Expert Mental Health Billing Services That Maximize Revenue

PGM: The Mental Health Billing Experts

Running a successful mental health organization requires expert billing solutions that boost revenue while reducing administrative burdens. At PGM, we specialize in mental health billing services, ensuring providers receive full reimbursement while maintaining compliance with complex insurance regulations.

When you partner with PGM, one of the country’s leading mental health billing companies, you gain access to experienced billing professionals who understand the intricacies of billing for mental health services, from proper coding and payer requirements to regulatory compliance. Our dedicated team ensures accurate claim submission, denial prevention, and seamless behavioral health revenue cycle management, so you can focus on providing quality client care.

Whether your practice specializes in psychotherapy, psychiatry, or substance abuse treatment, our customized behavioral health billing solutions are designed to optimize cash flow and reduce operational costs. More mental health providers are choosing PGM due to our commitment to accuracy, transparency, and financial success.

Contact PGM today to learn how our specialized mental health billing services can help your practice thrive.

The Leading Choice for Mental Health Billing Services

Managing a successful mental health practice requires expertise not only in client care but also in navigating the complexities of mental health billing services. From coding accuracy to payer-specific requirements, the financial health of an organization depends on efficient billing for mental health services. At PGM, we specialize in streamlining the behavioral health revenue cycle management process, ensuring that providers receive maximum reimbursement while minimizing administrative burdens. Our dedicated team understands the unique challenges associated with billing for behavioral health services, such as handling multiple service types, managing prior authorizations, and staying compliant with changing regulations.

With decades of experience, PGM has built a reputation as a leader in behavioral health billing, offering tailored, scalable solutions that enhance efficiency and revenue flow. We utilize cutting-edge technology, expert billing professionals, and a proactive approach to claim management to improve clean claims, reduce denials, and drive better cash flow. Whether you’re an independent therapist, a multi-provider clinic, or a large mental health organization, our comprehensive mental health billing solutions are designed to strengthen financial performance, allowing you to increase client volume and provide high-quality care and support.

The Unique Challenges of Mental Health Billing

Billing services for mental health presents unique challenges due to complex payer policies, strict documentation requirements, evolving regulations, and many other challenges. Successfully managing billing for behavioral health services is essential for timely reimbursements and financial stability.

One of the primary complexities of mental health billing is navigating payer-specific rules for services like therapy, medication management, and telehealth. Each insurance company has distinct billing codes, claims requirements, coverage limitations, and reimbursement rates. For instance, some insurers require pre-authorizations for therapy sessions beyond a set limit, while others have specific time-based billing codes that impact reimbursement rates. Failure to comply with these nuances can result in denied claims, delayed payments, and even revenue loss.

For providers who accept Medicare and Medicaid, billing becomes even more complicated. Strict – and often changing – guidelines govern billing for mental health services, requiring precise documentation, coding accuracy, and adherence to reimbursement policies. Non-compliance can lead to audits, penalties, and legal risks, making expert billing support essential.

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Full-Service Mental Health Billing by PGM

PGM specializes in behavioral health billing services, ensuring compliance, correct and complete reimbursements, and minimized denials. Our deep industry knowledge helps practices navigate the challenges of behavioral health billing, improving revenue cycle performance and operational efficiency.

Mental Health Services Billing

Billing for mental health services requires precise coding and documentation. Whether it’s individual therapy, group therapy, or psychiatric evaluations, PGM ensures accurate coding and submission to prevent underpayments, denials, and clawbacks.

Modifier Management

Correct application of CPT and HCPCS modifiers is crucial in billing for behavioral health services, especially for services involving multiple providers or extended sessions. PGM ensures the consistent and correct use of modifiers, helping ensure our partners receive proper reimbursement while always following the rules and regulations.

Proper Mental Health ICD-10 Code Selection

Accurate ICD-10 coding is essential for properly documenting conditions such as anxiety disorders (F41.1) or major depressive disorder (F32.9). Our certified coders stay current with the latest coding updates, which increases clean claim rates and decreases denials and delays.

