The Psychology of Billing: Reducing Stress Around Money in Private Practice

For many mental health providers, billing is not just an administrative task, it’s an emotional experience.

Even the most clinically confident clinicians can feel a knot in their stomach when sending an invoice, discussing fees, or following up on a balance. Money can quietly activate shame, avoidance, people-pleasing, or fear of being perceived as “in it for the money.” These reactions are not signs of weakness. As a psychiatrist or mental health nurse practitioner, you know they are human responses shaped by personal history, training, culture, and the unique relational nature of therapeutic work.

Taking a compassionate look at the psychology of billing can help reduce stress, strengthen boundaries, and ultimately support both ethical care and sustainable practice.

Why Billing Feels So Hard for Mental Health Providers

Psychiatrists and mental health nurse practitioners are trained to attune, empathize, and hold space for vulnerability. Billing, by contrast, can feel transactional, rigid, or even at odds with therapeutic values. Difficult emotional themes include:

Shame: Internalized beliefs such as “I shouldn’t care about money” or “helping professionals shouldn’t charge this much” can create discomfort around fees and collections.

Avoidance: Delaying invoices, ignoring accounts receivable, or hoping balances resolve themselves can be a coping strategy rather than laziness.

Boundary confusion: Because therapy is relational, money conversations can feel personal. Most people have money issues, including patients and the mental health providers who care for them. Providers may fear damaging rapport or being perceived as uncaring. 

Imposter syndrome: Thoughts like “Am I really worth this rate?” can surface during fee discussions, especially for newer clinicians or those raising rates.

Recognizing these as understandable human reactions is the first step toward change. The next step is trying to shift how you think about billing.

Mindset Shifts to Reduce Billing Stress

Take some time to practice mindset shifts that can benefit your psychiatric practice. Not all of these will be easy, but growth comes from challenges. 

1. Reframe Billing as Part of Care 

One powerful mindset shift is to view billing not as separate from therapy, but as part of ethical, professional care.

Clear, consistent billing practices:

• Reduce anxiety for clients
• Prevent misunderstandings and resentment
• Model healthy boundaries and self-respect
• Protect the longevity of your practice so you can continue serving others

When billing is inconsistent or avoided, stress often builds on both sides of the therapeutic relationship. Clarity, while uncomfortable at first, is often kinder in the long run.

2. Separate Your Worth from Your Fees

Your fee reflects the cost of running a practice, your training, and the value of your time. It is not a moral judgment or a measure of your compassion. You can care deeply and still charge appropriately. Fees are a structure that supports the work, not a statement about who you are.

3. Normalize Discomfort Without Letting It Lead

Feeling uncomfortable does not mean you are doing something wrong. It means you are stretching into a boundary that may be new or historically challenging.

Instead of asking, “How do I avoid this discomfort?” try working through “How do I support myself here?”

4. Use Systems to Reduce Emotional Load

The more manual and inconsistent your billing process, the more emotional energy it requires. Automated statements, clear financial policies, and regular review of accounts receivable reduce the need for repeated, emotionally charged decisions.

Systems create neutrality. Neutrality reduces stress.

5. Clients Have Responsibilities 

Many providers unconsciously take responsibility for their clients’ financial emotions. While empathy is important, clients are capable of managing their own financial decisions, asking questions, and advocating for themselves.

Clear policies respect client autonomy rather than undermining it.

Compassionate Boundary-Setting in Practice

Boundary-setting around money does not have to be harsh. It can be calm, clear, and kind.

Examples of compassionate boundaries include:

• Discussing fees and policies upfront rather than waiting for problems to arise.
• Using neutral, consistent language in billing communications.
• Following the same process for all clients to avoid favoritism or resentment.
• Referring back to written policies rather than renegotiating in moments of discomfort.

Billing is a boundary that makes empathy – and your practice – sustainable.

When to Seek Support

If billing anxiety feels overwhelming, it may be helpful to explore it the same way you would encourage a client to explore a stuck pattern. Seek consultation or supervision to help work through mindset shifts and set up systems for success. Or work with a billing professional to offload both practical tasks and emotional strain.

