Therapy & behavioral health · 25 October 2026

What to Look for in a Mental Health Billing Company

A buyer's checklist for therapy, counseling and behavioral health practice owners

Choosing a mental health billing company is a bigger decision than it looks. The company you pick will touch every insurance dollar your practice earns, see your clients' protected health information, and become the first place you look when payments slow down. Most billing companies sound similar on their websites. The differences show up in the details: how they price, what they actually do each day, how they report, and what happens when you want to leave.

This guide covers what to look for and the questions to ask before you sign.

1. Real familiarity with behavioral health billing

Mental health billing has its own codes, rules and payers. A billing company that mostly works with medical specialties may not know the patterns that cause therapy claims to be denied. Ask how they handle:

Psychotherapy time codes (90832, 90834, 90837) and the documented time each requires
Diagnostic evaluations (90791, 90792) and payer limits on how often they can be billed
Add-on codes such as interactive complexity (90785) and psychotherapy add-ons used with E/M visits (90833, 90836, 90838)
Telehealth rules: place of service 02 vs 10, modifiers 95 and 93, and audio-only coverage
Carve-out behavioral health plans, where a medical plan sends mental health claims to a separate administrator
Supervised and pre-licensed clinicians, and which payers will credential or reimburse them

You don't need to quiz them like an exam, but their answers should be specific and confident. If they can't explain why a payer might deny a 90837, keep looking. Our guide to why therapy claims get denied covers the most common causes if you want a reference point.

2. A clear, written scope of work

"We handle your billing" can mean very different things. Ask for a list of exactly what's included, such as:

Eligibility and benefits verification (before the first session and when plans change)
Claim creation or claim review, and submission through a clearinghouse
Working clearinghouse rejections
Denial follow-up, corrected claims and appeals
Payer follow-up on claims with no response
Payment posting and reconciliation of ERAs and EOBs
Patient statements and answering patient billing questions
Monthly reporting

Also ask what's not included. Credentialing, prior authorizations, and old A/R clean-up are often priced separately or not offered at all.

3. Pricing you can actually compare

Most mental health billing companies charge a percentage of collections, a flat monthly fee, or a per-claim fee. Percentage pricing aligns the billing company's income with your payments, which is why it's common. To compare quotes fairly, ask:

Is the percentage applied to insurance payments only, or patient payments too?
Are there set-up fees, monthly minimums or long minimum terms?
Is working old unpaid claims included, or priced differently?
What happens to the fee if a payer recoups a payment later?

For reference, MedBill Solutions' ongoing billing starts at 3% of what we collect for you. Old unpaid claims are worked for 3% of what we recover, with no fee if nothing is recovered. We agree the exact scope and rate in writing before onboarding.

4. HIPAA basics handled before any client data

Any billing company that sees client information is a business associate under HIPAA. Before you share anything that identifies a client, the company should sign a Business Associate Agreement (BAA). Look for:

A BAA offered up front, not after you ask twice
Individual logins for each person who accesses your EHR, rather than a shared practice password
A clear answer on where their team works and how devices and access are secured
A process for removing access promptly if the relationship ends

Be cautious of any company that asks you to email a client list or insurance cards before a BAA is in place.

5. They work in your EHR, not theirs

Many therapy practices already use an EHR with built-in billing, such as SimplePractice, TherapyNotes or a similar system. Moving to the billing company's own software can mean migrating data, retraining staff and losing visibility. In most cases it's simpler for the billing company to work inside the EHR you already use, with access you control. That way you can see the claims, notes and payments yourself at any time. MedBill Solutions works in your existing EHR or billing system.

6. Reporting you can understand

You should never have to guess how your billing is going. Ask to see a sample monthly report. Good reports cover:

Sessions billed, payments received and outstanding balances
A/R by age bucket and by payer
Denials: how many, why, and what's been done about them
Claims not yet submitted, and why
Any action the practice needs to take, such as missing authorizations or documentation

The report should be in plain English, with a person you can ask about it.

7. Responsiveness and a named contact

When a client calls about a bill or a payer requests records, you need an answer quickly. Ask:

Who is my day-to-day contact, and how do I reach them?
How quickly do you respond to emails and messages?
How do you tell me about urgent problems, such as a payer suddenly denying every claim?

At MedBill Solutions, we reply within one business day.

8. A sensible exit

Even good relationships end. Before signing, check:

The notice period to cancel
Who follows up on claims already submitted when you leave
How you get your reports and any work-in-progress lists
That access to your systems will be removed and documented

If the contract makes leaving difficult or expensive, that tells you something.

Red flags to watch for

Promises of a specific increase in revenue or a guaranteed collection rate
Vague answers about what the percentage is calculated on
No BAA, or reluctance to sign one
Requiring you to switch EHR before they can start
No sample report, or reports that are only raw system exports

Questions to ask on the first call

Which behavioral health payers and EHRs do you work with now?
What exactly is included in your fee, and what costs extra?
How do you prioritize denials and old claims?
Can I see a sample monthly report?
Who will I talk to each week, and how fast do you reply?
When do you sign the BAA?

Next step

If you're comparing billing companies for a therapy or behavioral health practice, read how our insurance billing for therapists service works and how we handle behavioral health denial management. When you're ready, send us a short enquiry with your practice size and EHR, and we'll reply within one business day.

Looking for a therapy billing partner?

Ongoing billing starts at 3% of what we collect. We sign a BAA before any client data and work in your existing EHR. We reply within one business day.

Insurance billing for therapists → Send an enquiry