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A provider-side comparison of Alma, Headway, Grow Therapy and Rula in 2026: fee models, rate transparency, who owns your payer contracts, and how each compares to contracting directly.

Aetna's reimbursement changes for therapists credentialed through Alma took effect on July 15, 2026, as scheduled. If you are a solo therapist, psychologist, LCSW, LPC, or LMFT using Alma to bill Aetna, the rate changes are no longer something to prepare for they're now live on your claims. Here's exactly what changed, what happened between the announcement and the effective date, and what your options look like now. On May 20, 2026, Alma notified its providers that Aetna wo

By Danielle Wagar, CPES | Upstate Healthcare Admin You typed it into Google at 11pm after a particularly frustrating day. "Can I leave Headway?" Maybe your reimbursement rates feel insulting for the level of care you provide. Maybe you are tired of being locked out of your own billing data. Maybe a client mentioned they found you through the directory and you realized, with a sinking feeling, that you have been building someone else's referral network for free. Whatever broug

If you look strictly at the headline conversion factor, Medicare PT/OT Fee Schedule reimbursement for physical and occupational therapy appears to have received a welcome boost for 2026. However, the actual impact on your clinic's bottom line is more nuanced. While the baseline conversion factor rose by over 3%, a new permanent 2.5% efficiency adjustment applied to non-time-based work Relative Value Units (RVUs) offsets those gains for certain services. Depending on your cli

Remote Therapeutic Monitoring (RTM) is the use of medical devices to collect non-physiological data, such as therapy adherence and pain levels, from patients at home. Despite its potential, many practices have resisted launching RTM programs, citing rigid rules that often resulted in significant clinical effort going unreimbursed. The 2026 Medicare Physician Fee Schedule (MPFS) has changed the landscape, introducing new CPT codes with substantially lower billing thresholds. F

When a practice upgrades its clinical workflow say, moving from a platform like TherapyNotes to a system like Jane, backed by a clearinghouse like ClaimMD there is usually a lot of excitement. You look forward to cleaner interfaces, better scheduling, and fresh features. You check the boxes to link your new clearinghouse, hit submit on a few test claims, see them go through successfully, and assume the transition is complete. Then, two weeks pass. You know you’ve had claims p

It’s a scenario that makes every private practice owner’s stomach drop. You pull your weekly remittance advice, expecting a healthy reimbursement for a complex patient session where you billed multiple units or multiple distinct codes. Instead, the payment that hits your account is a fraction of what you calculated. Your first instinct? Call it an underpayment, blame a payer glitch, and gear up for a timely filing appeal. But before you spend hours on hold or drafting appeal

If you have been wondering whether Medicare still reimburses virtual therapy visits, the direct answer is yes. Physical therapists (PTs), occupational therapists (OTs), speech-language pathologists (SLPs), and audiologists remain fully eligible to bill Medicare for Telehealth services through December 31, 2027. While political debates and temporary funding fights caused confusion early in the year, Congress officially resolved the status of therapy Telehealth. Here is what ha

Is your practice invisible online? Learn why your Google Business Profile views matter for growth and get 4 simple fixes to boost local search rank

It is one of the most frustrating notifications a private practice owner can receive. You submit a clean batch of claims, wait weeks for reimbursement, and instead open a Remittance Advice marked with a rejection code: Denied for Incorrect NPI. This specific rejection is incredibly common, yet completely avoidable. The most frustrating part is that an incorrect NPI claim denial often has absolutely nothing to do with you doing anything wrong clinically. Your NPI is real, your

It is the silent cash flow leak that every private practice owner deals with. You look at your schedule for the day, see a full lineup of five or six sessions, and plan your business revenue accordingly. Then, at 10:00 AM, a text arrives: "So sorry, something came up and I can't make it today." Two hours later, another client simply fails to log into the telehealth portal or show up at your office. Most therapists accept cancellations and no-shows as an inevitable, frustratin

When you first opened your private practice, your main goal was likely filling your schedule. To make that happen, you probably joined every insurance panel available in your area. Most therapists treat their panel list as a permanent setup: they take whatever insurance walks in the door and rarely look at their insurance contracts as a strategic business lever. But as your practice grows, taking every plan without a clear strategy can quietly cap your income. If you are work

It is a moment of total panic. You log into your billing portal or open the mail to find a notice from an insurance company stating you have been overpaid. They want their money back. To make matters worse, the notice is for claims you successfully processed and closed a year or more ago. If your stomach drops when you see these letters, you are not alone. This is happening constantly right now. Insurance audits and retrospective demands are skyrocketing across the mental hea

There is an exciting point in a therapy practice owner's career when the waitlist grows too long, demand outpaces your schedule, and you realize it is time to expand. You decide to transition from a solo setup to a group practice model by hiring your first associate or licensed clinician. Many practice owners assume that because they are already in-network with insurance panels, bringing a new therapist on board simply means handing them a client roster and billing under the

You submit a batch of claims through your clearinghouse, check your dashboard a week later, and notice a handful are marked as pending. Another week passes, then a month, and nothing moves. The money sits in administrative limbo while your practice overhead keeps running. For solo and small group mental health, physical therapy, occupational therapy, and speech-language pathology practices, watching revenue freeze behind an insurance wall is one of the more demoralizing parts

By Danielle Wagar, CPES | Upstate Healthcare Admin Here is a scenario that plays out in mental health practices regularly: a provider completes Medicare enrollment, receives their PTAN, and starts seeing Medicare patients. A few months in, they notice some Medicare patients have cards that say Humana, UnitedHealthcare, or Aetna. Claims are submitting to the wrong payer. Prior authorization requirements keep appearing unexpectedly. The answer is that Medicare is not one thing.

By Danielle Wagar, CPES | Upstate Healthcare Admin Medicare enrollment is one of the most misunderstood processes in mental health private practice. Providers avoid it because it feels complicated. They delay it because they do not know where to start. And then they refer out every Medicare client for years — clients who could have been seen in their practice. This guide breaks down exactly how Medicare enrollment works for mental health providers. Who This Applies To Medicar

SimplePractice's free credentialing gets your applications submitted, but it will not build the billing system that gets you paid. Here is what is actually missing, and what to do about it.

By Danielle Wagar, CPES | Upstate Healthcare Admin Blue Cross Blue Shield is not a single insurance company. This is the thing most providers do not fully understand when they get credentialed with their local BCBS plan - and it is why BCBS claims can behave so differently depending on the patient in front of you. BCBS is a federation of 33 independent, locally operated member plans. When your patient has a BCBS plan from another state, the BlueCard Program governs how their

By Danielle Wagar, CPES | Upstate Healthcare Admin If you bill for telehealth sessions, you have almost certainly encountered modifier 95 and modifier GT. You may have used them interchangeably. You may have used the wrong one without knowing it and had no idea why claims denied. This guide clarifies exactly when each modifier applies and why using the wrong one will get your claims denied. What Telehealth Modifiers Do Telehealth modifiers are codes appended to a CPT procedur