You do not have to navigate the financial side of practice alone. If you’re ready to explore whether MindEase Billing is the right service to partner with to help you build a sustainable practice, click on the “Request A Discovery Call” button below. Or learn more about us first by visiting our home page.

In Network vs Out –

Contracting Strategies and Avoiding OON Discounts

Network Status

Although there are exceptions, a psychiatrist or mental health nurse practitioner in private practice is either In Network (INN) or Out of Network (OON) with an insurance company. We refer to this as the network status. There are pros and cons to either status.

Generally, the terms like “in network with,” “contracted with,” “on the panel with,” and “paneled with” an insurance are interchangeable. Sometimes mental health providers say “credentialed with” to mean contracted with, but credentialing and contracting are actually different.

In Network

Being INN means a psychiatrist or mental health nurse practitioner has a signed contract with the insurance company and among other things, agrees to a contract rate for each CPT code. That contract amount is all the mental health provider will get paid per code. The contract amount varies per code and differs by payer and is different across geographic regions. 

When submitting claims, submit the same rate per code to each payer, regardless of their reimbursement amount. The difference between your rate and the contract amount is a contractual write off. You don’t get to collect that from the patient. Being held to the contract rate is the main downside of INN status. 

The upside to being contracted, is that the patient’s out of pocket expenses are often lower than if they see an ONN provider, so seeing someone INN often makes better financial sense for a patient. Also, contracted providers are often listed in an online directory, making it easy for potential clients to find them; this can cut down on the need for psychiatrists or mental health nurse practitioners to engage in much marketing or networking.

Out of Network

OON providers don’t have the benefit of the network referrals from an online provider directory, so psychiatrists and mental health nurse practitioners may find they need to do some marketing or networking to bring on clients. And patients generally end up paying more out of pocket to go ONN. Some plans don’t provide any ONN benefits at all. These are downsides of being Out of Network.

But there are several advantages to being ONN.

While INN “contract amount” is used to refer to the reimbursement for each CPT code, ONN “allowed amount” is the more common term. Just like INN you would bill your full rate for each code regardless of the allowed amount. However, ONN providers are usually allowed to collect the difference between their rate and the reimbursement rate; they are not bound by the allowed amount. When done, it’s called balance billing. 

Being OON with some or all payers may also fit into the bigger picture strategy for your private practice.

Network Strategy

Though some psychiatrists and mental health nurse practitioners new to private practice think they need to contract with every insurance company they can in order to fill up their practice with clients, at MindEase we advocate for a more strategic approach.

Providers with a generalized practice may want more contracts while someone with a very specific niche can get away with less. 

If your practice is near some large employers, you may want to consider contracting with the payers that provide benefits to the employees.

There are national companies as well as regional ones and you may want a combination of both. Looking at market share for your region can help you determine what kind of blend fits for your practice. This ties into the phase of your practice. A provider with a new practice that needs to fill up quickly may want companies that have greater market share and can refer more clients (even if reimbursements are lower). While a mature practice may be able to add diversity with a company with smaller market share. 

Insurance Company vs. Network

Although most people use the term “insurance company” and “network” interchangeably, it is important to understand there is a difference.  The insurance company is typically the party that collects the premiums and pays the benefits. The network refers to the pool of health care providers that the insurance company pulls from. 

Most of the nationally recognized companies like Blue Cross Blue Shield (BCBS), United Behavioral Health (UBH), Cigna, and Aetna are both an insurance company and their own network. A therapist can contract directly with them. 

Other insurance companies may be too small to manage their own network, so they “rent” other networks. Cigna and Aetna networks are often used by tiny, obscure insurance companies. 

OON Discounters

One of the most common conversations on local listservs is what to do when you get a communication from MultiPlan asking you to accept a discount to get paid faster. We refer to these companies as “out of network discounters.” Below is our advice to avoid giving an unintended discount to a payer.

