10 Questions to Ask a Mental Health Billing Company Before You Hire

Quick answer: Before hiring a mental health billing service, ask about its first-pass claim rate, whether it specializes in behavioral health, what it charges and what that fee includes, how it protects patient data (including a signed HIPAA Business Associate Agreement), which payers it bills, whether you are locked into a contract, and how often it reports to you. A good partner should give you specific numbers, not vague promises.

Choosing a billing partner is one of the biggest financial decisions a private practice makes. The right company gets claims paid faster and keeps denials low. The wrong one quietly leaks revenue for months before you notice. This buyer’s guide walks you through the 10 questions every therapist, psychologist, psychiatrist, and group practice should ask, and what a good answer sounds like.

Key Takeaways

• Ask for hard numbers: first-pass claim rate, EOB posting time, and days in accounts receivable.
• Pick a billing company that focuses on mental and behavioral health, not every medical specialty.
• Most percentage-based billing services charge a share of what they collect. Compare what is included, not only the rate.
• Compare trial scope, total fees, renewal and exit terms. A free trial or month-to-month agreement does not eliminate your practice’s ongoing responsibilities.
• Expect reports on an agreed schedule plus a named billing manager you can reach directly.

What Does a Mental Health Billing Service Do?

A mental health billing service is a company that manages insurance billing for behavioral health providers. It submits primary and secondary claims, verifies coverage and procedure codes, posts payments from explanations of benefits (EOBs), follows up on unpaid claims, appeals denials, and reports on your accounts receivable. In short, it handles the paperwork between your practice and insurance payers so you can focus on clients.

Mental health billing has its own rules. Psychotherapy codes are time-based (for example, CPT 90832, 90834, and 90837 depend on session length), many payers require authorizations for ongoing care, and telehealth claims need the correct place-of-service code and modifiers. Ask how the team assigned to your practice checks claims against the relevant payer rules and how it measures errors; compare documented results rather than assuming a specialty label predicts performance. If you are still deciding whether to outsource at all, read our guide on the key reasons mental health professionals use an insurance billing service.

10 Questions to Ask Before Hiring a Mental Health Billing Service

1. What Is Your First-Pass Claim Rate, and How Fast Do You Post Payments?

Start with the track record. Ask every billing company for two numbers:

• First-pass and clean-claim rates: define the metric before comparing percentages. In HFMA’s terminology, a clean-claim rate tracks claims that pass processing edits without manual intervention; first-pass acceptance tracks claims payers accept for adjudication on the first attempt. Neither establishes payment. Ask the billing staff for the numerator, denominator, reporting period and payer scope, and review denials and payment outcomes separately.
• EOB posting time: how soon payment and adjustment information is recorded after complete EOBs or electronic remittance advice (ERAs) are received. Ask whether the turnaround is measured in business or calendar hours, how automated posting and exceptions are handled, and for recent results against a written target. Keep posting time separate from payer claim processing and the date funds reach your bank account; see CMS guidance on EFT and ERA.

Also ask how they handle the claims that do get rejected. A strong company tracks denial reasons, fixes the root cause, and appeals quickly. See the most common claim denials in mental health billing so you know what to ask about.

Good answer: “About 95% of our claims pass the first time, and we post EOBs within 24 hours of scanning.”

2. Do You Specialize in Mental and Behavioral Health Billing?

Behavioral health billing involves time-based psychotherapy codes, plan-specific authorization requirements, and evolving telehealth billing rules. Ask any prospective billing company, whether it serves one specialty or several, to explain how the team assigned to your practice handles these requirements. Do not use specialty focus alone to predict fewer denials or faster payments; request documented performance for the services and payers you use.

Ask what share of their clients are therapists, psychologists, psychiatrists, and counseling groups, and whether they understand your licensure type and payer mix.

Good answer: “We bill only for mental health providers.”

3. How Much Do You Charge, and What Is Included?

Ask each billing service to state its fee structure and calculation basis in writing. For a percentage quote, confirm whether the fee applies to insurance payments, patient payments or another defined amount, and how refunds are handled. Compare the same service scope, workload, minimums and additional charges. Do not treat a double-digit rate as proof of overpayment or a low rate as proof of poor service; ask for documented support commitments and performance evidence.

Compare what each fee covers: claim submission, denial appeals, secondary claims, patient statements, eligibility checks, and reports. A low rate with extra charges for appeals can cost more than a fair rate that includes everything. For a full breakdown, read how much mental health billing services cost.

