Uncategorized Archives - Page 2 of 3

If your ABA practice bills New York Medicaid, your revenue just dropped 14% and it’s not coming back. New York Medicaid cut the ABA 97153 unit rate from $16.85 to $14.45 between October 2025 and April 2026. For a mid-size NY ABA practice billing 400 units per week per BCBA-supervised technician, that’s: Old revenue per […]

Why 40% of Mental Health Practices Get Stuck in Credentialing Purgatory in 2026 (And the Specific Fixes to Get In-Network in 90 Days Not 180)

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Two industry stats every BH practice owner should know: 40% of mental health professionals report significant credentialing delays or outright denials — the single most common reason new clinicians can’t see insured patients and new facilities miss revenue targets in their first six months. Only 55-60% of behavioral health providers are in-network compared to 90% […]

Vermont Just Killed ABA Concurrent Billing. Michigan, Virginia, and Texas Are Next. Here’s How to Protect Your Revenue.

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If your ABA practice bills concurrent 97153 (behavior technician time under BCBA direction) and 97155 (BCBA protocol modification) simultaneously, 2026 is the year the rules got harder — and different in every state. The biggest news: Vermont Medicaid, effective January 2026, discontinued reimbursement for concurrent billing of 97153 and 97155, restricted telehealth ABA delivery, and […]

G0480-G0483 Drug Screen Coding: Why Most SUD Practices Are Under-Coding and Leaving 4-5x Revenue Per Test

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If your SUD practice runs definitive (confirmation) drug testing and 80%+ of your screens are billing as G0480, you’re under-coding the work. The G0480 to G0483 series is stratified by complexity (number of drug classes tested), and the reimbursement delta between G0480 and G0483 can be 4-5x per claim. For a residential SUD program running […]

Mental Health Parity Act Appeals: How Behavioral Health Practices Are Leaving Money on the Table

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If your practice bills any commercial insurance — Anthem, Aetna, United, Cigna, BCBS plans — you have parity-violation denials in your queue right now. They look like routine denials. They’re not. The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) and the 2020 amendments require that behavioral health and substance use disorder benefits […]

Outsource ABA Billing Services: When It Pays Off (And When It Doesn’t)

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The honest answer: Outsourcing your ABA billing makes financial sense when your collected revenue per BCBA hour is being suppressed by 4% or more in fixable categories you don’t have time to work. Below that threshold, in-house billing usually wins. Above it, you’re paying yourself to do work an outsourced team can do faster and […]

The 5 Denial Patterns Behavioral Health, ABA, and SUD Practices Lose the Most Revenue To

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We audit a lot of behavioral health, ABA, mental health, and substance use disorder practices. The pattern is almost always the same: 8 to 12 percent of net revenue is sitting in denials that nobody had time to rework. It’s not because the billing team is bad. It’s because there aren’t enough hours in the […]

Optometry Medical vs Vision Billing: 92xxx and 99xxx Code Boundaries

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The single most expensive mistake in optometry billing is treating every patient encounter as either a vision plan visit or a medical visit based on what insurance card they handed the front desk. It isn’t the card that determines the billing pathway – it is the chief complaint. Get that wrong, and you are either […]

SUD Residential Billing: R&B, PHP, and IOP Edge Cases Most Programs Get Wrong

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Substance use disorder residential billing is where clean claims go to die. The combination of ASAM level-of-care rules, HCPCS code selection, revenue code pairing for room and board, Medicaid MCO carve-outs, and the IMD exclusion creates a stack of failure points that most programs only discover after 60 days in A/R. If you run a […]

The CFO’s Guide to Offshore Medical Billing: What to Audit Before You Sign

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Before signing an offshore RCM contract, audit HIPAA, SOC 2, pricing, AM coverage, and denial workflows. 12-point CFO checklist and red flags to reject.

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Category: Uncategorized

New York Just Cut ABA 97153 Rates by 14%. Here’s What Every NY ABA Org Needs to Do Right Now.

Why 40% of Mental Health Practices Get Stuck in Credentialing Purgatory in 2026 (And the Specific Fixes to Get In-Network in 90 Days Not 180)

Vermont Just Killed ABA Concurrent Billing. Michigan, Virginia, and Texas Are Next. Here’s How to Protect Your Revenue.

G0480-G0483 Drug Screen Coding: Why Most SUD Practices Are Under-Coding and Leaving 4-5x Revenue Per Test

Mental Health Parity Act Appeals: How Behavioral Health Practices Are Leaving Money on the Table

Outsource ABA Billing Services: When It Pays Off (And When It Doesn’t)

The 5 Denial Patterns Behavioral Health, ABA, and SUD Practices Lose the Most Revenue To

Optometry Medical vs Vision Billing: 92xxx and 99xxx Code Boundaries

SUD Residential Billing: R&B, PHP, and IOP Edge Cases Most Programs Get Wrong

The CFO’s Guide to Offshore Medical Billing: What to Audit Before You Sign