Behavioral Health billing
Specialty
Recurring, authorization-bound sessions where documentation is the claim.
Scope of work
Where behavioral health revenue actually breaks
These are the failure points we look for first, in this discipline specifically.
Authorizations and session limits
Many plans authorise a fixed number of sessions in a window. When the count runs out mid-treatment, claims deny in blocks — an entire month of care at once, not a single visit.
Telehealth and place of service
Telehealth policy, place-of-service codes and modifiers keep shifting by payer and plan type. A wrong POS on a recurring weekly service repeats the error across every session.
Therapy and psychiatry combinations
E/M with an add-on psychotherapy service has specific time and documentation rules. Combined visits are frequently either undercoded to stay safe or coded in a way that cannot be defended.
Credentialing bottlenecks
Behavioral health groups add clinicians of several licence types, and panel closure, licence-level coverage rules and supervision billing determine whether that clinician can bill at all.
Patient responsibility on recurring care
Weekly care means weekly copays and rapidly accumulating deductible balances. Without a clear cadence, patient AR grows faster here than in almost any other outpatient setting.
Documentation-sensitive billing
Time statements, modality, and medical necessity narratives are the substance of the claim. Audit exposure is real, and defensive undercoding is its own form of revenue loss.
Interactive model
The shape of behavioral health revenue
An interactive illustration of the dynamic that defines billing in this specialty.
Behavioral health denials arrive in blocks, not singles. Drag through an authorised course of 20 sessions to see when re-authorisation has to start.
Interactive model
How we run behavioral health revenue cycle
The operating model is consistent; the controls inside it are specialty-specific.
01
Authorization and unit ledger
Every authorised course tracked by units used and units remaining, with re-authorisation initiated before the last session — not after the denials arrive.
02
Telehealth compliance check
POS, modifier and payer telehealth policy validated per plan and re-checked when policy changes, so recurring claims do not fail as a batch.
03
Recurring claim production
Session claims produced on a fixed cycle with time-and-modality validation, so weekly volume never depends on someone remembering to run the batch.
04
Credentialing and supervision mapping
Enrollment status tracked per clinician and payer, with billing routed correctly for supervised or incident-to arrangements, and honest holds while enrollment is pending.
05
Patient balance cadence
Copays and deductible balances communicated on a predictable schedule that respects the therapeutic relationship, with a clear escalation policy the practice signs off on.
Interactive model
What we typically run for this specialty
Coding & Charge Posting
Coding and charge posting handled with specialty context, so documentation,
Prior Authorization
Authorization requests initiated, tracked and documented so procedures are not
Eligibility Verification
Coverage, benefits and patient responsibility checked before the visit,
How this specialty is staffed
Ophthalmology accounts are run by a named team that works this discipline daily — charge entry and coding review, payer-specific scrubbing, denial root-cause follow-up and AR recovery, all inside your existing EHR and practice management system.
Get an Ophthalmology Revenue Health Check
A structured review of your ophthalmology denials, AR ageing and front-end workflow — with findings specific to this discipline.
