Questions practices ask
Medical Billing FAQ for Therapy and Behavioral Health Practices
Straight answers to the questions therapy and behavioral health practice owners ask us most: what billing costs, how long credentialing takes, which software we work in, how to switch billing companies, Medicare and Medicaid, telehealth, and denials.
Showing 24 questions
Working With Medtransic(7)
A medical billing and credentialing company for therapy and mental health practices. Not a medical transportation company, and not Medtronic.
Medtransic is a medical billing and insurance credentialing company.
- Our main specialty is mental and behavioral health: therapists and counselors, psychiatry, psychology and substance use treatment.
- We also bill for ABA, speech, occupational and physical therapy practices.
- We work inside your own software, most often SimplePractice or TherapyNotes.
Medtransic is not a medical transportation company and is not affiliated with Medtronic, Med-Trans or MedTrans.
Billing is 4-8% of collections. Credentialing is $150 per application, per provider.
- Billing: 4-8% of what we collect for you. You pay a share of what comes in, not a flat monthly fee.
- Credentialing: $150 per application, per provider.
- No long-term contract.
- The client portal is included with every client account.
We specialize in billing and credentialing for therapy and behavioral health practices.
Mental and behavioral health is our main specialty. The practices we work with most:
- Mental health and behavioral health
- Psychiatry and psychology
- Substance use treatment
- ABA therapy
- Speech, occupational and physical therapy
We work with these practices in all 50 states. Every client has a dedicated account manager, and our coders are matched to your specialty. Medtransic is HIPAA compliant.
We work inside the software you already use, so you do not change systems to work with us.
SimplePractice and TherapyNotes are the systems our clients use most. We also work in:
- ICANotes
- WebPT and CentralReach
- Qualifacts
- Tebra (formerly Kareo)
- eClinicalWorks and Office Ally
If you use something else, tell us. We take on other systems as clients need them.
Your credentialing, documents and claims, in one login. It is the same view our team works from.
- Credentialing: each payer application shows its stage, its history, and the date you can start seeing that payer's patients.
- Documents: one list of what we still need from you. Upload once, and it reaches every payer that asked for it.
- Billing: every claim with its stage and amount, the denials we are working, and your receivables by age.
- Messages: questions go straight to your credentialing coordinator or billing team.
The Medtransic HIPAA Compliant Portal runs on AWS under a signed Business Associate Agreement. It is included with every client account.
If your practice owns its software and clearinghouse account, the new team only needs a login to start.
- Check that the practice, not the biller, owns the software login and the clearinghouse account.
- Add the new billing team as users. Nothing has to be migrated.
- Put the cutover date in writing, and agree who works the claims billed before it.
- Update payers only if something on their record changes, such as your remit address or bank details.
- Watch the first month: claims accepted, payments posting, claim counts matching your visits.
Under 45 CFR 164.504(e), your old billing company's contract must require it to return or destroy your patient data when the contract ends, where feasible. Get a full export in writing before you give notice.
It depends on who owns the follow-up. Billing fails when nobody works denials and unpaid claims every week.
In-house can work when:
- You have a trained biller with time to work denials and unpaid claims every week.
- Someone covers when that person is away.
Outsourcing makes sense when:
- Claims sit unpaid and nobody follows up.
- Your biller has left, or billing falls to a clinician.
- You are adding clinicians, payers or locations.
Whatever you choose, ask any billing company how it prices, how long the contract runs, and what you can see without calling.
Credentialing(4)
Credentialing is how an insurer checks your qualifications before it adds you to its network.
The insurer verifies your license, education, work history, malpractice coverage and any sanctions.
- Credentialing checks that you qualify.
- Contracting sets what you are paid.
- Enrollment loads you into the payer's claims system with an effective date.
Until all three are done, that payer may not pay you at in-network rates.
In our experience, credentialing usually takes 60 to 90 days with each payer.
Payers set their own timelines. Evernorth, for example, says joining its behavioral health network can take up to 90 calendar days.
What keeps it on track:
- A complete application with no missing documents.
- A current, attested CAQH profile.
- Applying to all payers at the same time, not one after another.
- Following up with each payer on a schedule.
You can see them, but the payer may not pay you in-network until your effective date.
- Some payers pay back to an effective date.
- Others pay nothing before the date they load you into their system.
Check each payer's policy before you schedule its members.
CAQH is now DataSpring. Many payers pull your credentialing data from its Provider Data Portal.
- You keep one profile instead of retyping the same details for every payer.
- DataSpring says the portal is free for clinicians, groups and practices.
- Profiles are re-attested every 120 days. A lapsed profile can stall every application at once.
Medicare and Medicaid(3)
Yes. Since January 1, 2024, licensed marriage and family therapists and mental health counselors can enroll in Medicare.
- Medicare pays them 75% of what it pays a clinical psychologist (CMS).
- Enrollment is through PECOS or the CMS-855 paper forms.
- Medicare requires payment by electronic funds transfer as part of enrollment.
Each state runs its own Medicaid program, with its own enrollment and its own rules.
- In many states, Medicaid members are covered through managed care plans, and each plan has its own enrollment.