Network Shopping

Most payers want to pay as little as they can for benefits, so when a claim comes in, they do a little network shopping. First, they search to see if you’re contracted directly with them. If so, they (should) process claims INN saving some OON costs. If you’re not contracted with them directly, they’ll see if you have a contract with some other network they partner with or “rent” a network from. If they don’t find you on one of those contracts, they reach out to OON discounter like MultiPlan.

Aggressive Encouragement

Aetna and Cigna often use OON discounters; if you’re OON with them keep this in mind. They could hire MultiPlan (renamed Claritev in February 2025) or another similar company to see if you would like to take a pay cut. They aggressively “encourage” psychiatrists and mental health nurse practitioners to be treated as In Network with very low reimbursement rates.

The OON discounter will fax you a negotiation. Then another. And another. Then they might call and/or email. The gist of the communication is that if the provider agrees to the discount, they will get paid “right away.” 

Avoid the Discount

The payer is obligated to process clean claims in a timely fashion which is generally 30 business days in most states. If a claim cannot be processed within this timeframe either because there’s a backup at the company or information is missing from the claim, you are supposed to receive communication directly from the payer about this. Usually this is sent in writing; they don’t normally call and they don’t contact you aggressively or pressure you with “right away” payment tactics.

Our advice is to ignore the OON discounter communications. Shred the faxes. Delete the messages.

However, if you do end up on the phone with one of these discounter reps, do not give them any information. One give-away that you’re talking to such a representative is that they are unlikely to be able to tell you who the patient or the insurance company is. If you are asked for a TIN or patient ID#, you can say “all the information the insurance company needs to process the claim is already on the claim form.” Or “I’m fine waiting until the actual insurance company processes the claim.”

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To see if MindEase Billing might be a good fit for your psychiatric practice, check out our home page or click on the “Request a Discovery Call” below to get started.

Verifying Mental Health Benefits with Online Portals

Over the past 5-10 years, the advent and improvement of online portals, some maintained by insurance companies and some designed to allow access to multiple payers, has brought many efficiencies for benefit verification as well as a few challenges. If you’re a psychiatrist or mental health nurse practitioner in private practice – and you’re verifying benefits yourself – this guide is designed to help you get started using online portals.

1. What Are Online Portals Used For?

Insurance portals are web-based platforms provided by insurers or third-party entities that allow providers to:

• Verify patient eligibility and coverage.
• Check claim status and retrieve EOBs.
• Submit prior authorizations for services.
• Access payer-specific guidelines and policies.

Common portals include:

• Availity: access to Blue Cross Blue Shield and several other payers 
• OneHealthport (1HP): access to several Pacific Northwest payers 
• Optum/UnitedHealthcare Provider Express 
• Noridian (or equivalent Medicare portal in your area) 

Though you can use most portals to do more than check coverage, this guide won’t go into using portals for requesting an authorization, submitting claims, or retrieving EOBs. 

2. How Do You Access Online Portals?

Each portal requires an account, which generally involves a registration process. For improved efficiencies, we recommend first registering for multi-access portals (like Availity and 1HP). Then supplement with single-access portals (like Provider Express) to fill in the gaps for companies you can’t access within the multi-access portals.  Here’s how to get started:

1. Visit the website to find the registration page.
2. Provide necessary credentials (your Tax ID, NPI number, contact details).
3. Assign user roles within the portal. 
4. Link the portal to your practice management or billing system if the platform supports integration.

3. What Coverage Details Can You Find?

When verifying benefits through an online portal, you can find a variety of details. In order to access the information, you generally need at least your client’s name, date of birth and ID number. 

• Patient eligibility status: The policy’s effective date. Or termination date if not active.
• Deductible & Out of Pocket status: See amount paid and/or remaining.
• Cost Sharing: Co-payments or coinsurance amounts.
• Coverage limits: There may be session limits. Or no out of network coverage.
• Authorization requirements: See if your services need pre-approval.

We recommend making a note of the benefit details for easier reference later. You can record the information in a spreadsheet or custom form, print or take a screenshot, or write a summary in the EHR/billing software. 

