Insights
Notes from running the revenue cycle we build for.
Operational writing on behavioral-health billing, provider readiness and payer contracts — from a team that runs a multistate psychiatry practice on its own software.
Reading an 835: what the remittance is telling you
An 835 pays a claim and explains the payment in the same file. What the group code, reason code and remark code on each line actually mean, and why reading them as a workflow beats reading them as a document.
Eligibility is not a one-time check
A 271 response describes coverage as it existed at the moment you asked. Why eligibility needs to be a recurring check tied to the date of service, not a one-time intake step.
What a payer actually checks before it pays a telehealth claim
Place of service 02 vs 10 selects a payment rate, not just a location. The audio-only modifier, the telehealth-eligible code list, and why behavioral health runs under different rules.
Timely filing: the deadline that quietly writes off revenue
Medicare's federal window is fixed at 12 months. Commercial and Medicaid MCO windows are set by contract and often far shorter — and a second, separate clock governs appeals.
What a 95% clean-claim rate actually requires
Most behavioral-health groups sit between 75% and 85%. The four checks that close the gap, and why denials are rarely billing errors.
The gap between hired and billable is a revenue problem
For a group hiring 25 clinicians a year, provider activation delay is often the largest recoverable revenue item nobody is measuring.
Underpayments are silent. Denials are loud.
A denial announces itself. An underpayment just looks like a payment — unless you can prove what the contract said.
Four things generic RCM tools get wrong in psychiatry
Behavioral-health denials cluster around four constructs most specialties barely use — and every one is catchable before submission.
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