Good answer: A single, clearly stated percentage with no setup fees. ePsych Billing, for example, operates at 4.75%.

4. Can I Trust You With My Practice and My Clients’ Data?

You are handing a billing company your revenue and your clients’ protected health information. Trust has to be earned with proof, not promises. Check four things:

• HIPAA requirements: For a HIPAA-covered practice, an outside billing company that creates, receives, maintains, or transmits protected health information (PHI) on the practice’s behalf is generally a business associate. Put the required Business Associate Agreement (BAA) in place before sharing PHI, and ask how the company implements the agreement’s safeguards.
• Data ownership: confirm in writing that you own your billing data and can take it with you if you leave.
• Reputation: read client reviews and ask for references from practices similar to yours.
• Access to leadership: can you speak with the owner or a senior manager when something goes wrong?

Transparency is a good sign. ePsych Billing owner Alex Trent shares free billing tips for mental health professionals on his YouTube channel, so you can judge his expertise before you sign anything.

5. Which Payers Do You Bill: Medicare, Medicaid, Commercial, and Telehealth?

Choose a billing partner with documented experience with the specific payer programs and plans your practice uses. Identify the relevant Medicare, Medicaid and commercial plans, provider types and services. Ask who is responsible for enrollment or network-participation checks, payer-specific submission requirements, payment posting and follow-up, and which of those tasks the quoted service includes.

Do not assume that wider insurance coverage or a proposed financing model automatically increases the need for outsourced billing. Ask how each applicable payment arrangement affects your practice’s claim submission, encounter reporting, payment reconciliation and follow-up work. Identify which tasks your team will retain, which the vendor would handle, and how performance and costs will be evaluated. The same goes for virtual care: ask how they code telehealth sessions, including place-of-service codes and modifiers.

Good answer: “We bill Medicare, commercial insurers, and telehealth claims every day, and we keep up with payer rule changes for you.”

6. Is There Any Upfront Risk or Long-Term Contract?

Review the proposed contract length, setup fees, pricing basis and trial terms before choosing a billing service. Those terms affect your commitment and potential costs, but a long-term contract or the absence of a free trial does not by itself establish service quality or place every risk on your practice.

If a free trial or month-to-month arrangement matters to your practice, ask for its scope, any charges and what happens when it ends in writing. Also confirm renewal and cancellation notice, any remaining fees, access to your billing records, and who will handle open claims during offboarding. Evaluate the written responsibilities and exit process rather than treating contract length as proof of the vendor’s confidence or results.

Good answer: “Try us free for 30 days. After that it’s month-to-month, and you can leave any time.”

7. Can’t I Just Do My Own Billing?

You can, and some solo clinicians do. Weigh the time needed for claim submission, payment posting, denials and payer follow-up against your other work. Review your own billing workload and results before assuming that self-billing or outsourcing is the better choice. Whichever approach you use, assign responsibility for checking claim acknowledgments, following up unresolved claims and recording the applicable deadlines for initial filing, corrections or appeals. Tracking errors, unpaid claims and follow-up tasks can help you decide whether more support is needed to address common insurance billing challenges.

If you do choose to bill yourself, our mental health billing tips will help. If you are seeing signs your practice needs a mental health billing company, such as a growing stack of unpaid claims, it is time to outsource.

8. How Much Money Will I Actually Save?

By ePsych Billing’s estimate, a practice filing about 6,200 claims per year can save as much as $42,000 annually by outsourcing its billing. Savings come from three places: fewer denied and written-off claims, faster payments, and no cost of in-house billing staff.

To estimate your own savings, compare your current collection rate, days in accounts receivable, and total billing costs (software, staff time, and your own time) with what the billing service charges. Ask the company to walk you through this calculation for your practice.

9. Is a Billing Service Better Than Hiring Office Staff?

Compare how each option would handle your actual workload. For in-house billing, include wages, applicable payroll taxes and benefits, software, training, supervision and backup coverage in the cost estimate. Ask who will handle time-sensitive claims when the primary biller is absent or leaves; cross-training or another documented backup arrangement may help maintain coverage.

For an outsourced service, ask who is assigned to your account, how absences and turnover are covered, what your practice must still do, and how service problems are escalated. Compare a written quote—including its fee basis, minimums and any additional charges—with your full in-house cost for the same work. Neither a team structure nor outsourcing by itself establishes uninterrupted coverage or lower total cost. See the comparison table below.

