Each clinician you add adds one more NPI, license type and payer panels to the claim. Mental Health Billing keeps those records straight so claims, payments and denials stay tied to the right provider as your group grows.
A solo clinician with 1 NPI and 1 set of payer contracts. A group has a single billing entity, many rendering clinicians and payer relationships that seldom match from person to person. This is where those things occur.
When provider info is in multiple spreadsheets and follow-up is whoever has time, claims get touched twice or not at all. Writing out the workflow, one record per clinician and payer, makes it easier to see where the gaps are.
Use them together or individually. Before we start work, we write down the scope.
We verify the clinician’s NPI, taxonomy, license type and payer participation against what’s on the claim so the billing and rendering information is what the payer has on file.Small note Enrollment and credentialing is done with each payer, by your team or a separate vendor. Our review is no alternative to them.
Before the first visit, where in scope, we check for active coverage, copays, deductibles, visit limits, and authorization rules for the clinician who will see the patient. Small note The eligibility response of a payer is not a promise of payment, but the time of the check.
We enter charges from each clinician’s note and superbill. Then we check diagnosis codes, CPT codes, modifiers and dates of service before a claim goes out.Little note Code goes with what the record shows, and no review catches everything.
The billing provider field contains the group’s organizational NPI and the treating clinician’s NPI is in the rendering field, and the service location is reported when requested by the payer.
For each denial we read it, separate billing errors from enrollment or documentation issues, fix and resubmit what we can, and prepare appeals where we have documentation to support an appeal.Little note Some denials are not appealable and recovery is not guaranteed.
We post each payer deposit to the correct claim and clinician, record adjustments and patient balances and flag payments that differ from the expected amount.
Work unpaid and aging claims by payer, clinician, age. Call payers for status. Keep written log of what is still open and why. Small note Follow up does not guarantee collection or a date of payment.
Where in scope, we send patient statements only after the payer has processed the claim and adjustments are applied, so the balance is consistent with the remittance.
Group billing looks different for a 5-therapist counseling practice than it does for a psychiatry group that has nurse practitioners. License type, payer contracts, service mix and site all change the claim, and one clinician's billing rules aren't always the same as the next.
Group practice billing and group therapy coding are two different topics. This page is about the former.
Several factors can affect how claims are constructed when clinicians work under one organization. Current payers vary so each rule below is verified against policy.
Our workflow is built around your current process and the services you have under contract.
Walk through who bills what today and where claims get stuck at.
Compare NPIs, license types, payer participation to claims data.
Check benefits and authorization rules when applicable prior to the visit.
Create a claim for each clinician’s documentation with the appropriate billing and rendering fields.
Submit claims and track payer responses and status.
Distinguish enrollment issues from billing errors, and correct or appeal.
Reconcile each deposit to claims, clinicians and adjustments.
Work aging claims and record what is still open.
The clients do not necessarily go through all eight steps, and the order depends on the services you choose.
By outsourcing some or all billing, clinicians and front desk staff can spend less time chasing claims. Results are impacted by your payers, your documentation and how much you outsource.
These are potential benefits, not guaranteed results.
If a behavioral health group wants to compare billing companies, it should ask who owns each task and how open items are reported. That’s our answer for both.
Billing across clinicians, specialties, payers and locations. Answers on how to make it all work.
Billing support for practices with multiple clinicians. This includes claims, payment posting, denials and A/R for all providers including each clinician’s own NPI, license type and payer status. It’s another coding issue to bill for group therapy sessions.
A solo clinician will usually have one NPI, one set of payer contracts and one remittance trail. A group has a number of rendering clinicians, usually with varied licenses and payer panels, with an organization billing for them. Payments also have to be broken out again to each clinician.
The claim is submitted by the billing provider and paid. The rendering provider is the provider who performed the service. Many groups bill under the organization and list the clinician as rendering, although some payers or arrangements require something different.
Generally, eligible clinicians have their own Type 1 NPI, and payers expect to see it on claims as the rendering provider. A Type 2 NPI is also used by a group that bills as an organization. Test your setup with each payer.
If a clinician is not enrolled with a payer or the payer’s records are out of date, claims can be denied, paid at a different rate or not accepted. Enrollment is determined with the payer. We’ve seen denial patterns in our follow-up spots that point to it, so your team can act.
Yes if they are in scope. The three have different codes, documentation and payer rules. Tell us about the specialties and license types that make up your group and we will set the scope around that.
We post each payment to the individual claim by payer, clinician and date of service, post contractual adjustments and patient responsibility and reconcile the total to the remittance. Differences are put on review.
What tasks are you outsourcing and who manages credentialing and enrollment. Identify the flows of provider and payer data to the billing team, clinical documentation flow and desired claim and A/R reports.
On the contact page, let us know how many clinicians you have, the specialties you have, the payers you work with, your current billing process, and any open denials. We will explain what support is a fit.
If your group is adding clinicians, losing track of claims and payments, or letting denials sit, send us your clinician count, main payers and open claim concerns. We would describe our approach to the work.
Contact Billing Team →