4. Advantages of Using Portals for Verification

• Saves Time: Faster than calling the insurance company. 
• Improves Accuracy: Reduces miscommunication by providing written documentation.

Some companies like Regence BCBS require you to check benefits on Availity; talking to a human is practically unavailable. Other companies may not have a requirement to use a portal, but hold times can be prohibitively long, representatives can be trained at varying levels and more often than not the reps are off-shore which can lead to frustrating results if you don’t ask your questions effectively. 

5. Challenges of Using Portals for Verification

• Missing or Inaccurate Information: Not all plans show full (or correct) benefits online.
• Learning Curve: Learning how to navigate the portal and interpret the results will take some trial and error.

Each portal is designed differently, from where and how to find information, to what’s available, to how the details are displayed, to how accurate the information is. If the benefit results are confusing or sparse, you may be able to contact the insurance company for clarity, but as noted above, that might not be an option. If not, you may need to see how claims process, then compare to the various benefits you found in the portal to create a feedback loop for yourself. The feedback can help you determine the best place in the portal to look for the most applicable benefits for the service you provide.

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If verifying benefits is something that can improve your insurance billing, but you don’t want to do it yourself, consider outsourcing. To see if MindEase Billing might be a good fit for your psychiatric practice, click on the “Request a Discovery Call” below to get started.

Single Case Agreements and Other Tools for OON Patients

As the new year approaches, and with turmoil ahead with potential skyrocketing premiums, you may see patients change insurance plans in the coming months. You may find patients who were previously in network are suddenly out of network (OON).

But a change of insurance doesn’t necessarily have to mean goodbye, leaving patients without their usual support during a time when they likely need it most. As a psychiatrist or mental health nurse practitioner, you may have a few tools at your disposal to continue care. 

This article covers single case agreements (SCA), transitions of care (TOC), and in network exceptions (INE). Though there are some distinctions between them, the common thread is that they allow you – as an OON provider – to be treated in network to some degree.

By utilizing one of these tools, patients can benefit by receiving continuity of care with a provider they’re familiar with. Let’s look at how these work.

Making the Request 

Typically, the patient makes the initial request with their insurance. TOCs are generally available from a new insurance company when a large employer switches from their previous one. We sometimes see TOCs granted when a mental health provider goes out of network, but not often.

SCAs and INEs can also make sense to pursue when an employer switches insurance companies. But generally, if the patient switches insurance on their own (on the ACA Marketplace), these options are unlikely to be allowed.

Clarifying Patient Responsibility

Just because a request is made, doesn’t mean it will be granted. Some, like an SCA, could take a few weeks to be finalized and are generally not backdated. Therefore, it’s important to have conversations with your patient about their financial responsibilities during any windows between coverage, or in the event the request is not fulfilled.

Making the Case

As the psychiatrist or mental health nurse practitioner, you may be asked to make a case, justifying why you should be given some kind of in network access. We recommend making sure the insurance company is aware of one or more of these points:

• Continuity of care – Make this point 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.
• Expertise – Make this point if your specialty can be more effective, reduce the duration of treatment more than seeing someone with a more generalized practice.
• Hospitalization – Make this point if the treatment you provide can reasonably be argued to keep the patient out of the hospital or reduce the cost of medications. Insurance companies love saving money.

Claims Processing and Balance Billing

Before agreeing to terms, it’s important to understand how claims should process. 

An SCA is actually a contract you and the insurance company sign. It makes you in network for a specific patient. SCAs process with in network benefits, at the rates you agreed to (see “Agreeing to the Terms” below), and you cannot balance bill (you take the insurance discount because you’re contracted).

INEs are generally delivered as an authorization, with a defined date range. You’re likely to receive an authorization number which goes on claim form. Claims should process using in network benefits. The reimbursement rates used are non-negotiable and variable OON amounts, and you are allowed to balance bill up to your billed rate.

TOCs should process like an INE and you can balance bill if you want. They are usually for a short amount of time (3 months is common) and are designed to give a patient more time to find an in network provider. After that, if the patient continues to see you, claims should start processing with OON benefits if they have any.

