management with a psychotherapy add-on in the same visit
- Teams whose telehealth claims keep coming back over place of service or modifiers
- Growing practices where a new provider can start seeing patients before anyone’s set them up to bill
The Platform
Why AdvancedMD Billing Works Differently
AdvancedMD is a general ambulatory practice management and EHR platform with a lot of configuration underneath it. Fee schedules, carrier setup, claim scrubbing rules and worklists are things you set. You don’t just accept them. That depth is why it handles complex billing well. It’s also why two practices on the same software can get very different results.
Master Files Decide Everything Downstream
Providers, facilities, carriers and fee schedules get configured once, then quietly govern every claim after that. Set up a carrier with the wrong payer identifier, or leave a provider without a taxonomy, and you’ll get denials that look like payer behavior. They’re really a settings screen nobody’s opened in two years.
Claim Scrubbing Happens Before Submission
The platform checks claims against rules before they go out, which catches a good share of what would otherwise come back as a rejection. It’s only worth something if someone works the claims it stops. A held claim helps nobody until it’s fixed and resubmitted.
Built For General Medicine, Not Behavioral Health
The templates and defaults assume a general ambulatory practice. Behavioral health work runs fine here, including time-based psychotherapy codes, add-on codes billed with a medication management visit and authorization tracking for ongoing therapy. It won’t arrive set up, though. Someone has to configure it on purpose.
Worklists Are The Product
Accounts receivable control, claim worklists and the financial ledger are where the billing work actually happens. The system’s good at telling you what needs attention. It has no opinion about whether anyone’s looking.
The Workflow
The Billing Workflow, And Where It Gets Stuck
A visit produces a charge, the scrubber checks it, the claim goes out through the clearinghouse, and remittance comes back for posting and reconciling. The platform handles that part well. It’s the configurable parts that slip, the same pieces that made the software attractive in the first place, and they drift as staff turns over and payers change their requirements.
Claims Held By The Scrubber
A held claim isn’t a submitted claim. Scrubber-held queues are common, and they’re silent, since from the biller’s side nothing was ever denied. Working that queue every day is what keeps a clean submission process from turning into a slow leak.
Fee Schedule Drift
Contracted rates change, and the fee schedule in the system doesn’t update itself. Once the two drift apart you can’t tell an underpayment from a correct payment, so underpayments get posted and closed like everything else.
Enrollment For Claims, Remittance, And Payment
Electronic claims, electronic remittance and electronic funds transfer are three separate enrollments per payer, and they don’t finish at the same time. Claims flowing while remittances still show up on paper is normal. Practices just put up with it far longer than they should.
Reporting Reflects Setup, Not Reality
The reports are capable, and they report exactly what the system was told. Charges posted to the wrong provider, write-offs coded as contractual adjustments, payments applied to the account instead of the claim: each one produces a report that looks fine and describes something that didn’t happen.
- Whenever anything changes at a payer, audit the carrier and provider master files. A stale identifier in a settings screen will generate denials that no amount of claim-level rework will fix.
- Make sure you’ve finished all three enrollments with every payer, for claims, remittance and payment. Partial enrollment is the normal failure mode here, not total failure.
Our Role
Operating AdvancedMD Well
AdvancedMD rewards someone who’ll actually go into the configuration, and it punishes practices that treat it as a black box. We take on the operational work. We keep the master files honest, clear the held-claim queue before it turns into a backlog, post remittances at the claim level so the reports mean something, and push on denials while they’re still inside the appeal window.
- You keep AdvancedMD and your existing setup. We work inside it rather than rebuilding it.
- We clear scrubber-held claims on a daily cadence, because a held claim produces no denial and therefore no alarm.
- We keep carrier, provider, and fee schedule master files current, which is where a surprising share of recurring denials actually originate.
- We post remittances at the claim level and reconcile them, so underpayments are visible instead of buried in an account balance.
- We finish and maintain electronic claim, remittance, and payment enrollment per payer, and keep provider enrollment aligned with what’s being billed.
When the problem is configuration, like a carrier record with a stale payer identifier or a fee schedule that stopped matching your contracts, an Automation Program builds one workflow from start to finish in your own systems, such as comparing what each payer paid with your contracted rates, for $5,000, or five monthly payments of $1,000. If you want the daily billing work handled too, that’s our Ongoing Billing, priced by practice size (see billing prices by practice size).
AdvancedMD features, modules, and enrollment steps vary by edition and change over time. Treat this as general guidance and confirm your configuration with AdvancedMD directly.
FAQ
Frequently Asked Questions
Do We Have To Leave AdvancedMD To Work With You?
No. We work inside the AdvancedMD instance you already run, with the setup you already have. Your data, your history and your clinicians’ workflow stay where they are. What we take on is the work the platform leaves to you. That means the carrier and provider master files, the claims the scrubber holds, remittance posting at the claim level and denials while they’re still inside the appeal window.
Why Do AdvancedMD Claims Get Rejected Or Denied?
Often it’s something set once and never revisited. A carrier record with an outdated payer identifier, a provider missing a taxonomy or an enrollment, or a fee schedule that no longer matches the contract. The claim’s doing exactly what the configuration told it to do.
What Is A Held Claim And Why Does It Matter?
The system checks claims against rules before submitting and holds the ones that fail. That’s a feature. But a held claim was never denied, so it won’t show up in denial reporting, and a queue of them can build for weeks while everything looks healthy.
Can This System Handle Behavioral Health Billing Properly?
Yes, with configuration. It wasn’t designed around psychiatry and therapy, so time-based psychotherapy codes, psychotherapy billed with a medication management visit and authorization tracking for ongoing care need to be set up on purpose. Once they are, the platform’s capable.
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.