Per-diem payment
Learn how each payer pays the day: Medicare’s IPF PPS, negotiated rate, or case rate.
Billing Assistance for Psychiatric Hospitals, Distinct Part Units and Inpatient Behavioural Health Facilities. We take care of authorisations, facility and physician claims, denials, payments and ageing A/R one admission at a time.
One admission might take weeks, be billed daily, need payer reviews every few days and result in both a facility bill and a separate physician bill. We keep the dates, payer rules and follow-up in check.
Context Note: Rules are facility, payer, contract, and service dependent. Your facility is the clinical and compliance decisions.
Learn how each payer pays the day: Medicare’s IPF PPS, negotiated rate, or case rate.
Track approved days and next review date due.
Alert your clinical team to missing billing information.
Find out if benefit is administered by a separate administrator.
Facility and physician claim details must match.
Work denials, short payments and unresolved A/R.
These are the usual reasons for unpaid days, late payment and rework.
The IPF PPS paid by Medicare is a per-diem payment adjusted for patient age, MS-DRG, comorbidities, day of stay, and facility factors such as wage index and rural or teaching status. Other payers pay negotiated case rates or per diems.
Approved days, admission date and next review deadline must be consistent. An authorisation is not a payment promise but we do track authorisation details and payer contact information.
We review the denial reason, the authorisation history and the records submitted by your facility, then arrange billing corrections or appeals. “Clinical determinations are the province of the facility and the payer.
Medicare requires physician certification on admission, recertification on day 12 and then every 30 days. Part A also has a lifetime limit of 190 days for care in freestanding psychiatric hospitals, but separate-part units do not have the same limit.
Some plans exclude behavioural health and manage it separately. Before anything is submitted we check who is authorised, the claim address and the appeal rights.
The dates, diagnoses, and provider information on the UB-04 and CMS-1500 must tell the same story, although each claim has its own rules.
We review remittances, claim status and contract terms to determine next steps: correct, reprocess, appeal or call the payer. A check is made for a gap before it can be called an underpayment.
Give us the entire revenue cycle or just the time-consuming tasks.
Check coverage and behavioural health benefits, identify carve-outs and document approved dates and review deadlines.
Confirm diagnoses, charges, and codes against documented services and each payer’s requirements.
Prepare and review UB-04 facility claims for admission dates, covered days, revenue codes and payer fields.
Professional coding and correct place of service to support psychiatrist and other clinician claims.
Research rejected and denied claims, coordinate corrections, organise appeal files as necessary and track deadlines.
Process payments, adjustments and patient balance. Resolve discrepancies in remittance and contract terms.
Track aged unpaid claims, by payer, balance and next action to ensure open work is visible.
The hospital and the treating physicians submit a separate bill for the same admission. The two must agree on the facts but differ on the rules.
Bills facilities stay under institutional rules.
Separate claim bills for services of each treating psychiatrist or eligible clinician.
Billing, authorisation and clinical staff all working with the same dates
Days to review, days approved, admission dates and claim data must be consistent. We handle the billing follow-up and leave the clinical decisions to your facility.
It is contingent upon what your facility is classified as and the rules of each payer.
We submit claims according to current IPF PPS rules such as covered days, certification dates, and the 190-day limit in freestanding hospitals. Quality reporting stays at your facility, but a missed submission costs you 2 percent of the annual update. Each plan has different rules about Medicare Advantage.
Federal Medicaid funds also generally do not cover adults ages 21 through 64 treated in an institution for mental diseases, with some exceptions, and the psych under 21 benefit covers younger patients. We are confirming what your state will pay for.
Review the rules for each plan and any delegated behavioural health administrator for authorisation, claim routing and appeals. Payers have their own "notification windows" after an emergency admission.
The records are consistent in the billing, sensitive information is handled carefully, and the claims are accurate.
Review and follow-up routine that fits your payer mix and scope of choice.
Review your payer mix, facility type and current billing process.
Review benefits and make note of authorisation dates and review due dates.
Verify diagnoses, charges and claim details against the record.
Prepare and send facility and physician claims.
Denial processing, payment posting and remittance reconciliation.
Open A/R follow up, trace repeat problems.
Steps will vary depending on payer requirements and the services you enroll in.
For inpatient facilities and the physician groups who treat them.
Scope is dependent on your facility type, payer mix and existing team.
A specialist partner allows your team to identify denied days, missed deadlines, and stalled claims earlier.
FAQs about inpatient billing. Common questions and answers.
Revenue Cycle Support for psychiatric hospitals and units: authorisation tracking, claims, denials, payment posting and A/R follow-up.
Inpatient billing covers one continuous stay, usually paid by the day, with continued-stay reviews and separate facility and physician claims. Outpatient is billed session by session.
It pays eligible inpatient psychiatric facilities a daily rate, adjusted for patient age, MS-DRG, comorbidities, day of stay and facility factors, and has a separate per-treatment payment for electroconvulsive therapy. CMS updates rates every year.
Medicare Part A covers up to 190 days lifetime in a free-standing psychiatric hospital. Days spent in a separate-part psychiatric unit of a general hospital do not count toward this limit.
The UB-04 lists the institutional charges, dates and revenue codes of the facility. The CMS-1500 is used to bill for a physician's or other clinician's professional services using procedure codes and place of service. They have their own rules.
Missing or mismatched approvals – or a late review – can result in denied days. Authorisation on file does not guarantee payment.
We can review the reasons for the bill, coordinate corrections, organise records for justified appeals and follow up with the payers. We do not make clinical decisions.
Use the form above or email us at info@mentalhealthbilling.us. Do not send patient identifiable information via unsecured email.
Talk to us about denied days, authorisation gaps, payer routing or ageing A/R.