A 5-Point Checklist for Psychiatrists and Mental Health Nurse Practitioners in Private Practice

 

Running your own practice – whether you’re a psychiatrist or mental health nurse practitioner – means wearing a lot of hats: clinician, scheduler, office manager, and for many… biller. If you’ve been managing (aka “winging”) your own insurance billing, you might be wondering

Is it time to outsource this part of my practice?

Here’s a simple checklist to help you decide.

 

Check 1. You’re Spending More Than 3–5 Hours/Week on Billing

Time is money. If you’re spending hours each week checking benefits, submitting claims, calling insurance companies, or sending patient bills, ask yourself:

• Could this time be used to see more clients and grow your practice?
• Could this time be used to rest & recharge to show up strong and healthy?
  

If billing is eating into your practice growth and/or your sanity, it’s probably time to get support for your psychiatric practice.

Check 2. You’re Ignoring Claims Results

If you’ve ever said…

• “I don’t know why this was denied, but oh well.” 
• “Why didn’t they pay as much as last time?” 
• “Did this go to the deductible? I thought the deductible didn’t apply.” 
• “I’ll get to that later…”

                                   … then you could be leaving money on the table.

Outsourcing to a good billing company can take those worries off your plate, because they stay on top of denials, follow-ups, and appeals — so you don’t lose out on income you’ve already earned.

Check 3. You Don’t Know If You’re Being Paid Correctly

Do you know what you’re supposed to be reimbursed by each payer? If not, it’ll be hard to know if you’re getting shortchanged, which can put a damper on your psychiatric practice. 

A good billing company compares your explanation of benefits (EOBs) to your fee schedules to ensure you’re being reimbursed at the correct contract amounts. When you’re not, they’ll flag and fight underpayments.

Check 4. Your Cash Flow Feels Inconsistent or Unpredictable

Is your monthly revenue erratic? Delayed payments, missing claims, or unworked aging can seriously mess with your income.

A good billing team keeps your revenue cycle smooth by:

• Submitting claims consistently
• Submitting clean claims
• Following up on unpaid claims
• Monitoring trends across payers

Check 5. You’re Ready to Grow — But Billing Is Holding You Back

If you’re:

• Planning to expand your caseload
• Launching new services
• Or just want some breathing room…
  

Then offloading billing is a smart move. It clears up mental space and frees you to focus on strategy, care, or scaling. 

So… Is It Time?

If you checked even two or three items on this list, it might be time to outsource the medical billing.

As a psychiatrist or mental health nurse practitioner, you went into your own private practice to service the clients you can best help, enjoy freedom and autonomy with your time and priorities, and to make a good living. Don’t get bogged down in the parts of your private practice that someone else can do better and more effectively – like the billing.

At MindEase Billing, a medical billing service in Oregon, we welcome psychiatrists and mental health nurse practitioners in solo private practice. To learn more about us, check out our Services Page. When you’re ready to request a Discovery Call to see if we’d be a good fit, hit the button below.

or How to Check Benefits Without Losing Your Mind

 

Patients don’t like to get a bill for services they thought would be covered by their insurance. And you don’t want to write off patient responsibility you thought insurance would cover. But these are the common results when patients are seen before verifying mental health benefits. If you do your own billing or you work with a biller who doesn’t check benefits, use this guide to empower yourself and avoid surprises.

Step 1. Gather Essential Patient Information Early

Before contacting the insurance company, collect the following demographic and other details to streamline the process for verifying mental health benefits:

• Full Name (as listed on the insurance card)
• Date of Birth
• Insurance ID and Group Number
• Primary Policyholder’s Information (if different from the patient)
• Insurance’s Customer Service Phone Number (typically on the back of the card)
• Reason for Visit: This helps ensure you verify for the correct service (e.g., outpatient mental health).
• Other coverage. You need to know about all behavioral health plans related to the service you provide. You must submit claims to the primary payer first, even if there’s no coverage.

Pro Tip: Use digital intake forms that allow patients to upload their insurance cards directly, reducing administrative burden and transposition errors.

Caution: Dealing with secondary coverage and coordination of benefits (COB) can be frustrating, especially when the plans are not coordinated properly. The patient will need to be involved if this is the case.

Step 2. Contact the Insurance Company

Create a benefits verification script to ensure nothing is overlooked when you’re verifying mental health benefits. 