What To Expect: Maximized Reimbursement and Compliance

PGM’s expert mental health billing services help practices enhance revenue, minimize errors, and maintain compliance. Our clients typically experience a 20-30% increase in collections, a 40% reduction in denials, and significant improvements in behavioral health revenue cycle management performance.

How PGM Gets the Best Results in Mental Health Billing

PGM is a leader in mental health billing services because we combine advanced technology with expert billing support to optimize revenue and minimize administrative burdens. Our dedicated team understands the complexities of billing for behavioral health services, ensuring that providers receive the reimbursements they deserve without unnecessary claim delays or denials. By implementing industry-leading technology and a proactive approach to revenue cycle management, we help practices streamline their operations while meeting ever-changing regulations.

Our success in behavioral health billing is driven by key factors, including:

Complete Behavioral Health Billing Services
From claim submission to full behavioral health revenue cycle management, we ensure accuracy and efficiency.
Mental Health Billing Software Integration
Our innovative software automates billing tasks, reduces errors, and strengthens coding accuracy.
Payer Negotiation Strategies
We work with insurers to secure optimal reimbursement rates for mental health billing.
Personalized, Flexible Billing Solutions
Unlike generic billing providers, PGM offers customized solutions tailored to the unique needs of mental health practices.
Regulatory Oversight
Our team stays updated on changing insurance policies to ensure compliance with Medicare, Medicaid, and private payers.
Denial Prevention and Revenue Optimization
We proactively monitor claims, resolve denials quickly, and enhance cash flow.
End-to-End Mental Health Revenue Cycle Management
From client eligibility verification to payment posting and financial reporting, we handle the entire revenue cycle.
Data-Driven Analytics for Financial Optimization
Our advanced reporting tools provide actionable insights into billing performance, helping our practices identify trends, increase reimbursement rates, and improve decision-making.

PGM Revenue Cycle Management

Medical Coding

According to the AMA, the average medical practice submits more than 50% of its claims with incorrect codes. Inexact and inconsistent coding increases the risks of undercharging, overcharging and post-payment audit.

At PGM, all of our clients undergo a practice evaluation where our certified coders, in conjunction with our reimbursement specialists, analyze practice procedures and codes to make recommendations that ensure accurate and optimum reimbursement.

Patient Charge and Demographics Data Entry/Upload

Patient demographics and charges are collected from your office daily. Data can be scanned, faxed or couriered to any one of our locations. Once the data has been received, a dedicated PGM account representative will enter the information into our practice management system.

For PGM clients using an electronic medical record system (EMR/EHR), patient demographics and charge data can be electronically transferred in real-time to our practice management system though our EMR/EHR medical billing interface.

Claims Review

PGM's reimbursement specialists compile and review all client patient and charge data. Billing uploads and batches are balanced, and our medical claims process software is used to 'scrub' claims for errors and omissions. PGM's software performs thousands of checks, including CPT/ICD-9 validations, modifier checks, demographic comparisons and payer-specific edits.

The claims review process ensures that practice billing data is being accurately captured and that claims are clean prior to being submitted for payment. Clean claims greatly increase the rate of payment, helping to maximize the amount collected and reduce accounts receivable.

Claim Submission

Once the claims are reviewed and audited, they are transmitted to the various payers for reimbursement. PGM has the ability to electronically transmit claims to thousands of payers nationwide. For those payers that do not have the ability to receive electronic claims, PGM will generate and mail paper claims.

After submission, claims receive an additional level of "scrubbing' by our clearinghouse. Edits and errors are relayed back to PGM for correction.

Payment Posting

Payments are received either hard copy or via electronic remittance advices (ERA). PGM clients are given the option to continue to receive payment at the practice or to have PGM manage all payments at one of our facilities.

Once payment is received, it is reviewed and line-item posted into our practice management system by one of our reimbursement specialists.

Claim Tracking

Once payments have been posted into our practice management system, they are run through our payer-specific rules software, which aggressively detects unpaid or misadjudicated claims.

Once an unpaid or misadjudicated claim is flagged, it is brought to the attention of one of our reimbursement specialists for further investigation and active follow-up.