Agreeing to the Terms

Make sure you understand any terms or limitations as described above. With SCAs you can generally negotiate your rates. Try to settle on something as close to your regular billed rates as possible. For TOCs and INEs you won’t be able to negotiate. 

Claim Processing Errors

Though claims should process as described above, sometimes they don’t. Generally, they don’t flat out deny but will instead process with OON benefits when they should use in network. Before agreeing to using one of these tools, make sure you’re committed to reviewing the EOBs for processing errors and have the capacity to call the insurance company to send claims back for reprocessing as needed.

If you don’t personally have the bandwidth, either don’t take on such cases or make sure your billing service understands how these work and have the workflow in place to identify and challenge processing errors.

If you want to see if MindEase is a good fit for your solo mental health private practice, click on the Request A Discovery Call button below.

This guide is designed for psychiatrists, mental health nurse practitioners, and therapists who are thinking about hiring a (new) biller, and want to get it right. There’s more to billing than just submitting claims and hoping you get paid. 

Working with an excellent billing service can help you make more money and serve your ideal clients with peace of mind. A bad biller can sink your business, reducing your revenue and increasing your stress. Therefore, it’s an important decision to make; one worth deliberation.

MindEase Billing is a billing and consulting company in Portland, OR. We’ve seen the pain and loss that comes from choosing the wrong biller. Many of our clients found us after first enduring a bad experience. 

We developed this guide from their misfortunes to help you avoid one or all three of the mistakes they made with previous billers:

• Not Knowing What You Need or Want 
• Basing the Decision on Price Alone  
• Staying in a Bad Relationship Too Long

Mistake #1: Not Knowing What You Want or Need

Before interviewing and comparing billing services, conduct a Needs Assessment by reflecting on your current state versus your goals. Then when you talk with prospective billers you can determine how they can help you bridge the gap from where you are to where you want to be. This is the first step in managing your own expectations. Here are some things to consider…

• Current vs goal revenue. 
• Current vs ideal # of clients/sessions. 
• Why are you looking for a billing service? What pain or frustrations are you having that make you think a (new) biller could help you with? 
• What expectations do you have of a billing service? How do you want your biller to help you?  
• What concerns do you have about working with a (new) biller? 
• What deal breakers are you watching for?

Within the mistake of Not Knowing What You Need and Want is making the assumption that all billers are created equal. Billing services are not a commodity, like gas or sugar.  Instead, each biller decides what services to provide, who they service, how to charge, and what values are important in guiding their practice. Understanding this can help you avoid Mistake #2.

Mistake #2: Basing the Decision on Price Alone

What’s the number one question providers have for billers? Yep, “What do you charge?” But now that you understand what you need, you can reframe the question into “What do I get for what you charge?” 

While basing your decision on price alone is a mistake, cost is a part of the equation. It’s important to know what you get for the price and how you’ll be invoiced. So, let’s look at The Service and The Invoice below.

The Service

The main purpose of a billing service is to submit claims. But if claim submission is all the billing service does, don’t expect a high level of practice advocacy. On the other hand, you shouldn’t expect to pay much, either.

A billing service can give you so much more than just claim submission. At MindEase we think these 5 components are worth consideration when interviewing prospective billers: 

• Benefit Verification 
• Claim Submission 
• Getting You Paid 
• Reporting 
• Communication

Let’s look at each in more detail below.

Benefit Verification. Does the biller verify benefits routinely or only on request? Does the biller calculate the patient’s financial responsibility (PR)? Does the biller make the benefits and PR estimates available to you? Do they make them available to your patients?

Claim Submission. This is the obvious thing a biller does and frankly this is the easiest part. But you should still understand how your biller manages this step.

How does the biller get your session information and the amount of money you collected from the patient? Do you fill out a digital log? Does the biller dip into your EHR? Does the biller look for errors you’ve made and ask for clarification before submitting claims? How often are claims submitted? 

Getting You Paid. A billing service should be able to track the money coming into your practice. They should be committed to not only making sure you get paid, but making sure you get paid correctly and in a timely fashion. How does your prospective biller do this?