Key Questions Include:

• Effective date of the policy?
• What are the outpatient mental health benefits? This is the deductible, copay/coinsurance, and out of pocket amount.
• Has the deductible been met for the year? If not, what amount remains?
• Is prior authorization or PCP referral required for the service? If so, how do you get one?
• Are there session limits? (e.g., 20 therapy visits per year)
• If applicable to your practice, are benefits the same for therapy (90834, 90833, 90836, 90837, etc) as for office visit codes (E/M codes like 99203, 99214)?
• Is telehealth or virtual therapy covered under this plan? If so, do they have the same benefits?
• Is there any coordination of benefits on file? If so, what insurance company is the other plan and in what position is it (primary or secondary)?
• What’s the claims mailing address and payer ID number?

Pro Tip: Use insurance portals (e.g., Availity or payer-specific portals) to verify benefits online. But be cautious: it can take time to master each portal and learn what information is trustworthy and what is not.  

Pro Tip: Create a reference document to easily access your practice information. You will be asked for a few identifying details like your NPI, TIN, name, business address, call back number, etc. This is also a great place to note which networks you are contracted with and any payer specific identifiers (like your Medicare PTAN).

Step 3. Maintain a Tracking System for Calls When Verifying Mental Health Benefits

• Create a Log or Tracker: Use a spreadsheet or CRM tool to document insurance verifications.
• Essential Columns to Track:
  • Date and Time of Call
  • Insurance Representative’s Name
  • Confirmation Number (if they can generate one)
  • Notes on Coverage, Co-pay, and Limits

Pro Tip: You can automate some of this with practice management software that includes a verification module (e.g., SimplePractice, TheraNest).

Step 4. Educate Patients on Their Benefits

Help patients understand their financial responsibility and coverage limitations. Clear communication prevents surprise bills and promotes trust.

• Provide a Summary of Benefits: Offer patients a written summary after verification.
• Clarify Copays and Deductibles: Explain what will be charged per session and what they need to pay out-of-pocket if the deductible isn’t met. Make sure patients understand you verified the benefits to the best of your ability, but if you misunderstood something or were misquoted, they may still owe more than you’re estimating.
• Set Expectations Around Session Limits: Alert patients to limits on covered visits and discuss payment options if additional sessions are needed.

Pro Tip: Offer insurance education sheets in your office or via email to help patients understand key terms (deductible, co-insurance, etc.).

Pro Tip: Create a chart of contract amounts for each company you’re contracted with. This can help you estimate coinsurance as well as how many sessions it could take to meet the deductible. 

Step 5. Verifying Benefits Regularly

• Ask patients about new coverage annually and after long gaps in treatment. If a patient has a new plan, check coverage again.

Step 6. Troubleshoot Problems When Verifying Mental Health Benefits

• Problem: Insurance Says Patient is “Not Covered.”
  • Solution: Confirm you’re using the patient demographic details you were given. If that still doesn’t work, communicate with the patient to clarify the details and/or inform them they don’t seem to have coverage to work with you. Explore the opportunity to see them on a cash pay basis.
• Problem: Coverage for Telehealth is Unclear.
  • Solution: Confirm the CPT codes for telehealth services and ask if modifiers (like GT or 95) are needed to indicate virtual care.
• Problem: Authorization is Required but Not Obtained.
  • Solution: Call for retroactive authorization and document all communication to support appeals if the claim is denied.

Step 7. Automate and Outsource When Possible

• Automate Verification: Many practice management systems integrate with insurance portals to automatically verify benefits at regular intervals.
• Consider Outsourcing: For busy practices, outsourcing insurance verification to a billing company can save time and reduce errors. We know an excellent billing company!

Step 8. Create a Standard Operating Procedure (SOP) for Staff

• Document the Process: Outline step-by-step instructions for verifying benefits.
• Train Staff: Regularly train administrative staff on insurance verification best practices.
• Assign Responsibility: Designate a team member to handle all verifications to ensure consistency.

Step 9. Monitor Trends in Coverage and Adjust Services Accordingly

• Keep track of common insurance denials and coverage limitations over time. Use this feedback to improve your billing practices to submit clean claims that sail through the claims adjudication process effectively.
• Adjust your practice’s service offerings and policies to align with these trends (e.g., focus more on telehealth if in-person sessions face more restrictions).

