Created for behavioral-health operators using practical revenue-cycle experience. It provides general business education—not billing, legal, clinical, insurance, coding, or compliance advice.
Define the problem before comparing vendors
Start by documenting why the organization is considering a billing company or a change. Common reasons include aging A/R, recurring denials, limited reporting, staff turnover, growth, a new location, payer complexity, or a lack of confidence in current results.
Separate problems a billing company can directly control from upstream issues it can only identify or escalate. A vendor cannot prevent every authorization or documentation failure, but it should make those failures visible, quantify their impact, and support a clear response process.
- Services, locations, levels of care, and monthly claim volume
- Payer mix, network status, and reimbursement arrangements
- Current systems, clearinghouse, payment, and reporting workflows
- Existing A/R, denials, underpayments, and transition risks
- Functions expected from the vendor versus retained internally
- The financial and operational outcomes the change should improve
Compare the scope—not only the percentage
A quoted percentage or monthly fee has little meaning without a precise scope. Determine whether the proposal includes benefits verification, authorization support, coding, charge entry, claim submission, payment posting, denial management, appeals, patient billing, A/R follow-up, underpayment review, credentialing, contracting support, and management reporting.
Clarify exclusions, pass-through charges, implementation fees, minimums, old-A/R fees, clearinghouse costs, statement costs, payment processing, record requests, and termination assistance. Compare total expected cost using realistic volume and service assumptions.
- What triggers a separate or higher fee?
- Who performs each task and where is the team located?
- Which activities require provider staff to intervene?
- How are after-hours, urgent, and payer-escalation needs handled?
- Are legacy balances priced and worked differently from current claims?
Test the operating workflow
Ask each company to walk through realistic behavioral health scenarios rather than a generic sales demonstration. Follow one claim from pre-admission information through authorization, documentation, coding, submission, adjudication, denial, appeal, and final resolution.
Evaluate how the vendor identifies missing information, records payer status, assigns work, communicates deadlines, escalates risks, and closes the loop with the provider. The organization should be able to see both activity and meaningful progress.
- A claim delivered outside an authorized date range
- A payer requesting clinical records
- A partial payment or suspected underpayment
- A denial approaching an appeal deadline
- A coordination-of-benefits problem
- A balance that has received repeated follow-up without resolution
Require reporting that can be validated
Dashboards should reconcile to claim-level detail, deposits, payment posting, adjustments, and the general ledger process used by the organization. Ask how the vendor calculates clean-claim rate, days to bill, denial rate, net collection rate, days in A/R, expected reimbursement, and recovered dollars.
Review sample reports using definitions, dates, exclusions, and source fields—not screenshots alone. Leadership should be able to identify what changed, why it changed, which claims support the number, and what action is underway.
- Cash and collections by service and posting month
- A/R aging by payer, level of care, status, and owner
- Denial count and dollars by internal root cause
- Expected-versus-actual reimbursement
- Timely-filing and appeal-deadline risk
- Unresolved provider requests and operational dependencies
Review data, access, security, and contract terms
The organization should understand where its data is stored, who can access it, how access is logged, which systems are used, and how information can be exported. Obtain qualified privacy, security, and legal review for applicable requirements, including any business associate agreement and subcontractor arrangements.
Contract language should address services, fees, performance reporting, data ownership, record retention, insurance, confidentiality, security incidents, audit cooperation, dispute handling, termination, transition support, and access after the relationship ends. Avoid relying on sales assurances that do not appear in the agreement.
- Provider access to billing systems and claim-level data
- Data export format and frequency
- Business continuity and incident-response responsibilities
- Use and oversight of subcontractors
- Termination notice, fees, and transition obligations
- Ownership and portability of payer, patient-account, and reporting data
Validate references and plan the transition
Speak with organizations that resemble yours in size, services, payer mix, and stage of growth. Ask references about implementation, communication, reporting accuracy, denial handling, staff continuity, unexpected fees, and what happened when results fell below expectations.
Before launch, create a transition plan covering data transfer, old A/R, payer and clearinghouse access, bank and remittance routing, open authorizations, unbilled services, unresolved denials, patient balances, reporting cutover, and ownership during overlap. Set 30-, 60-, and 90-day measures so the relationship begins with evidence rather than assumptions.
- Named owners on both sides
- Claim, payment, denial, and A/R reconciliation
- Inventory of open deadlines and unresolved requests
- Staff training and escalation contacts
- Baseline metrics and first-quarter targets
- A documented contingency and exit path
Find your clearest next step.
Use the free assessment to identify the revenue-cycle area your organization should examine first.
Start the assessment →