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There’s a version of underpayment that doesn’t show up as a problem. Claims go out. Payments come in. Nothing gets denied. And you’re still not getting paid correctly. I recently worked with a behavioral health provider in Chicago who was billing Medicare for 90837 via telehealth. Everything looked fine. No rejections. No obvious errors. Payments were landing consistently. She was getting about $102 per visit. Seemed low to me for a metro area like Chicago. The issue wasn’

A practical guide from a billing and credentialing consultant Introduction There are more therapists starting private practices right now than at any point in the past decade. Demand is strong, awareness is high, and the tools to get started are more accessible than ever. And yet, most clinicians feel overwhelmed almost immediately when it comes to marketing. From what I see working closely with private practices, the issue is not effort. It is direction. Marketing in 2026

A Practical Guide for Therapy and Rehab Practice Owners As a practice grows, there comes a point where the administrative side of the business becomes harder to manage than the clinical work itself. Claims are being submitted, but payments feel inconsistent. Patients are being scheduled, but information is incomplete. Staff are doing their best, but processes vary depending on who is handling them. At that stage, most practice owners recognize they need support. What is less

Disclaimer I am not an attorney, and this is not legal advice. This article is for general educational purposes only. Entity rules for licensed professionals vary by state, by profession, and sometimes by ownership structure. Before forming your business, you should confirm the rules with your state licensing board, your attorney, and your CPA. For tax elections like S-corp treatment, you should also get individualized tax advice before deciding what makes sense for your pra

If you are a therapist, PMHNP, psychologist, or private practice owner, you have probably heard the pitch. Join Headway, Alma, or Rula. Get credentialed faster. Stop dealing with billing headaches. See more clients. Get paid. And look, I get the appeal. Insurance enrollment is slow, payer systems are clunky, and admin work is the part nobody romanticizes when they picture private practice. These platforms stepped into a real pain point and built a business around it. But here

If you’re a practitioner in the wellness or mental health space, you didn’t get into this business because you had a passion for CPT codes and claim rejections. You did it to help people. But as your practice grows, the "administrative tax" starts to feel heavier every month. I’ve worked in a variety of Electronic Health Records (EHRs), but there is one that consistently stands out for its elegance and efficiency: Jane App. Full disclosure: I am not sponsored by or affiliated

In the world of Occupational Therapy, "working smarter, not harder" often comes down to your billing strategy. While most OTs rely on the "big three" (97530, 97110, and 97112), there is a massive opportunity to capture the value of your specialized clinical expertise through Cognitive, Sensory, and Developmental Testing codes. If you aren't utilizing codes 96112, 96113, 97533, 97550, and 97551 , you’re likely leaving significant revenue on the table. Here is how to integrate

The number one question I get asked about credentialing is "How long does it take?" Hiring a new clinician feels like growth until they cannot bill insurance for three months. Most practice owners underestimate credentialing timelines because payer enrollment is opaque, inconsistent, and rarely explained clearly. Payer Timeline Estimates The following table outlines typical ranges by payer type. Note that "Effective Dates" are often assigned after approval, not at the time of

Most practice owners in Physical Therapy, Occupational Therapy, and Mental Health assume billing starts when they click Submit Claim . It doesn’t. Your revenue cycle starts the moment a prospective client calls, fills out a form, or books a free consult. If you are not verifying benefits before the first session, you are not just delaying payment. You are rolling the dice on whether you will get paid at all, and how much. Front-end verification is not “extra admin work.” It i

Remote Therapeutic Monitoring (RTM) is being pitched to therapy practices as a new revenue stream. RTM can be legitimate and clinically helpful, but it is also easy to implement poorly. The difference comes down to workflows, documentation, and payer rules. RTM can be valuable, but only when it is implemented intentionally, compliantly, and with a clear operational plan. This post breaks down what RTM actually is, who it is appropriate for, and where practices tend to run int

Many therapists assume that accepting insurance means joining a panel. It does not. Out-of-network billing lets you work with clients who have insurance coverage without signing a contract with any payer, and without giving up control over your fees, your schedule, or how you run your practice. This post walks through how OON billing actually works, what courtesy billing means in practice, and what you need to set it up correctly. What OON Billing Actually Means for Therapist

Skip the overwhelm, avoid the common legal pitfalls, and build a practice that gives you clinical freedom and financial independence. You spent years honing your clinical skills. You’ve mastered your craft, cared for your patients, and navigating the institutional world. But lately, the pull toward independence has become impossible to ignore. You want the freedom to set your own schedule, the autonomy to choose your patient load, and the financial rewards that come with buil

Are you spending too much time on insurance claims? Learn when to hire a fractional 1099 medical biller to increase your clinical income and end the admin struggle.

If your income swings month to month, it is usually not a “marketing problem.” It is a systems problem. More clients helps, sure. But stable income comes from three boring, beautiful routines that keep money from leaking out of your business. 1) A clean front-end money policy This is the foundation. Without it, every other fix is a band-aid. Minimum standards: Written financial policy signed before the first visit Card on file Payment collected at time of service (or within 2

If you’re using Jane and billing feels inconsistent, it’s almost never one “big” issue. It’s usually a handful of small setup gaps that create denials, missing payments, and AR that quietly piles up. This checklist is the baseline I use when helping therapy practices get billing in Jane clean and trackable. If you want hands on help with this, start here: Jane billing help Step 1: Confirm your “billing basics” inside Jane Before you touch Claim.MD , make sure your foundation

Every January, clients suddenly balk at cost. Most of the time it is not “therapy got expensive.” It is deductible reset, coinsurance returning, or a plan change. You can prevent most drop-off with a simple process. 1) Do a quick January check on active clients You do not need to verify everyone in one day. Prioritize: Weekly and biweekly clients Anyone who paid little or nothing in late December Anyone with a high-deductible plan history 2) Verify benefits for cost, not just

The Hidden Administrative Burden in Therapy Practices Billing and insurance work rarely arrives as one big task. Instead, it shows up in fragments: Claims that sit in “submitted” status with no clear next step. Denials that require multiple corrections. Patient questions about balances that do not match expectations. Portal logins, follow-ups, and tracking spread across systems. Individually, these tasks seem manageable. Together, they create an ongoing administrative load th

For many therapy practices, billing isn’t inherently difficult due to the rules themselves. It becomes challenging when the systems around billing are unclear or inconsistent. A low-stress billing system requires structure, clarity, and a consistent process. Let’s explore how you can create a more manageable billing experience. Establishing a Clear Workflow A defined path from session to payment reduces uncertainty and improves accuracy. Here’s how to get started: Map Out You

Superbills should support client reimbursement, not create confusion. Clear workflows reduce errors and improve client satisfaction. Confirm Required Information A complete superbill includes essential client details. Make sure to include: Client name Provider credentials NPI (National Provider Identifier) Practice address Tax ID CPT (Current Procedural Terminology) codes ICD-10 (International Classification of Diseases) codes Dates of service Rate charged or paid Provider si

If you’ve ever looked at an EOB like: Billed: $150 Allowed: $92.13 Paid: $37 …and thought “what even is this,” you’re not alone. “Allowed amount” is one of the most important numbers on an EOB, and most therapy practices are guessing their way through it. Let’s fix that in plain English. This is for: PT / OT / SLP and rehab practices Mental health practices and groups Chiropractic, acupuncture, and massage therapy clinics who want to actually understand how payers decide what