With a strong process in place for verifying mental health benefits, you can reduce billing errors, improve patient satisfaction, and increase cash flow. 

If you’re stuck, confused, and or frustrated doing your own billing, reach out today for a consultation. You’re ready to outsource your billing to a trusted billing company, reach out to us to request a Discovery Call to see if we have an opening to take on your billing.

(original publication 6/25/20; updated 6/12/25) 

 

When you started your private practice, what goals did you have in mind?

Maybe you were hoping to achieve the independence that comes with running your own business, or you wanted to specialize in one particular area of practice. Maybe you were drawn to the freedom of dictating your own schedule. No matter what you had in mind, the prospect of making more money in private practice compared to community mental health was likely a big consideration. 

According to ZipRecruiter, Mental Health Nurse Practitioners and Psychiatrists in private practice in the United States earn between $68k-$399k annually. Although earning potential will vary depending on the hours you work, your location, and the cost of living, taking home a six-figure salary while operating a private practice is achievable. 

At MindEase Billing, many of our new clients are ready to grow their business and/or increase their revenue – and part of our mission is to help them do it. Here’re a few lessons we’ve learned from successful, six-figure private practice Psychiatrists and Mental Health Nurse Practitioners.

They do the math

Successful private practice therapists plan ahead by staying on top of their current revenue and make changes when needed. 

To earn six figures in private practice, do the math. Divide your revenue goal by your number of annual work weeks. (Remember to consider time off for holidays, vacation, and restoration; it’s not realistic long-term to work 52 weeks a year.) Then, divide it again by your ideal number of weekly clients. This will determine your average revenue per session. 

In many locations, for Psychiatrists and Mental Health Nurse Practitioners, 20 sessions (50 minutes each) per week is sufficient for a therapist to break the $200K mark. 

If you’re outsourcing your billing, aim to keep your billing expense below 10% of your revenue per month to maintain a long-term sustainable relationship.

Here’s a chart you can model as you work through your own plan.

They prioritize billable work

Can you manage all the coding services, payment tracking, financial and revenue reports while managing your busy schedule? Maybe. But what would your revenue look like if you spent more time on billable work and less on the actual billing, follow up and other insurance-related headaches? 

Six-figure earning Mental Health Nurse Practitioners and Psychiatrists prioritize billable time and tasks that only they can do, outsourcing other business management and accounting tasks to experts.

They’re diligent about filing claims and reducing errors 

When you keep your activity and records organized, you can submit claims quickly and receive payments faster. Not allowing claims and outstanding balances to linger allows deeper and more timely insight into the state of your finances. 

Hiring a professional medical biller will ensure billing and coding accuracy as well as timely claim submissions. At MindEase Billing, we know the importance of minimizing errors when it comes to cash flow and revenue growth.

Conclusion

Making time to grow your practice can be tough. Whether you’re just starting out, or your practice isn’t accomplishing what you’d hoped, carving out some time to review your plans and processes can help you identify the gap between where you are and where you want to be. 

If you’re ready to explore outsourcing your billing to MindEase, click the Request A Discovery Call button below to get started.

Whenever the economy shifts, as we’re currently seeing happen with COVID-19, patients are more likely to lose or change insurance. Since insurance coverage is a major factor in any patient-therapist relationship, a change to that coverage can be a risk to your practice. Even more importantly, it leaves patients without their usual support during a time when they likely need it most.

Whenever the economy shifts, as we’re currently seeing happen with COVID-19, patients are more likely to lose or change insurance. Since insurance coverage is a major factor in any patient-therapist relationship, a change to that coverage can be a risk to your practice. Even more importantly, it leaves patients without their usual support during a time when they likely need it most.

But a change of insurance doesn’t have to mean goodbye.

Many therapists are using Single Case Agreements (SCAs) to retain patients experiencing a change of insurance. An SCA is an agreement between a therapist and an insurance company you are Out of Network with (OON) that allows you to effectively be treated as In Network for a particular patient’s case. Patients benefit from receiving continuity of care with the same therapist they’re familiar with, and therapists benefit by maintaining relationships with patients and often attaining the same, or similar, rates.

So how does an SCA work, in practice?

