BH Practice Billing Best Practices — 50-Point Checklist 2026
Intake (10)
- Verify insurance active DOS
- Verify BH benefit specifically
- Verify deductible + copay + coinsurance
- Verify out-of-pocket max status
- Verify provider in-network
- Verify prior auth required + status
- Verify referral required + status
- Collect patient signature on consent forms
- Collect patient signature on ROI
- Verify secondary insurance if applicable
Session Documentation (10)
- Sign note within 24 hours
- Document time in + time out
- Document CPT + medical necessity
- Document DSM-5-TR justification
- Document intervention type
- Document response to treatment
- Document homework/next steps
- Attach outcome measurement (PHQ-9, GAD-7)
- Update treatment plan quarterly
- Signature includes credentials + license number
Coding (10)
- Verify CPT matches session type
- Include modifier 95 for video telehealth
- Include modifier 93 for audio-only telehealth
- Add-on 90833/90836/90838 for med management + psychotherapy
- Add-on 90785 for interactive complexity
- Use correct POS (11 office, 02/10 telehealth)
- Verify E/M level supports MDM + time
- Verify group therapy participant count
- Verify supervision documentation for 97155
- Verify J-code strength for MAT
Submission (10)
- Submit within 48 hours of DOS
- Batch submission daily
- Track submission timestamp
- Verify clearinghouse acceptance
- Monitor first-pass acceptance rate
- Rebill rejected claims within 24 hours
- Attach documentation for high-risk claims
- Follow payer-specific submission rules
- Track claim status daily via portals
- Document all payer communications
Follow-Up (10)
- Weekly denial trend review
- Payer-specific edit rule updates
- Appeal every 90837 downcode
- Appeal PHP/IOP LOS denials
- Appeal ASAM level down-codes
- Track appeals outcome
- Escalate stuck claims to payer supervisor
- Follow state regulator complaint path for systemic issues
- Report to owner: monthly KPI dashboard
- Continuous improvement based on data
– KD, Revenant Care