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A full treatment center still struggles with cash flow if eligibility checks are late or authorizations lapse. We coordinate admissions, utilization review, and billing into one accountable revenue cycle.
Dedicated revenue cycle management tailored to the specific documentation standards and utilization guidelines of each ASAM level of care.
24-hour medically monitored acute withdrawal services. We track daily nursing documentation and physician rounding logs.
Structured residential clinical recovery environments. We manage per-diem institutional billing and room and board synchronization.
Day treatment programming. We manage structured group counseling and psychiatric medication oversight.
Structured step-down clinical care. We track active attendance and authorized units.
Ongoing relapse prevention psychotherapy and recovery maintenance counseling.
Opioid Treatment Programs billing with bundled administration codes.
Substance use disorder treatment involves distinct billing models that demand precise coordination across nursing and medical providers.
We synchronize institutional per-diem claims and professional attending physician claims to ensure clean adjudication.
Covers facility overhead, room and board, and 24-hour nursing observation.
Covers direct physician evaluations and separately billable individual psychotherapy encounters.
Substance use disorder admissions happen quickly. Waiting 24 hours for a verification of benefits creates financial exposure.
We provide 2-hour rapid intake verifications detailing deductible balances and carve-out authorization requirements.
Comprehensive benefits summary detailing exact deductibles, copays, and carve-out payer rules.
Active tracking of approved per-diem days with proactive alerts before concurrent review deadlines.
We structure concurrent utilization packets to mirror ASAM criteria for maximum authorization retention.
Commercial payers frequently carve out behavioral health & addiction benefits. Misrouting institutional admissions to standard clearinghouses triggers fatal 60-day timely filing denials.
We establish a disciplined division of operational ownership between your facility's clinical team and our certified billing specialists.
You submit client insurance data. We verify benefits within 2 hours to confirm deductibles and pre-cert rules.
Upon clinical admission, we submit the initial authorization request to the payer’s utilization department within mandatory 24-hour notification windows.
We coordinate concurrent review milestones with your clinical team and submit extension packets before authorization expiration.
We generate daily claims across institutional and professional services. We post electronic remittances and file formal appeals for adverse determinations.
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) |
We work seamlessly inside Kipu, Sunwave, TherapyNotes, AdvancedMD, and enterprise behavioral health platforms with zero disruption to clinical documentation.
We partner with accredited substance use disorder facilities that value compliance and dedicated revenue cycle operations. Here is how we evaluate fit:
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
Direct answers to common questions about treatment facility billing, rapid VOBs, UB-04 vs. CMS-1500 synchronization, and ASAM criteria.
We understand that admissions in substance use disorder treatment are time-critical. Our dedicated intake verification team provides comprehensive VOB reports within 2 hours during normal operating windows, detailing active deductibles, out-of-pocket maximums, and carve-out authorization requirements.
Yes. We manage both billing pathways: institutional facility per-diem charges (UB-04 / 837I) with appropriate revenue codes, and attending physician / psychiatric medication management encounters (CMS-1500 / 837P), ensuring clean synchronization without dual-billing rejections.
We establish forward tracking schedules based on initial approved days (e.g. 3 days for detox, 7 days for residential, 14 days for PHP/IOP). Our team alerts your clinical staff 48 to 72 hours prior to expiration to gather updated progress notes and submit concurrent review extension requests.
When an individual steps down from Residential to PHP or IOP, we coordinate concurrent discharge and admission authorizations simultaneously. This prevents coverage gaps, unauthorized treatment days, or retroactive per-diem claim denials.
Most commercial and Medicaid payers evaluate medical necessity using the American Society of Addiction Medicine (ASAM) Criteria across six dimensions. We guide your utilization staff on structuring clinical documentation packets to align directly with ASAM dimensional requirements.
Our fees are performance-aligned as a percentage of net collections (typically 2.99% to 8.5%), scaled based on average facility census, levels of care offered, and payer mix complexity. See our pricing overview for detailed tier information.
Yes. Through our credentialing services, we manage Type 2 institutional NPI enrollment, facility payer applications, and medical director rendering links for accredited treatment programs.
No. Our operational facility review evaluates de-identified aggregate remittance data, census billing schedules, and denial categorization logs. We never collect patient names, dates of birth, or confidential substance use clinical records.
Discover where unbilled per-diem days, authorization drop-offs, or carve-out rejections are impacting your facility’s cash flow. Zero patient data required.
Speak directly with an MDRG billing operations manager about your facility’s census tracking, UB-04 revenue codes, or concurrent review workflow. No sales pitch, zero claim data needed.
