BH Practice M&A — 2026 Billing Due Diligence Playbook

BH practice acquisitions are accelerating in 2026 as PE-backed platforms roll up multi-state ABA, SUD, and MH operators. Billing due diligence is the single biggest source of post-close surprises — where 30-40% of deals get retrade after close.

The 8 Billing Diligence Items

1. Denial rate — 6 months of denial data by payer + CPT
2. Days-in-AR — trend line + aged AR composition (see DAR guide)
3. Payer contract library — all commercial + Medicaid contracts + terms
4. Credentialing status — every clinician × every payer status
5. Compliance program — MHPAEA parity, CFR 42 Part 2, HIPAA
6. Cash flow reconciliation — bank deposits vs claim payments
7. Charge capture completeness — session count vs billed encounter count
8. Coding accuracy — sample audit of 100 claims

Red Flags That Kill Deals

• Denial rate above 15%
• Days-in-AR above 60 days
• MHPAEA parity appeals never attempted (=recovery upside)
• Credentialing gaps > 20%
• Aged AR over 90 days > 15% of total

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– KD, Revenant Care