Reports. Billers are a vital link to your cash flow and reports are a crucial source of information that reflects the health of your practice.  Your biller should use a variety of reports to help manage your practice and you should have access to (and encouraged to review) reports on a routine basis so you can make informed decisions.

Communication. During the interview, does the biller seem genuinely interested in working with you? Do they seem to care about the health and goals of your practice? Do they seem easy to communicate with or is it like pulling teeth to have a conversation? We recommend steering clear of anyone who seems annoyed to have to answer your questions.

As a client, when and how do you communicate with them? Do they talk to your clients?

The Invoice

There are 4 main structures billing services use when invoicing their clients:

• Hourly Rate 
• Percentage 
• Per Session 
• Per Patient

The structure the biller employs is the core of your invoice. Whatever structure the biller uses, it’s important to understand which service components are covered in this structure and what might be charged separately. For example, are these included in the core invoice structure:

• practice set up 
• monthly minimum 
• sending/receiving faxes 
• database charges 
• postage (mailing patient bills, etc) 
• claims appeals 
• dunning (soft collections) 
• practice advice/consultation 
• communicating with patients 
• cleaning up patient accounts that you or your previous biller might have messed up

Mistake #3: Staying in a Bad Relationship Too Long

We love psychiatrists, mental health nurse practitioners, and therapists. They have big hearts and giving spirits. They help others find the best in themselves.  They’re also pretty forgiving – perhaps to a fault. This is what can cause them to get stuck in a painful or dysfunctional professional relationship too long. 

This section is designed to help you recognize when or whether you’re in a bad billing situation and to help you avoid one if you’re not. You’ll need a few benchmarks or metrics to monitor.

Cash Flow. Your primary metric is your cash flow.  Have you noticed a drastic and/or consistent decrease in cash flow without a decrease in your volume? Don’t let this persist. 

Your Experience. Your secondary metric is your experience. Are you treated kindly and professionally when you have a question or concern? Does the biller acknowledge and fix their mistakes (often before you even notice)? Are they proactive and communicative about industry changes? Or are they rude, indifferent, uninformed or chronically unavailable? 

Patient Experience. Patient interactions matter, too. Ask a cross-section of clients about their experience when dealing with the biller. Are they getting their questions and concerns addressed with respect and empathy?

Other Red Flags. Is the biller taking increased time off due to illness or a pending retirement? Does the biller complain about their own stress? Is the biller looking for a job? Does the biller hint at increasing their client load, but isn’t making improvements in processes or adding staff? Does the biller complain about or disparage their employees?

If the biller is mature, they want your honest feedback so they can clear up any misunderstanding and/or improve their service. But if the biller is not interested in your feedback or makes unsustained efforts to improve the service, you really don’t need to stay. 

It’s easy for MindEase to say “just get out” of the relationship, but frankly that’s our advice. Your practice is too important to let incompetence or indifference be responsible for your cash flow and a chunk of your success.

Conclusion 

This guide was born out of the pain our providers experienced prior to coming to MindEase. Most of the billers we have cleaned up behind are not bad people, they were simply sloppy, poor communicators. 

If it’s time for a (new) biller, take some time to do a Needs Assessment, then diligently interview prospective billers who meet your needs. Don’t settle. We want you to have high expectations from your billing service, because your practice depends on it.

If you’re a psychiatrist, mental health nurse practitioner, or therapist in solo private practice and want to see if MindEase is a good fit, click the Request A Discovery button below. To learn more about us in general, head to the MindEase Home Page.

As a psychiatrist or mental nurse practitioner in private practice – especially if you’re just starting out, trying to keep overhead low – it’s tempting to handle your own billing. After all, how hard can it be to submit a few insurance claims, right?

It’s true, submitting claims isn’t rocket science, but managing the billing is more than just submitting claims. The reality is: DIY billing often costs you more than it saves. Not just in dollars, but in time, stress, and missed growth opportunities.

