Our Four Pillars of Practice Optimization

We move mental health providers beyond the basics, turning complex insurance rules into reliable revenue streams.

01 — Unlock Full Revenue Potential: CPT, HCPCS, & ICD-10 Mastery

Are you aware that most providers only bill 4–6 codes, leaving significant patient interactions and revenue on the table? Insurance companies are only responsible for verifying benefits and paying properly coded claims—they will never tell you how to maximize your billing.

We solve this problem by:

• Advanced Staff Training: Training your team on lesser-known, applicable codes to capture all billable services.

• Custom Cheat Sheets: Providing quick-reference guides so your providers can bill differently based on time, service, and specific patient interaction.

• Ongoing Support: Offering dedicated email and phone support for unique billing situations and claim challenges.

02 — Strategic Paneling: In-Network vs. Out-of-Network

Choosing your network status is a major financial decision. Did you know that even as an out-of-network provider, your clinical notes can still be audited for medical necessity?

While being in-network broadens your client base and offers discounted rates, reimbursement rates can vary by up to 40% based on factors like your license type, appointment setting, credentialing state, and degree obtained. We help you make strategic choices by:

• Analyzing potential reimbursement rates across different carriers.

• Understanding the compliance risks associated with both in-network and out-of-network status.

• Guiding you toward the most financially beneficial and stable network strategy for your practice.

03 — Navigating Medicare: Opting-Out, Cash Pay & Write Offs

Accepting Medicare patients requires strict adherence to specific rules—messing this up can lead to major compliance issues.

• Accepting Assignment (Non-Participating): As a non-participating medicare provider, you can accept assignment by checking the appropriate box on the CMS-1500 form. This means you don’t agree to Medicare guidelines and can charge the patient whatever rate you wish.

• Cash Pay (Opt-Out): To accept a Medicare patient as strictly cash-pay, you must formally opt-out of all assignments on the CMS assignment CMAC website for your jurisdiction. This is the only way the patient will be barred from seeking reimbursement from Medicare.

We ensure your practice is made aware of CMS protocols allowing you to accept assignment or formally opt-out.

04 — EMR, Claims, and Follow-Up: Mastering the Revenue Cycle

While self-service therapy billing software (Theranest, Jane, Simple Practice, Therapy Notes, and others) is convenient, claims often get lost, partially paid, unallocated, clawed back or rejected without clear explanation.

Full integration and proactive follow-up are critical:

• Portal Integration: We help you fully integrate your system and gain access to external portals like Change Health Care, Availity, Echo, Evernorth, and Optum.

• The 14-Day Rule: You must always follow up on any claim that hasn't updated or moved within 30 days.

• Correcting Claims: When resubmitting, amending, or voiding a claim, you must reference the original claim to avoid automatic rejection.