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In recurring therapy, revenue leaks from small administrative oversights repeated across dozens of visits. We implement disciplined revenue operations to stop authorization lapses and secure your therapy claims.
When clients attend weekly or biweekly sessions, minor administrative oversights compound into thousands of dollars in delayed claims and patient disputes.
When an authorization allows 12 sessions and a client attends 16, the final 4 claims are rejected. Without active unit tracking, unapproved care results in complete revenue write-offs.
Payers flag high-frequency 60-minute therapy sessions (90837) when notes lack exact start and stop timestamps (e.g. 10:04 AM – 10:57 AM), downcoding claims to 45-minute rates (90834).
Filing telehealth encounters with the wrong place-of-service code (POS 10 for patient at home vs. POS 02) or wrong modality modifier (-95 vs. -93) triggers instant clearinghouse rejections.
Commercial insurance cards often route mental health claims to separate managed carve-out payers (Optum BH, Carelon, Magellan) rather than the primary medical clearinghouse payer ID.
When primary ERA remittances sit unposted in an EHR, secondary Medicaid or commercial claims are stalled until timely filing deadlines pass permanently.
Delaying patient statements leads to billing disputes and severely reduced collection velocity.
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 solo clinicians establishing their first in-network contracts to established group practices managing multi-site schedules.
We provide a dedicated billing department for independent therapists.
We standardize charge capture and unify credentialing for multi-clinician practices.
We secure reimbursement for family and group therapy alongside interactive complexity documentation.
We manage your psychotherapy claims alongside complex diagnostic testing evaluations.
Billed codes must accurately reflect the documented direct clinical contact time, therapeutic modality, and individual payer requirements.
Standard time thresholds: 90832 (16–37 min), 90834 (38–52 min), and 90837 (53+ min). The billed code must accurately reflect the documented direct clinical contact time and medical necessity.
Family psychotherapy without patient present (90846, 50 min) and family psychotherapy with patient present (90847, 50 min). Both codes require explicit treatment plan documentation.
Multi-patient group therapy sessions. Each participant is billed under 90853 with an individualized session note reflecting personal participation and therapeutic response.
Billed in conjunction with primary therapy codes (90791, 90832, 90834, 90837) when communication barriers, high emotional reactivity, or third-party involvement complicate care.
Telehealth billing rules are not universal. Applying Medicare telehealth rules to commercial payers or assuming Medicaid plans follow identical place-of-service standards causes systematic front-end rejections.
POS 10 indicates services provided in the patient’s home, while POS 02 indicates telehealth provided in other locations. Some commercial payers require POS 11 with modifiers, while others demand strict POS 10 compliance.
Modifier -95 identifies synchronous real-time audio/video encounters, whereas modifier -93 applies to audio-only phone sessions where permitted by state parity laws and payer contracts.
Clear, step-by-step operational handoff between your clinicians and MDRG’s certified billing specialists.
Your clinician conducts the therapy session and completes the clinical note in your EHR with exact start and stop timestamps (e.g. 10:02 AM – 10:55 AM).
We review every encounter for CPT accuracy and modifier correctness.
We transmit claims electronically and resolve any front-end rejections within 24 hours.
We post electronic remittances and reconcile them directly to your bank deposits. We bill patient balances and appeal denials immediately.
In therapy practices, billing disputes strain therapeutic relationships. When patients receive unexpected balance statements three months after an encounter, confusion and payment hesitation follow.
We coordinate patient billing immediately following electronic remittance (ERA) posting. Patients receive clear, itemized statements explaining their exact balances directly through your EHR portal.
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 directly inside your existing behavioral health EHR platform. Your clinicians and front desk document as usual without learning new tools.
We partner with practices that value clinical documentation compliance and dedicated US-managed billing operations. Here is how we evaluate operational 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 recurring therapy billing, time rules, telehealth modifiers, and outsourcing transitions.
Payers frequently target 60-minute therapy sessions (90837) with automated audits if notes lack exact timestamps or describe routine check-ins. Our certified coders review notes to verify that exact start and stop minutes (minimum 53 minutes of direct contact) are recorded and that the clinical narrative supports extended therapeutic intensity.
Telehealth rules are not universal. Medicare, commercial plans, and state Medicaid programs have divergent requirements regarding POS 10 (patient at home), POS 02 (telehealth facility), modifier -95 (video), and modifier -93 (audio-only). We maintain payer-specific crosswalks to apply the precise combination required by each insurer before claim release.
We track authorized session counts and expiration dates inside your billing ledger. When a client reaches 2 to 3 remaining sessions, our team alerts your practice or initiates the concurrent authorization renewal workflow with the payer, preventing unapproved sessions and retroactive claim denials.
After the primary insurer adjudicates the claim via electronic remittance (835), patient responsibility is posted automatically. We generate clean, itemized digital statements through your EHR portal within 5 business days, ensuring patients understand their balance without delayed surprises.
Timely filing limits vary widely by payer contract—from as short as 90 days for some commercial insurers to 180 days, 365 days, or state-specific Medicaid deadlines. MDRG submits all clean claims within 24 to 48 hours of note completion to maintain a safe operational buffer.
Our fees are performance-aligned as a percentage of net collections (typically 2.99% to 8.5%), scaled to your monthly claim volume, provider count, and payer mix. We only get paid when your practice collects. See our pricing overview for detailed tier information.
Yes. Through our credentialing services, we manage CAQH profile maintenance, initial network contracting, rendering NPI linking, and re-credentialing for LCSWs, LPCs, LMFTs, LMHCs, and psychologists across commercial and Medicaid networks.
No. Our operational billing review uses de-identified aggregate remittance data or view-only access to your billing ledger. We evaluate denial codes, time documentation consistency, and aging AR without ever collecting patient names, member IDs, or psychotherapy clinical records.
We analyze a de-identified sample of your recent therapy claims to identify denial root causes, modifier mismatches, and uncollected revenue. 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.
