Questions to Ask When Selecting the Best Medical Billing Partner.

Choosing the right medical billing partner is one of the most important decisions a psychiatric private practice can make. An experienced, reliable billing company not only maximizes revenue and minimizes denials but also helps you navigate the ever-changing landscape of mental health reimbursement. Below is a guide tailored specifically for psychiatric providers. Use these questions—organized by topic—as you interview prospective billing companies. Feel free to adapt them to your practice’s particular needs (e.g., telepsychiatry, group practice, solo practitioner).

1. Experience & Credentials in Psychiatric Medical Billing

Psychiatric billing has nuances that differ from general medical billing, ranging from mental health parity laws to specific CPT codes (e.g., 90791 for diagnostic evaluation, 90837 for psychotherapy). Be sure your billing partner has solid, specialized experience.

• How long have you billed for psychiatric or behavioral health practices? You want a partner who understands codes like 90792 (psych eval with medical services), E/M + psychotherapy add-ons (90833, 90836, 90838), and can distinguish when to bill 90785 (interactive complexity).

• Can you provide references from other psychiatric practices (solo or group)? Speaking with existing mental health clients, particularly those offering telepsychiatry or services like medication management, can reveal how well the company handles nuances like state-specific regulations or carve-outs for substance use treatment.

• Are you affiliated with any behavioral health billing associations (e.g., HBMA, AAPC)? Membership signals ongoing training on changing CPT/ICD-10 updates, especially in mental health.

• Do you have experience billing for CPT codes unique to psychiatry (e.g., EAP benefits, neuropsychiatric testing, group therapy codes)? Practices that offer group therapy (e.g., 90853) or psychological testing (e.g., 96130–96133) need a billing partner who won’t miscode or underbill.

  
  

2. Scope of Services & Psychiatric-Specific Offerings

A full-service psychiatric billing company should handle charge entry, claims submission, denial management, and patient statements—while also understanding things like mental health parity and telehealth modifiers (95, GT, GQ).

• Which services are included in your standard psychiatric billing package?

  • Charge entry for all mental health CPT codes (initial eval, psychotherapy, medication management)

  • Electronic or paper claim submission to commercial payers, Medicaid, Medicare (with appropriate 59, 25, or 95 modifiers for telehealth)

  • Denial management for payers that often deny therapy claims (e.g., lack of prior auth, missing 150-minute limits)

  • Patient statements specific to behavioral health (e.g., co-pay after deductible, co-insurance for out-of-network therapy)

• Do you handle credentialing and insurer panel applications for psychiatrists, psychiatric NPs, or LPCs?Psychiatric practices often need credentialing with commercial carriers, Medicaid behavioral health plans, or state-specific mental health networks. Clarify whether these services are bundled or billed separately.

• Are prior authorizations and clinical documentation audits included? Many therapy sessions and medication management services require precertification (especially for certain antidepressants or injectable meds). Confirm whether the company will submit prior authorization requests and manage any chart audits.

• Can you coordinate with EAP (Employee Assistance Program) vendors or carve-out behavioral health plans? If you contract with EAP vendors (e.g., ComPsych, Magellan), ensure your billing partner can file direct claims and follow up on EAP reimbursements.

  
  

3. Technology & System Integration

Psychiatric practices often use specialized EHRs (e.g., Valant, SimplePractice, TherapyNotes). Seamless integration means fewer manual uploads, more accurate charge capture, and faster revenue cycle.

• Which EHR/practice management platforms do you support? Specifically ask about your system (e.g., “Have you billed through TherapyNotes or SimplePractice before?”). The right integration reduces “double entry” errors.

• How do you receive encounter data—batch upload, secure portal, or direct EHR integration? Practices that bill frequent psych med management (e.g., 99214 + 90785) need a streamlined process so visits aren’t delayed.

• What security measures (HIPAA-compliant) do you have in place for transmitting PHI? Encryption, secure FTP, or a dedicated portal are standard. Confirm that all servers and data centers meet HIPAA requirements.