Here’s what most providers don’t realize until they’re in too deep:

 

1. You’re Leaving Money on the Table

Money. Most providers didn’t get into psychiatry to make a ton of money. But your private practice does need to generate revenue, enough to pay your overhead, your taxes, and of course you. 

When you do your own insurance billing you have to learn how, when, and where to submit claims. But your work isn’t necessarily done after claims are submitted. Some claims will be denied, rejected, or underpaid, all affecting your cash flow and revenue. Many DIYers…

• Leave money on the table by under-coding, missing add-on codes, or filing claims past the timely filing window.
• Delay revenue by using incorrect modifiers.
• Don’t notice when payers underpay.
• Give up on denied claims that could have been recovered.

If you fail to review your EOBs closely or stay on top of payer trends, you could miss out on thousands per year. A good biller takes most of these tasks off your plate. They understand that your revenue is in their hands and can help you succeed by billing cleanly, consistently, and timely.

 

2. You Don’t Get the Time Back

Time. Insurance billing can steal more time than you may have budgeted for. For your psychiatry practice to avoid leaving too much money on the table (see #1 above) you’ll need to…

• Check benefits to know what you should get paid.
• Create and submit claims.
• Review EOBs to identify processing errors/denials/rejections.
• Correct and resend claims as needed.
• Call insurance companies to challenge processing errors (and repeat until resolved).

Billing takes time. Fixing your mistakes takes time. Troubleshooting payer mistakes takes time. Denials take time. And calling insurance companies? That’s practically a part-time (unpleasant) job.

If you’re spending a meager 5 hours a week on those billing tasks, you’re not only cutting into patient hours – you’re cutting into admin, personal or family time, too. At a $200 minimum per session (for MDs and NPs) that’s $1000 you could have been paid for the time you spent. If a good biller had taken those tasks off your plate for 5-10% of the revenue, you would have paid them $50-100 to earn that $1000. Or instead of working, you could have spent those 5 hours on something much more satisfying than billing.

 

3. You’re Back to the Burnout

Health. If you’re like most psychiatrists and mental health nurse practitioners, a big reason you’re starting a private practice is because you’ve been pushed to burnout in other settings. Though it may be a different flavor, doing your own billing can bring you right back to the edge of burnout due to being…

• Stressed about the learning curve to manage the billing efficiently.
• Overwhelmed by creating effective processes & workflow.
• Anxious about cash flow and revenue.
• Disheartened by incompetence from payer representatives.
• Frustrated by so little to show for the time spent.

A good billing service has the processes and workflows in place to shield you from the vast majority of payer shenanigans. They submit claims regularly to help you maintain smooth cash flow and help identify ways to increase revenue.

 

4. You Can’t Grow

Sustainability. Handling your own billing because you have more time than money, may seem like a good way to get your practice started, but keep in mind, you could be setting yourself up for a vicious cycle. If you plan to grow your practice, it will be hard to do so with the extra administrative work of insurance billing. As your client load increases, so will the time you need to budget for billing. This can hamper your ability to…

• Hire associate clinicians
• Launch new services or programs
• Explore new modalities
• Take care of yourself

As a psychiatrist or mental health nurse practitioner in private practice, aim to build something sustainable. If you want to grow – whatever that means to you – you need to offload the stuff that bogs you down. Billing is easily at the top of that list. When billing is off your plate, you free up time and energy to focus on the growth – and health – of you and your practice. 

 

Final Thoughts

A good billing company doesn’t just submit claims; they can help increase your revenue, catch mistakes, follow up on aging claims, and give you peace of mind. It’s an investment with a return that can pay for itself many times over.

Letting go doesn’t mean losing control. It means reclaiming your time, maximizing your revenue, and building a sustainable practice.

Ready to outsource your billing? At MindEase Billing, we specialize in working with psychiatrists and mental health nurse practitioners in solo private practice. Whether you’re just starting out or need to stabilize your mature practice, we’d love to hear from you. To see if we might be a good fit, click the “Request A Discovery Call” button below. To learn more about MindEase head over to our Services page.

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.