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Episode 2: Behavioral Health Claim Denials, Common Causes and How to Fix Them
Why do behavioral health billing claims face so many challenges, and why can mental health billing work so differently from billing in general medicine? Sarah Mitchell and Michael Carter break down the coding, documentation, insurance and payment issues that can leave behavioral health practices fighting for reimbursement.
MZ Medical Billing Podcast Season 1, Episode 2
Behavioral Health Claim Denials: Common Causes and How to Fix Them
with Sarah Mitchell & Michael Carter
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What this episode is about
Behavioral health billing involves a mix of time-based CPT codes, payer-specific coverage rules, documentation requirements and authorization processes that can make a routine claim surprisingly difficult to get paid. In this episode, Sarah and Michael look at what happens from the first patient visit through claim submission and denial follow-up.
They discuss the difference between 90791, 90834 and 90837, why session length matters when selecting a psychotherapy code, and how psychological testing, family therapy, group therapy and substance use services introduce additional medical coding rules. They also cover insurance verification, behavioral health deductibles, prior authorization, medical necessity and the five-step billing process used to catch problems before they turn into unpaid claims.
The conversation also looks at what happens after a denial, including reviewing EOB and ERA codes, identifying the root cause, correcting claims, submitting appeals and tracking recurring denial patterns. Sarah and Michael explain how accurate claim submission and focused denial management can help practices address billing problems before they become recurring revenue losses.
Denial management is a practice's financial immune system. If it isn't strong, the rejection spreads, claims pile up, and the practice bleeds cash.
Who's talking
Sarah Mitchell
Sarah spends her days inside coding architecture and payer rulebooks, translating them into workflows a front desk can actually run.
Michael Carter
Michael lives in the CPT and HCPCS code books, tracking every time threshold and modifier so mental health providers don't have to watch the clock mid-session.
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MZ Medical Billing handles behavioral health billing like this every day, for practices, not just for podcasts. Reach out if you want a second set of eyes on yours.