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Behavioral-health billing requires precise alignment with your clinical workflows. We build custom revenue cycles that prevent downcoding and capture every minute of therapeutic care.
A solo therapy practice, a prescriber psychiatry group, and an addiction treatment center break in completely different operational places. Select your practice model below to see how we solve your specific friction points.
High-volume 60-minute individual sessions (90837) routinely face automated downcoding to 45 minutes (90834), costing clinicians $35–$50 per patient encounter due to missing start/stop timestamp logs or incorrect telehealth POS 10 vs 02 codes.
Our certified coders verify exact timestamp continuity inside your EHR notes, apply active state-specific telehealth modifiers (-95 vs -93), and eliminate downcoding clawbacks before electronic release.
Commercial insurance cards display major payers like BCBS, Aetna, or UnitedHealthcare, but mental health benefits are quietly carved out to separate specialty networks. Here is why unguided billing breaks.
From pre-encounter carve-out verification to penny-perfect bank reconciliation, see how every claim moves through our audit-proof lifecycle.
Real-time 270/271 inquiry before patient encounters to verify behavioral health deductible status, active session copays, and hidden third-party carve-out payer ID routing.
Therapy and behavioral practices often struggle between overburdened in-house staff and software-only auto-submission. See how a dedicated behavioral RCM pod changes the financial equation.
| Billing Capability & Standard | In-House Clinic Biller | Software Auto-Submit | MD Revenue GroupDedicated Behavioral Pod |
|---|---|---|---|
Specialized AAPC Behavioral Coders Certified experts who know psychotherapy timestamp rules, add-ons, and ASAM levels | Costly & Hard to Find ($65k+/yr) | None (No Human Review) | Included (Dedicated Behavioral Pod) |
Pre-Submission Timestamp Scrubbing Verifying notes match start/stop times before claims leave to stop 90837 downcoding | Inconsistent / Manual | Not Checked (Blind EDI) | 100% Pre-Claim Audit |
Automated Carve-Out Payer Rerouting Identifying Optum BH, Carelon, and Magellan before submitting to primary clearinghouse | High Error Rate | Routes to Primary (Rejection) | Automated Crosswalk Routing |
Aggressive Denial Appeals SLA Formal clinical narrative appeals for unworked denials within 48 business hours | Often Backlogged / Abandoned | Clinician Must Appeal | 48-Hour Systematic SLA |
Practice Pricing & Risk Alignment Compensation model aligned directly with actual collections and financial performance | Fixed Salary, Taxes & Overhead | Monthly Fee Regardless of Pay | Performance-Based (2.99%–8.5%) |
Long-Term Contract Commitment Flexibility to evaluate partnership value monthly without restrictive lock-ins | Severance & Re-hiring Friction | Annual Platform Lock-In | Month-to-Month (Earned Trust) |
Between silent payer downcoding, managed care carve-outs, and unworked technical denials, most behavioral health practices lose 12% to 22% of earned clinical revenue. Calculate your potential exposure below.
We work directly inside your existing behavioral health EHR platform. Your clinicians and front desk document as usual without learning new tools.
High-frequency codes, add-on structures, and modifiers where documentation precision and payer-specific rules determine reimbursement velocity.
| Code / Modifier | Service Description | Operational Billing & Documentation Note |
|---|---|---|
| 90832–90837 | Individual Psychotherapy (30, 45, 60 min) | Requires exact start/stop timestamps in note; downcoding risk without documented intensity. |
| 96130–96131 | Psychological Testing Evaluation | First hour (96130) + add-on hours (96131); separates clinician interpretation from testing technician time. |
| +90833 / +90836 | Psychotherapy Add-on to E/M Encounter | Must have a separate, distinct time log for the psychotherapy portion of the visit. |
| 90791 / 90792 | Psychiatric Diagnostic Evaluation | 90791 for diagnostic assessment without medical services; 90792 includes medical examination. |
| 99484 / G0511 | Collaborative Care & Behavioral Health Integration | Monthly time-based management requiring structured care plan and designated psychiatric consultant. |
| Modifiers -95 / -93 | Telehealth Modality Identifiers | -95 for real-time synchronous audio/video; -93 for audio-only encounters (payer acceptance varies). |
| Modifiers -HO / -HE | Credential-Level State Identifiers | Used by state Medicaid programs to distinguish Master's-level clinicians (-HO) from Doctoral clinicians (-HE). |
Clear division of operational ownership between your clinical team and MDRG's certified billing specialists.
We establish a secure data bridge to your EHR and audit a sample of recent claims. This maps your exact denial root causes and payer bottlenecks.
We scrub every session claim for exact timestamp compliance and correct telehealth modifiers before leaving your clearinghouse portal.
We categorize rejected claims immediately upon ERA receipt. We resubmit correctable technical rejections within 48 hours and launch clinical appeals for medical necessity denials.
You receive clear reporting on net collections, contractual adjustments, and denial distribution by payer.
To evaluate your billing setup, denial patterns, and fee schedule alignment, our billing directors review aggregate practice data. Zero patient-identifying data is required.