Denial Management and Follow-up

Only 70% of the average medical practices insurance claims are ever paid by insurance providers. While a practice may submit a perfectly clean claim to a payer, there is no guarantee that it will get paid or, for that matter, get paid accurately.

It's no secret that payers continue to impose increasingly complex rules, systems and loopholes with the single goal of limiting payment. This frequently means that practices remain unpaid on the valuable service provided to patients.

PGM's incentive-based fee structure ensures that we work hard to make sure nothing gets left behind. Once an outstanding claim has been identified as past due, PGM's system alerts our account representative who then reviews the history and follows up on the claim accordingly.

Patient Balances Billing

At PGM, we understand that patients are the lifeblood of the practice. We work directly with the practice to custom tailor a patient billing profile to perform all patient billing functions on behalf of the practice.

The typical patient billing profile includes a series of easy to understand statements. Should a patient fail to make payment, additional letters and/or a call sequence is initiated. For questions regarding a bill, patients are provided a toll-free number to call where one of our patient billing specialists is ready to answer any questions.

PGM does not perform collection services, and therefore patient billing services are structured to encourage patients to resolve outstanding balances. For those patients who refuse or are unable to complete their obligation, PGM will work with the practice to structure a patient payment plan or transition the balance to a third-party collection agency for resolution.

Reporting

PGM provides advanced financial and practice analysis tools designed to give enhanced visibility into practice operations at the click of a button. Practices are provided access to PGM-online, our Internet-based reporting system, where they can access hundreds of practice analysis and performance reports. Should a practice require additional information, custom reports are also available upon request.

Additionally, PGM's reimbursement specialists provide frequent practice performance reviews offering additional insight into practice financial operations.

Mental Health Billing Software Solutions

PGM offers cutting-edge billing software to streamline mental health billing services, automate processes, and reduce errors. Our system effectively integrates with EHRs, minimizing manual data entry while ensuring accurate coding and reducing claim denials. With real-time claim tracking and compliance tools, our software helps providers manage client data and navigate complex insurance rules effortlessly. Advanced reporting features also support behavioral health revenue cycle management, optimizing financial performance and reimbursements.

With our deep expertise and extensive experience in providing mental health billing services, practices can expect increased efficiency, improved reimbursement, and a significant reduction in administrative burdens. By partnering with PGM, mental health providers gain more time to deliver quality client care, while we manage the complexities of mental health medical billing.

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Why Choose PGM for Your Outsourced Mental Health Billing?

PGM specializes in mental health billing services, providing tailored solutions that streamline operations, decrease denials, and ensure accurate reimbursements. Our expert team understands the complexities of billing for mental health services, ensuring accuracy in coding, compliance with insurance regulations, and efficient claim processing. Whether you operate a solo practice or a large behavioral health facility, we offer comprehensive behavioral health revenue cycle management designed to improve cash flow and financial stability. By leveraging cutting-edge technology and proactive support, we help mental health providers minimize administrative burdens and focus on delivering quality client care. When you select PGM, you will be getting a partner recognized as one of the best behavioral health billing companies in business today.

Specialized Knowledge in Mental Health Billing Services

With decades of experience in behavioral health billing, PGM ensures providers receive maximum reimbursement while following payer policies. Our team is highly skilled in managing billing for behavioral health services, including therapy sessions, psychological assessments, medication management, and crisis interventions. We navigate complex coding requirements, insurance authorizations, and regulatory updates to prevent claim denials and revenue loss. By offering end-to-end mental health billing solutions, from eligibility verification to payment reconciliation, PGM helps practices elevate their financial performance and achieve long-term stability.