- Federal rules let a state allow up to 12 months to file a claim (42 CFR 447.45).
- State fee-for-service deadlines run from 90 days to 12 months. Managed care plans set their own.
Check which plans cover your clients before you enroll, and track each plan's deadline separately.
Give an ABN before a service you expect Original Medicare to deny as not reasonable and necessary.
The Advance Beneficiary Notice (form CMS-R-131) lets the patient choose:
- Get the service and have Medicare billed.
- Get the service and not bill Medicare.
- Decline the service.
Without a valid ABN, you may not be able to bill the patient if Medicare denies the claim.
Claims and Denials(4)
A rejected claim never entered the payer's system. A denied claim was processed and refused.
- Rejection: usually bad data, such as a wrong member ID. Fix it and send it again.
- Denial: the payer decided not to pay. You appeal it.
A rejected claim was never filed, so the filing deadline keeps running. Fix and resend it quickly.
Most denials trace back to something checkable before the session: coverage, authorization, credentialing or a deadline.
Common causes:
- Coverage was not verified, or the plan changed.
- A required authorization was missing or ran out.
- The clinician was not yet credentialed with the payer.
- The claim was filed after the deadline.
In 2024 HealthCare.gov plan data, administrative reasons made up a quarter of denials. Fewer than 1% of denied claims were appealed, and about one in three appeals won (KFF analysis of CMS data).
It depends on the payer. Missing the deadline usually means the claim cannot be paid.
- Medicare: 12 months from the date of service (42 CFR 424.44).
- Medicaid: 90 days to 12 months, depending on the state. Managed care plans set their own.
- Commercial plans: set in each contract.
Medicare must pay a clean claim within 30 days of receiving it.
- Medicare: paper claims wait longer before payment than electronic ones.
- Commercial plans: state prompt-pay laws set deadlines for state-regulated plans. Self-funded employer plans fall under federal law instead.
- Medicaid: set by each state and plan.
A claim with an error or missing information takes longer, which is why clean claims matter.
Coverage and Authorization(3)
Verify benefits before the first visit, not after the claim comes back.
- The plan is active, and you are in network with it.
- Who manages behavioral health. It is sometimes a different company from the one on the card.
- Copay, coinsurance and deductible.
- Whether authorization is needed, and after how many visits.
- Any visit limits. Some plans cap therapy visits or require authorization after a set number.
- Whether telehealth is covered.
It depends on the plan. Higher levels of care, ABA and psychological testing often need approval first.
- Since January 1, 2026, Medicare Advantage plans, Medicaid and CHIP programs, and Marketplace plans on the federal exchange must decide standard requests within 7 calendar days and urgent requests within 72 hours (CMS-0057-F).
- Original Medicare requires prior authorization only for a narrow set of items and services.
- Commercial plans set their own lists and timelines.
If a session happens without a required authorization, the payer usually denies it. Ask the payer at once whether it accepts a late request.
Yes. Under the No Surprises Act, clients who do not have or use insurance get a good faith estimate.
- The rule took effect on January 1, 2022.
- A client can dispute a bill that is at least $400 more than the estimate (CMS).
Give the estimate before care starts, and update it if the plan of care changes.
Therapy and Telehealth Billing(3)
Medicare wants the telehealth place of service: one for a client at home and one for a client somewhere else.
- Medicare's coverage of mental health telehealth to a client's home is permanent.
- Audio-only sessions are allowed when the client cannot or will not use video.
- Medicare's in-person visit rule for mental health telehealth starts after December 31, 2027.
- Commercial and Medicaid plans set their own telehealth rules, so check each payer.
Claims rely on the progress note, not on private psychotherapy notes.
HIPAA gives extra privacy to psychotherapy notes a therapist keeps apart from the chart. Payers ask for the progress note instead.
A progress note that supports a claim usually shows:
- The date and the session length.
- Who was present.
- The diagnosis and why the session was needed.
- What was done, and the plan.
- The clinician's signature and credentials.
Many therapy services are billed in time units, so the note must record the minutes for each timed service.
- Record the minutes for each timed service, not just the total visit time.
- Each payer has its own rules for turning minutes into units.
- Check plan visit limits and authorizations along with the minutes.
Questions by Practice Type(46)
Each question below is answered in full on the page for that practice type.
Behavioral Health
- Do you work with agencies and group practices, or only individual therapists?
- Which systems do you work in?
- We hire clinicians through the year. How does enrollment keep up?
- Can you take over while claims are in flight?
- Do you handle Medicaid and managed care plans?
- We already have a billing company. What does switching look like?
- What do we actually see each month?
- How do we choose a billing company for a behavioral health group practice?
- What does it cost?
Psychiatry
- How much does psychiatry billing cost with Medtransic?
- Do you credential psychiatric nurse practitioners?
- How do you bill for psychiatric services?
- Can you bill a medication visit and therapy on the same day?
- Does Medicare still pay for telepsychiatry at home?
- What should I look for in a psychiatry billing company?
- Which systems do you work in?
- Is psychiatry billing difficult?
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