• Do you provide an online dashboard or client portal to track claims, denials, and AR in real time? Having access to up-to-date Aging Reports (e.g., AR > 60 days) is critical for cash flow, especially if you practice medication management that relies on monthly refills.

  
  

4. Compliance & Quality Control

Mental health coding updates can be frequent, especially as telehealth rules evolve. Ensuring compliance helps your practice avoid audits and penalties.

• How do you ensure HIPAA compliance throughout the billing cycle? Ask about staff training, encryption protocols, and periodic risk assessments.

• What quality control checks do you perform for psychiatric codes (e.g., verifying time-based psychotherapy documentation)? Ensuring that “total time” meets the requirements for 90837 (53–89 minutes) versus 90834 (38–52 minutes) can save headaches during audits.

• How often do coders/billers participate in continuing education on mental health coding updates? Check if they attend AAPC or HBMA webinars specifically focused on behavioral health.

• Have you ever undergone a payer audit or external compliance review related to mental health claims? How was it resolved? A clear history, even if a few years ago, shows transparency and a process for corrective action.

  
  

5. Reporting & Communication

Timely, actionable reporting helps a psychiatric practice identify trends (e.g., high denials on telehealth codes) and adjust workflows or documentation.

• What types of reports can we expect, and how often (e.g., weekly aging, denial summary, payer mix)? You’ll want at least a monthly overview of:

  • Total claims filed broken down by CPT code (90791, 90837, 99213, etc.)

  • Clean-claim rate for mental health claims versus overall clean-claim rate

  • Aging buckets: AR 0–30, 31–60, 61–90, >90 days (especially because many psych claims hang in review longer)

• Can you customize reports to include metrics important to psychiatry (e.g., telehealth vs. in-person revenue, collections per provider)? Tracking revenue by service line (psychotherapy, med management, psychological testing) can help you budget and forecast.

• Who will be our dedicated account manager or point of contact, and what’s their background in behavioral health? Ensure they understand psychiatric workflows—when you bill 90846 (family therapy without the patient present) vs. 90847 (with patient present), for instance.

• What is your typical response time for inquiries (e.g., claim status, coding questions)? Rapid turnaround is crucial when a denied therapy claim affects provider compensation and cash flow.

  
  

6. Pricing & Fees

Transparent pricing helps you model your overhead. Psychiatric billing companies may charge a percentage of net collections or a flat fee per claim—each has pros and cons.

• Do you charge a percentage of net collections or a flat fee per claim?

  • Percentage models may align incentives, but can be unpredictable if your payer mix shifts (e.g., more out-of-network self-pay therapy sessions).

  • Flat-fee models provide predictability but might not incentivize maximum collections.

• Are there separate fees for credentialing, payer enrollment (e.g., for Medicaid behavioral health carve-outs), or prior authorizations? Some companies bundle credentialing only if you sign a one-year billing contract. Clarify any “discounted” rates versus the industry standard (e.g., $250 per panel application vs. discounted $100).

• How will our fees adjust if billing volume changes, seasonal fluctuations, or provider additions? If you add a new therapist or begin offering group therapy, confirm how that impacts your monthly fee.

• Do you require a minimum monthly revenue guarantee or upfront setup fees?Many vendors ask for a 90- to 180-day minimum or a one-time implementation charge. Ensure you understand all “hidden” costs—software access, reporting modules, or AR follow-up beyond X days.

  
  

7. Turnaround Time & Performance Metrics

Psychiatric services can experience longer reimbursement cycles, especially from Medicaid behavioral health plans. Keep an eye on KPIs that matter most to your practice.

• What is your average turnaround time from receiving encounter data to claim submission? Ideally, claims should be filed within 48–72 hours of service to avoid unnecessary lag.

• What is your clean-claim rate for behavioral health claims (percentage accepted on first submission)? A strong billing partner should aim for ≥95% clean-claim rate, focusing specifically on codes like 90792, 90834, and pharmacy reimbursement when meds are administered onsite.