Certified Experts in Behavioral Health Billing

Our certified billing specialists stay up to date with the latest CPT, ICD-10, and HCPCS codes, ensuring compliance and reimbursement success. We have extensive experience in billing for behavioral health services, including:

Psychotherapy (CPT 90834, 90837)
Psychiatric diagnostic evaluations (CPT 90791, 90792)
Group therapy (CPT 90853)
Medication management (CPT 99212-99215)
Telehealth mental health services (CPT 96127, 90846-90847)

Personalized Billing Solutions for Mental Health Providers

Unlike generic billing providers, PGM offers tailored mental health billing solutions designed to meet the unique needs of behavioral health practices. Our software integrates seamlessly with EHR systems, streamlining workflows, reducing administrative burdens, and improving claim accuracy. With a deep understanding of mental health billing services, we provide technology-driven solutions that enhance efficiency and maximize reimbursements. Features include:

Automated charge capture to prevent missed billing opportunities and ensure accurate claim submissions
Custom reporting dashboards for real-time financial tracking and revenue insights
Integrated eligibility verification to minimize denials and prevent reimbursement delays
HIPAA-compliant electronic claims submission for faster, more secure payment processing

With PGM’s advanced behavioral health billing technology, mental health providers can improve operational efficiency while focusing on client care.

Full Reimbursement for Mental Health Providers

PGM’s mental health billing services prioritize revenue optimization through accurate claims submission, correct coding, and proactive denial management. Our expert team ensures:

Proper coding for mental health services, including therapy sessions, psychological assessments, and medication management.
Accurate documentation to support medical necessity and drive down the risk of denials.
Appeal management for denied claims to recover lost revenue.
Negotiation with payers to secure better, fairer reimbursement rates for billing for behavioral health services.

With PGM’s behavioral health billing solutions, your practice will benefit from increased revenue, faster payments, and reduced administrative stress. Let us handle your mental health billing, so you can deliver exceptional client care and support while growing your practice.

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Dedicated Support for Mental Health Billing Success

At PGM, we deliver mental health billing services with a strong emphasis on expert support, helping providers streamline operations and grow their revenue. We’ve earned a reputation as one of the top mental health billing companies because our team offers personalized guidance, proactive problem-solving, and real-time assistance to navigate billing for mental health services, evolving payer requirements, and compliance regulations. From managing strict documentation requirements to handling prior authorizations, we provide tailored solutions to minimize administrative burdens and improve cash flow.

With PGM as your billing partner, you can focus on ensuring quality care while we handle financial complexities, ensuring timely reimbursements and optimized revenue. Experience the difference of a behavioral health billing team committed to your success and long-term stability.

A Hands-On Approach to Client Support

We assign dedicated account managers who understand the unique challenges of mental health billing, ensuring smooth communication and quick issue resolution. Our team collaborates with your staff to enhance efficiency in billing for behavioral health services, cutting denials and improving cash flow. Choosing PGM means gaining more than a billing provider — you gain a committed financial partner.

Industry-Leading Mental Health Billing Expertise

PGM’s specialists are experts in mental health billing codes and payer regulations, ensuring accurate claims submission and full compliance. Whether billing for therapy sessions, psychiatric evaluations, or medication management, we ensure proper documentation and coding to reduce claim denials and enhance reimbursements. Our in-depth knowledge of behavioral health billing helps practices maintain viability and grow their revenue.

Faster, More Reliable Claims Processing

At the heart of our mental health billing services is an efficient claims management system. We take a proactive approach to reviewing claims, preventing denials, and resolving issues swiftly. Our attention to detail increases clean claim rates, improves cash flow, and reduces administrative burdens, ultimately contributing to your financial success.

Ensuring Compliance and Reducing Risk

Keeping up with Medicare, Medicaid, and private payer policies is essential for mental health providers. PGM’s experts continuously monitor regulatory changes to ensure your practice stays aligned with evolving requirements, avoiding costly penalties and delays. Our compliance-first approach ensures your mental health billing remains accurate, secure, and legally sound.

Stronger Financial Health for Your Practice

With PGM as your behavioral health billing partner, you benefit from seamless claim management, expert financial guidance, and optimized behavioral health revenue cycle management. Our commitment to accuracy and efficiency helps increase reimbursements while reducing administrative stress — so you can focus on what matters most: providing exceptional care and support to your clients.

Learn More About PGM’s Mental Health Billing Services

Are you ready to enhance your practice’s financial health? PGM offers a free consultation to explain how our expert mental health billing services improve revenue cycle management and reimbursement success.