Group NPI, Tax ID (EIN), and individual rendering provider NPIs, licenses, and primary taxonomy codes.
List of participating commercial, Medicaid, and managed behavioral health payers, including effective dates.
Recent 835 ERAs or EOB summary pages showing current reimbursement rates, contractual adjustments, and denial codes.
Your team’s primary billing friction points (e.g. 90837 downcoding, authorization lapse, credentialing lag).
Your current clinical software (TherapyNotes, SimplePractice, Valant, etc.) and clearinghouse gateway.
Approximate monthly charge volume to help us scope dedicated billing manager and certified coder allocation.
We do not hide behind anonymous offshore call centers or unverified software bots. MDRG provides direct access to credentialed revenue cycle managers and certified coding specialists.
Our coding and audit specialists maintain active credentials with the American Academy of Professional Coders (AAPC), ensuring precise CPT, ICD-10, and modifier application for behavioral healthcare encounters.
All data exchange, clearinghouse connections, and EHR interactions strictly adhere to HIPAA Omnibus standards, including 256-bit SSL encryption, restricted role-based access, and signed Business Associate Agreements (BAAs).
Founded by Faisal and Salwa in 2023 with over 13 years of combined revenue cycle leadership. Every practice has a named billing operations manager with direct phone and email escalation pathways.
Transparent month-end reporting on net collections, gross claims, denial categorization, and days in AR. We earn your partnership through monthly performance without restrictive multi-year lock-ins.
“Independent behavioral health clinicians should never have to sacrifice patient session time to battle commercial insurance clearinghouses. We treat your revenue cycle with the exact operational discipline you apply to patient care.”Faisal & Salwa — Founders, MD Revenue Group
We partner with practices that value compliant clinical documentation and dedicated US-managed billing operations. Here is how we evaluate partnership fit:
Explore specialized billing workflows, credentialing guidelines, and coding protocols for specific behavioral health clinical models.
Mental Health Billing Services
We capture revenue for therapy sessions, psychological testing, and collaborative care.
Outpatient Therapy Billing
Streamline your claim workflows for individual, group, and family therapy.
BH Credentialing & Enrollment
Let us handle payer network contracting for your entire clinical roster.
Prior Authorization Management
We manage pre-cert and concurrent reviews for your IOP, PHP, and therapy sessions.
Claim Denials & Appeals
Our certified coders analyze root causes and submit clinical appeals for behavioral health rejections.
Addiction Treatment Billing
Secure reimbursement for your SUD, PHP, residential, and MAT programs.
Psychiatric Billing Services
Maximize revenue for integrated behavioral health, mid-level supervision, and collaborative care.
Direct answers to common questions about behavioral health billing workflows, payer parity, start/stop times, and outsourcing transitions.
Session-based billing relies on exact start and stop timestamps and precise modifier application. Behavioral health claims are heavily scrutinized for therapeutic intensity and time adherence. Minor documentation mismatches trigger automated payer rejections.
We require basic practice details: EHR platform name, participating payer roster, and a de-identified sample of recent remittance advices (EOBs/ERAs) showing denial codes and payment amounts. We never request patient names, dates of birth, member IDs, or clinical psychotherapy session notes for an operational audit.
We handle your complete enrollment lifecycle. We manage CAQH profile updates, initial network applications, and routine re-credentialing. Payer enrollment timelines typically range from 60 to 120 days depending on network volume. Explore our dedicated credentialing services for detailed scope.
Telehealth modifier rules (-95 for synchronous audio/video, -93 for audio-only) and place-of-service codes (POS 10 for patient home, POS 02 for telehealth facility) vary significantly across commercial payers, Medicare MACs, and state Medicaid programs. We apply payer-specific scrubbing algorithms to verify that documentation and billing codes match each insurer’s active rules prior to claim submission.
We support all major behavioral health EHR platforms like TherapyNotes, SimplePractice, and Valant. If your practice uses a custom software, we evaluate direct clearinghouse export options during onboarding.
Our fees are performance-aligned, typically ranging from 2.99% to 8.5% of net collections based on monthly claim volume, clinical provider count, service complexity, and payer mix. We only earn when your practice gets paid. See our full pricing overview for plan details and inclusions.
We coordinate a structured 2- to 4-week transition: establishing parallel clearinghouse connections, mapping active recurring authorizations, auditing historical accounts receivable, and setting clear cutoff dates for legacy submissions. Claims continue flowing daily without submission blackouts.
This hub covers multidisciplinary behavioral health: outpatient psychotherapy, group counseling, addiction treatment facilities, and integrated behavioral clinics. If your practice is a dedicated physician-led psychiatric practice specializing in neuropharmacology, TMS, Esketamine (Spravato), or complex inpatient psychiatric consults, visit our canonical Psychiatry Medical Billing page.
Discover where uncaptured session time, downcoding, and payer rejections are eroding your collections. No patient-identifying data required.
Speak directly with an MDRG billing operations manager about your EHR setup, payer friction, credentialing timeline, or practice transition. No sales pitch, zero claim data needed.