1. Patient requests SCA

Typically, the patient requests an SCA from their new insurance provider. This means that when changes are coming to insurance coverage, it’s helpful to have a conversation about whether there would be benefit to trying to continue the relationship under an SCA. The patient usually contacts a behavioral health representative of their insurance company.

2.Therapist negotiates with insurance company

Next, the therapist will need to accurately describe the benefits of continuing with the patient.

For a long term patient, the new insurance company may respond positively to the justification that you are providing continuity of care. If the patient can’t afford the OON benefits to see you, and if there could be setbacks in progress if they had to start over with a new (in network) therapist, make sure the insurance company is aware of this.

In the case a new patient is requesting an SCA, the insurance may want to know if the patient has a need for your specialty or geographic convenience. Likewise, if the treatment you can provide could reasonably be argued to keep the patient out of the hospital or reduce the cost of medications, the SCA might be allowed.

Regardless of the personal situation, an SCA needs to be accepted by both the insurance provider and the therapist. We recommend therapists negotiate rates so they are at or close to going rates.

3. Therapist and Insurance provider sign the SCA

Once an agreement is reached, then the new terms outlined in the SCA will be valid. Because an SCA is rarely backdated, it’s important that the patient understands their financial responsibilities in any interim windows between coverage, or in the event the SCA is not granted. By being proactive about the process, the lag in care can be shortened, which benefits both therapist and patient.

When we go through hard times, we need to rely on mental health professionals more than ever. Understanding the process and the elements of a strong case for a Single Care Agreement is one way we can continue serving and strengthening our local communities.

Sending claims to insurance providers is a large part of what what we do as medical billers, but our why? Our why is to bring peace of mind to mental health therapists, and we achieve that by improving cashflow and taking the messy insurance component off their plate. Here we share four strategies that can help improve cashflow and make any private practice more resilient. It’s always a good business practice, but now in times of uncertainty it’s critical to stop leaving money on the table.

Sending claims to insurance providers is a large part of what what we do as medical billers, but our why? Our why is to bring peace of mind to mental health therapists, and we achieve that by improving cash flow and taking the messy insurance component off their plate. Here we share four strategies that can help improve cash flow and make any private practice more resilient. It’s always a good business practice, but now in times of uncertainty it’s critical to stop leaving money on the table.

Accounts Receivable, or A/R, is the term for money that’s owed to your practice for billed clinical work. One of the most crucial components of our service is to provide clients with a monthly Aging Report, which shows Accounts Receivable as a list of bills that are overdue and by how long.

Providing therapists with these reports can immediately improve visibility. On our side, it helps us formulate a plan to correct and address cash flow problems. It also helps you make informed business decisions so your practice can stay cash flow positive.

Verifying benefits is part of understanding what billable amounts of a service can be recovered by a patient’s insurance policy. This can be a moving target. When patients meet their deductible, the industry (or global pandemics) cause coverage changes, or even as new codes are introduced, the amount of coverage may change.

We monitor patient benefits in a few ways. First, on the patient side, we calculate what they are likely to owe for a given session. We know from experience that unexpected, surprise bills have a higher likelihood of not getting paid on time, or at all.

From the insurance side, we know that how you code for services matters. One in five claims aren’t processed correctly, leading to providers getting underpaid, overpaid, or not paid at all. With a combination of expertise and thorough follow up, we help our clients recover what – without the right attention to detail – could otherwise be a loss.

Timely billing is another strategy we implement for our clients. When providers focus too much on billing amounts or processes, they may lose sight of when billing is conducted.

Getting claims in during the window where they will be processed and covered matters immensely for your cash flow. Since the windows will differ depending on the insurance provider, whether your practice is in-network or not, or who’s doing the billing (provider or patients), you might find yourself juggling a lot of different tasks.

We implement procedures to ensure we never miss a window. We’re also the enforcers of these procedures for your clients and are available to hold them accountable when necessary.

Full-service medical billing means it’s our business to improve your practice’s cash flow and give you back your time. Extra time gives you the power to refocus on parts of your practice that generate more revenue and bring you deeper satisfaction. For many of our clients, that’s pursuing interesting clinical work, research, or attending conferences and lectures.

Cash flow has always been a key indicator of any successful business, and now, it’s more important than ever. During uncertain times, all industries are changing quickly. Keeping up with these changes becomes even more time-consuming, and the benefits of having consistent, predictable cash flow is more than just a good business practice: it’s invaluable peace of mind.