• What is your average days in AR (accounts receivable)? Compare your practice’s AR with industry benchmarks: Psychiatry typically runs a bit higher than primary care. If their average is 45–60 days, you should push for 30–45 days.

• How do you monitor and report on key KPIs (denial rate, collection rate, net revenue)? Ask for sample dashboards or KPIs that show behavioral health breakdowns (e.g., insurance vs. self-pay, telehealth vs. in-office).

  
  

8. Denial Management & Appeals

Denied claims are inevitable, especially if payers challenge medical necessity, session length, or fail to recognize telehealth modifiers. Your billing partner needs a robust appeals process.

• What is your process for identifying and correcting denied or rejected psychiatric claims? Do they immediately resubmit with the correct modifier (e.g., 95 for telepsych), or do they wait for your approval?

• Are appeals and follow-ups on denied claims included at no extra cost? Some vendors consider “first-level appeals” included but charge for “second-level peer-to-peer appeals” or external reviews.

• Can you share a case study or example where you reversed a denial for a psychotherapy code? Look for instances where a payer denied 90837 for insufficient documentation, and the vendor successfully appealed.

• How soon do you notify us when a claim is denied, and what turnaround time do you guarantee for re-filing? You don’t want a denial sitting unaddressed for weeks, especially when a therapist’s paycheck may depend on timely appeals.

  
  

9. Patient Billing & Collections

A sensitive, clear approach to patient statements can improve collections, especially in mental health, where many patients pay out-of-pocket or have high co-insurance.

• Do you handle patient statements, collection calls, and payment plans, or is that our responsibility? If they manage patient billing, ask how they phrase statements so that balances for therapy sessions aren’t confused with other medical bills.

• What is your approach to self-pay/Out-of-Pocket balances common in psychiatry?Some vendors offer online payment portals with credit-card processing and text reminders—helpful for patients who prefer not to wait for mailed statements.

• How do you manage payment arrangements for patients undergoing long-term therapy (e.g., sliding-scale fees, extended payment plans)? Confirm if the vendor can track partial payments and report remaining balances accurately.

• What percentage do you allocate for bad-debt write-offs, and how do you handle accounts that remain unpaid >90 days? Understanding their policies helps you budget for allowance-for-doubtful-accounts, particularly if your practice offers free or reduced-fee initial consultations.

  
  

10. Contract Terms & Exit Strategy

No matter how confident you are, you may need to switch vendors someday. A clear exit strategy ensures minimal revenue disruption.

• What is the minimum contract term, and what notice is required for termination?Common terms are one year, with 30–60 days’ written notice.

• Are there penalties or fees for early termination? Some companies charge “data retrieval” fees or recoup “discounted credentialing” costs if you leave before Year 1.

• How will our patient data, claims history, and AR aging reports be delivered if we switch to a new billing partner?Ideally, you get a full electronic file (CSV or Excel) of all outstanding claims, denials, patient balances, and notes—within 14–30 days.

• Do you provide a transition plan for outstanding claims and pending appeals? Ensure that any claims in various stages (e.g., appeals, peer-to-peer reviews) are handed off smoothly, so they don’t fall through the cracks during the switch.

By asking these targeted questions—especially those specific to psychiatric billing (e.g., handling psychotherapy codes, prior authorizations for psychotropic medications, telehealth modifiers)—you’ll gain a comprehensive understanding of each vendor’s strengths and fit for your practice. Remember to:

1. Compare multiple billing partners on both pricing and performance metrics.

2. Request sample reports to verify that you’ll see critical data (AR aging, denial trends, revenue by CPT code).

3. Clarify any ambiguous terms in the contract—fees, service level guarantees, and exit costs.

4. Follow up with references from other psychiatric practices to confirm hands-on experience and responsiveness.

A well-chosen billing company becomes an extension of your practice, freeing you to focus on patient care, knowing that reimbursements are maximized, denials handled promptly, and compliance maintained. Good luck as you interview prospective partners and align your practice for sustainable financial success!