For the facility side of a Medicare admission, the per diem is the entire ballgame, and it is precisely where generalists drown. There is no single bundled charge that captures a stay; instead each covered day is priced off the federal base rate and then adjusted, with the variable per-diem factor paying the early days richest and the later days leaner. We build that claim to the framework's exact specification, apply every patient- and facility-level adjustment the case earns, and make sure the documentation underneath each day is sturdy enough to hold when a payer decides to look closer.
This is the revenue that evaporates silently. Under IPF PPS, qualifying co-occurring conditions a substance use disorder, certain medical comorbidities, the diagnoses on CMS's defined adjustment list each lift the per diem, but only when they're documented and coded across the days they actually apply. A chart that captures the admitting diagnosis and nothing more isn't merely thin clinically; it forfeits billable dollars on every date of service. We chase the full clinical picture, map it to the comorbidity and Code-First adjustments it triggers, and stop money that should have been collected from quietly going uncaptured.
The institutional claim is where an inpatient psychiatric stay gets paid or quietly falls apart. We assemble the UB-04 the way payers demand it: the correct 11X type of bill for the setting, room-and-board revenue coded to the room the patient actually occupied at the midnight census 0114 for a private psychiatric room, 0124 or 0134 when the bed was semi-private and interim claims dropped on the 60-day cadence Medicare allows for long stays, with the adjustments finalized on the discharge claim. Code the wrong room for the night and the day argues with itself.
The psychiatrist's work is a second claim entirely, and it doesn't bill itself off the facility's coattails. On the CMS-1500, with place of service 51, we report the admitting evaluation, the daily management, and the discharge initial hospital care under 99221 through 99223, subsequent days under 99231 through 99233, discharge-day management under 99238 or 99239 each one matched to documented complexity, each provider's NPI and taxonomy lined up against the service so a prescriber's code never lands under a credential that can't carry it.
This one isn't guidance; it's a wall. If the psychiatric diagnostic evaluation isn't performed and documented within twenty-four hours of admission, the payer simply will not pay for that admission date. We track it like the deadline it is billing 90792 when the same prescriber furnishes the evaluation and the medical services together, separating 90791 from the initial-care E/M when two different providers split the work so an admission day never goes dark over an evaluation that happened but landed an hour late or got coded wrong.
Electroconvulsive therapy carries its own logic on both claims: a separate per-treatment adjustment on the facility side and 90870 on the professional side, neither of which a general biller reliably catches. Where withdrawal management and co-occurring substance treatment fold into a psychiatric admission, we code the overlap correctly rather than letting one diagnosis swallow the other, and we keep the add-on and interactive-complexity services attached to the days they support instead of leaving them stranded off the claim.
Medicare's psychiatric benefit comes with rules that ambush the unprepared. A patient discharged and readmitted inside the three-day interrupted-stay window is one continuous stay, not two bill it as two and the second claim bounces. Freestanding psychiatric admissions draw down a 190-day lifetime ceiling that, once exhausted, is gone for good, with the correct occurrence codes required as benefits run out. We watch the benefit days, flag the exhaustion before it surprises anyone, and keep these moving parts from turning a paid stay into a written-off one.
We pin coverage down before the patient is ever registered: remaining Part A days, copays, coinsurance, the deductible, and the question that sinks more psychiatric admissions than any other does this plan even cover inpatient psychiatric care at this level, for how many authorized days, and routed through which behavioral carve-out? More than a few commercial and Medicare Advantage members have their mental health benefits administered by a separate entity like Optum, Carelon, or Magellan, and verifying that upfront is the cheapest denial you'll ever avoid.
An inpatient psychiatric admission lives or dies on authorization, and the work doesn't end at the front door. We secure the admission auth with every commercial and Medicare Advantage payer, then keep the concurrent reviews moving day after day so an unpredictable length of stay never outruns its approved days. Let an authorization lapse mid-episode while the patient is still in the bed and you've manufactured a denial out of care you actually delivered.
Before a single day is billed, we confirm eligibility, count the remaining Part A benefit days, capture the benefit detail line by line, lock in every authorization the admission requires, and for Medicare and any plan that demands it make sure the physician certification is in place, so the revenue cycle opens clean instead of scrambling to backfill coverage after the patient is already days into the stay.
Each day is built twice over: the facility per diem under IPF PPS with every age, comorbidity, ECT, and facility-level adjustment the case earns, and the psychiatrist's professional service coded to documented complexity. We capture the co-occurring diagnoses that lift the per diem and hold the documentation against the payer's medical-necessity standard before anything generates.
Scrubbed claims go out fast on the right forms the UB-04 transmitted as an 837I for the facility stay, the CMS-1500 as an 837P for the professional services with type of bill, place of service 51, revenue codes, authorization numbers, diagnoses, and code linkage all double-checked, so the first submission is the one that pays rather than the one that boomerangs.
Rejections get worked the day they land. We appeal denials, pursue aging balances on both the facility and professional claims, keep concurrent reviews from stalling, and hold payers to the contract, so your revenue never quietly disappears into some forgotten corner of the adjudication system.
You receive clear, regular reporting collections, denial patterns, AR aging, authorization status, payer mix, benefit-day burn so you can read the financial pulse of your facility at a glance instead of reverse-engineering it from whatever happens to be sitting in the account.
Eligibility calls, charge entry, authorization chasing, concurrent review, denial research, statement runs every hour your team pours into billing is an hour stolen from the people on the unit. We shoulder the whole load instead.
Behavioral-health-specific coding means we catch what slides past generalists: the comorbidity adjustment never documented, the ECT treatment left off the claim, the professional evaluation that missed the 24-hour window, the authorization that quietly expired mid-stay the slow leaks that drain inpatient psychiatric revenue one day at a time.
Clean first-pass claims paired with relentless follow-up shrink the gap between the service and the deposit, smoothing the cash-flow swings built into a psychiatric census that rarely holds steady from one month to the next.
The IPF PPS rate revisions that land every fiscal year, mental health parity, physician certification requirements, telehealth policy in flux, good-faith estimates for self-pay patients under the No Surprises Act, state Medicaid behavioral rules that shift by plan we track the moving parts so a compliance gap never ambushes your facility from a blind spot you weren't watching.
Add beds, stand up a second unit, open a new service line, or absorb a sudden surge of admissions our capacity stretches the moment you need it, with no job posting, no onboarding drag, and no dip in productivity during the handoff.
Transparent reporting keeps both sides of the claim in plain sight what's collected, what's pending, what's denied, and exactly why so you're never left guessing about the financial side of the facility you built.
We aren’t a general medical billing shop that dabbles in psychiatry between cardiology and orthopedics. Behavioral health its codes, its caps, its parity protections, its level-of-care logic is the whole of what we do, which is exactly why the nuance gets handled right the first time instead of learned on your dime.
An inpatient psychiatric stay straddles two billing worlds at once: the institutional UB-04 paid under IPF PPS and the psychiatrist’s professional CMS-1500 chasing it day for day. We move between them without breaking stride, so the facility claim and the professional claim both leave the door coded correctly a distinction plenty of billers never fully sort out.