10 most common billing questions answered by revenue cycle expert

A 2019 study surveyed 540 therapists to figure out why they chose their profession. Results varied, with many participants describing their decision as “influenced by unconscious motivations” and “their own psychic wounds.” In 2024, a similar study pushed back on the simplistic stereotype of a therapist as a “wounded healer,” identifying five complex domains of professional motivation for therapists.  

In a nutshell, there are many reasons why folks choose to work in mental healthcare, but—unsurprisingly—the ‘fun’ of claims and billing is not one of them.  

Helping people heal is what you’re passionate about, but the tedious work of managing business finances is vital to your continued success in the healthcare industry. To make this easier, we’ve compiled a list of commonly asked billing questions and asked the experts on our Revenue Cycle Management team for thoughtful responses. Check them out below! 

1. What are common avoidable claim denial reasons, and how can I prevent them? 

Eligibility issues are one of the most common and avoidable reasons for claim denials. Your clients’ coverage can change due to job transitions or shifts in payer enrollment periods, like calendar versus fiscal years. To stay ahead of this, make it a habit to verify insurance eligibility before their first session and recheck it regularly—quarterly is a good rule of thumb.  

Another frequent pitfall is missing timely filing deadlines. Each payer has its own rules, ranging from 30 days to a year. Take the time to know your payer contracts and track those deadlines to avoid unpaid claims.  

By staying proactive with these small steps, you can save yourself a lot of stress and ensure your practice runs smoothly. A little extra diligence now can go a long way in protecting your revenue and your peace of mind. 

2. How should I handle claims when denied due to payer outages or errors? 

If a payer outage or system error causes claim denials, start by gathering all denied claims and details, like the outage timeframe and issue type. Then, contact your payer rep or claims department to escalate the problem.  

Many payers treat these as “projects,” so having a clear, organized claim list can make a big difference. We know that denied claims can be incredibly frustrating, but staying proactive and prepared will help get them reprocessed and paid as quickly as possible.  

3. What’s the best way to verify insurance eligibility before a client’s first session? 

Simplifying your intake process can make a big difference for your practice. Many electronic systems include an eligibility feature to help you check coverage quickly and accurately. Payer portals are also a great resource for the most up-to-date policy details.  

If your clients have multiple insurances, keep in mind key rules—like Medicare is usually primary, and Medicaid is the payer of last resort. Understanding these basics can save you time and help you avoid coverage issues, making things easier for everyone involved. 

4. How do I handle clients with multiple insurance plans or conflicting benefits? 

Navigating overlapping insurance coverages might seem tricky at first, but there are standard rules to follow. For example, if an adult client has their own coverage, that will always take precedence as primary over their spouse’s policy. Dependents under 26 typically follow the “birthday rule,” where the parent whose birthday falls earlier in the year has the primary plan.  

However, exceptions like working retirees who qualify for Medicare yet also have employer insurance may shift these dynamics. Being mindful of these nuances ensures smoother claims processing. 

5. What should I do if eligibility tools provide incomplete or incorrect information? 

Sometimes technology falters, and that’s okay. If your eligibility check tools let you down, calling the payer directly is often the solution. Many payers offer automated systems for quick checks. But if that doesn’t work, speaking with a representative provides clarity. While it may take extra time, this step can prevent more significant issues later when claims are processed. 

6. What’s the most effective way to manage client payments and prevent overdue balances? 

Talking about payments upfront can help you avoid misunderstandings and conflicts with your clients. Letting them know about their copays, deductibles, or account balances before their appointments gives them time to prepare and ask questions. Many clients don’t fully understand their insurance benefits, so having these conversations early—and with empathy—can prevent bigger issues later. 

If a client needs help managing their balance, offering clear, short-term payment plans can make a big difference. Asking for a small down payment helps show commitment, and options like autopay or reminders can make it easier for clients to stay on track. When setting up payment plans, keep it simple: aim for 6–12 months with equal payments and avoid delaying the first payment more than 60 days. Aligning payments with their income schedule shows you understand their needs. 

By being proactive, flexible, and transparent, you can create smoother systems that support your clients while reducing stress for your practice. 

7. When should I send balances to collections, and what steps should I take first? 

Before sending a bill to collections, it’s important to try other options first. Over 60 to 90 days, send a few reminders—start with a friendly notice about the balance, and if there’s no response, follow up with more urgency. Once a bill is 90 days overdue, it’s much harder to get paid. If your efforts don’t work, collections might be necessary, but reaching out sooner gives you a better chance to resolve things kindly and maintain a good relationship with your client. 

8. I run a small practice; how do I decide if I should manage billing in-house or delegate out? 

As your practice grows, managing billing can quickly become overwhelming. Solo practitioners with a small claim volume might handle in-house tasks like eligibility checks and payment posting just fine. But when claim volume increases or payers require more follow-up, outsourcing billing can make a big difference.  

If key tasks like cash posting or working claims are falling behind, or if unpaid claims and rising AR balances are affecting your cash flow, it’s a sign your team is stretched too thin. Billing complexity, like dealing with denials or payer-specific requirements, can also drain time and energy. 

Outsourcing your billing to a trusted partner can ease the burden. They’ll handle time-consuming tasks like denial management and payer follow-up while your team focuses on client communication and front-end tasks. Whether you’re a new practice without billing expertise or an established practice ready to grow, outsourcing can help reduce stress and improve cash flow. 

9. How can I track underpayments when payer rates differ from contracted amounts? 

Tracking underpayments can feel like a second job, but it’s an important step to ensure your practice gets paid what it’s owed. Start by using your billing platform to document your contracted rates and compare them to what you’re actually being paid. Exporting billing data and reviewing it in spreadsheets can help you spot patterns, like underpayments from specific payers or for certain CPT codes.  

If you find underpaid claims, you can request adjustments or have a conversation with the payer. Even small discrepancies can add up over time, so regular reviews are key to protecting your practice’s income. You work hard—make sure you’re paid fairly for it. 

10. What should I expect from an RCM service beyond basic billing tasks? 

A great revenue cycle management (RCM) service does more than just handle billing and payments. As a practice owner, you deserve a partner who keeps you informed and helps you understand trends in your claims, like common denials or coding issues.  

RCM teams are billing experts, but they rely on open communication with you to fully understand your unique contracts and needs. This collaboration ensures claims are submitted correctly and meet payer requirements. A good RCM partner works with you to spot and fix gaps, so you can focus on your clients while improving your revenue. 

Curious about how this could work for you? Get your free billing health check from our expert RCM team!