If you run a psychiatry, TMS, or mental health practice, mastering TMS Medical Billing, psychiatric billing services, starts with understanding the language payers use. With preventable denials making up as much as 85 percent of all denials, knowing key billing terms will save time and recover revenue. Below I walk through the ten terms every mental health provider should know and how a specialized partner can help you plug revenue leaks.
Table of Contents
- Quick list of the 10 essential terms
- How to reduce denials and improve collections
- Final thoughts
Quick list of the 10 Essential Terms
- Appeal — The formal dispute you submit to a payer when you believe a denied claim was correct.
- ANSI 837 — The HIPAA-compliant electronic format for claims. 837I for institutional (UB-04) and 837P for professional (CMS 1500).
- Denial — When a payer refuses payment because the claim did not meet required rules or documentation.
- Clearinghouse Rejection — A preliminary rejection from your clearinghouse before the claim hits the payer; easier to fix than a denial.
- Claim Submission — The process of sending claims to a clearinghouse or payer using CMS 1500, UB-04, or ANSI formats.
- Claim Scrubbing — Automated checks that correct formatting and obvious errors before submission.
- CMS 1500 — The standard paper or electronic form for professional claims in mental health practices.
- UB-04 — The institutional claim form used by hospitals and many behavioral health facilities, also called CMS 1450.
- CPT Codes — Five-digit codes that describe services and procedures used by payers to determine reimbursement.
How to reduce denials and improve collections
Start with clean claims: use claim scrubbing, validate CPT and modifier usage, and route through a reliable clearing house to catch errors early. Track denial trends and appeal promptly when appropriate. If you want to scale faster or plug revenue leaks, consider a billing partner with deep psychiatry medical billing experience.
Grow a Thriving Psychiatry, Mental Health or TMS Practice
Need a billing partner that offers a turnkey solution? CBM Management, based at 2435 North Central Expressway Ste 1200, Richardson, TX 75080, brings over 40 years of revenue cycle management and practice start-up experience. We specialize in psychiatry, TMS, and psychiatric billing services and operate our own schools and clinics, so we know the domain intimately. HIPAA complaint and a revenue recovery specialist, we locate and plug revenue leaks while helping you build a lucrative practice. CBM Management provides full-service medical billing, psychiatry medical billing, and outsourced billing services tailored to mental health providers.
Final thoughts
Mental health billing can feel archaic and frustrating, but it is learnable. Focus on prevention: clean claims, robust scrubbing, timely appeals, and an experienced billing partner. If you handle these well, you will reduce denials and increase cash flow.
What is the difference between a clearinghouse rejection and a payer denial?
A clearinghouse rejection is an early automated check that flags errors before the claim reaches the payer. A payer denial occurs after submission and often requires appeals or additional documentation to resolve.
Which form should my practice use: CMS 1500 or UB-04?
Use CMS 1500 (or ANSI 837P) for professional claims from individual providers and UB-04 (or ANSI 837I) for institutional claims from hospitals and certain behavioral health facilities.
How can CBM Management help with psychiatric billing services?
CBM Management offers end-to-end medical billing and revenue cycle services, specializing in psychiatry and TMS Medical Billing. We provide claim scrubbing, denial management, appeals, and revenue recovery backed by decades of experience and in-house clinical operations knowledge.