10. How Often Will You Report to Me, and Who Is My Point of Contact?

Ask for a written reporting schedule and a blank or safely de-identified sample report. Agree how often you will receive or review updates—daily, weekly or monthly according to your practice’s needs—and how urgent billing issues will be flagged between reports. Reports should make clear what was billed, paid, denied and remains outstanding, including accounts-receivable aging. Confirm the reporting period, field definitions, access to supporting details and who will follow up on unresolved items.

Be wary of a company that is hard to reach. Ask whether you get a named billing manager and how quickly they reply. At ePsych Billing, every practice is assigned a personal billing manager, and clients can call Alex directly with questions. Knowing your billing service is there for you is one of the most important, and most underrated, factors when shopping for a billing company. Learn more about our billing process and client support.

Red Flags When Choosing a Mental Health Billing Company

• They can’t or won’t share their first-pass claim rate or denial rate.
• They bill for every specialty and have few mental health clients.
• They will not clearly explain fees, renewal, cancellation or the responsibilities for returning records and handling open claims.
• They won’t sign a HIPAA Business Associate Agreement.
• They will not agree to a reporting schedule or explain how you can review billing-status data.
• You can never reach the same person twice.
• Pricing is vague, or appeals and secondary claims cost extra.

Want a deeper checklist? Read about the 10 features that matter most in a mental health billing company.

In-House Billing vs. Outsourced Mental Health Billing

Checklist: What a Good Answer Looks Like

How ePsych Billing Answers These Questions

ePsych Billing was built by mental health specialists for mental health specialists. Here’s how we measure up:

• 95% of claims pass the first time.
• 24 hours: insurance payments are posted within 24 hours after your office scans EOBs.
• 4.75% of collections.
• 30-day free trial, then month-to-month with no long-term contract.
• A personal billing manager, plus direct access to owner Alex Trent.

See our full list of behavioral health billing services, or contact us to start your free trial.

Frequently Asked Questions

How much do mental health billing services charge?

Ask for a written quote that defines the fee structure, the payments or claims it applies to, any minimums or additional charges, and the included work. Compare equivalent scopes rather than judging value by the percentage alone. ePsych Billing charges 4.75%. Always confirm what the fee includes, such as denial appeals and secondary claims.

What is a good first-pass claim rate for mental health billing?

First confirm what the billing company measures: passing claim-processing edits, payer acceptance for adjudication, or payment. A quoted 95% target or result is not a guarantee that 95% of claims will be paid. Ask for the calculation, reporting period and payer scope, and distinguish a goal from measured performance. Compare payment outcomes and denials separately; a claim acknowledgment does not establish adjudication or payment.

Is it worth outsourcing billing for a small or solo practice?

It can be worth considering, but assess your practice’s workload and costs rather than assuming outsourcing is cheaper. Compare the time and cost of self-billing or in-house support with a written outsourcing quote, including tasks your practice must still handle, minimums and additional fees. A free trial and month-to-month terms can help you evaluate a service; they do not establish savings or remove the need to review the agreement. Confirm the trial’s scope, any charges, notice requirements, data access and responsibility for open claims before starting.

Does a mental health billing company need a HIPAA Business Associate Agreement?

Generally, yes—if your practice is a HIPAA covered entity and the outside billing company creates, receives, maintains, or transmits protected health information (PHI) on your behalf. Put the required Business Associate Agreement (BAA) in place before sharing PHI. The agreement must address permitted uses and disclosures, safeguards and other applicable obligations. Obtain advice for your specific arrangement.

Can I switch billing companies without losing money?

Plan the handoff, but do not assume that switching guarantees uninterrupted payments or recovery of every open claim. Agree in writing who handles existing claims, payer responses and deadlines; confirm secure data transfer and continued record access; and review notice requirements, termination terms and any remaining fees. Use our billing handoff checklist to assign responsibilities. Month-to-month terms do not replace a written transition plan.

What is the difference between a general medical billing company and a mental health billing service?

A general medical billing company serves multiple specialties; a specialty-focused service concentrates on mental and behavioral health. For either option, ask who will handle your claims and how they apply psychotherapy coding, authorization and telehealth rules for your provider type and payers. Compare documented denial and payment measures using the same definitions and reporting period, rather than assuming a specialty label predicts the result.

How can a billing company reduce claim denials?

By verifying eligibility and codes before submitting, tracking why claims are denied, fixing the root cause, and appealing quickly. Learn more about how a mental health billing company helps reduce claim denials.

Billing-vendor comparison worksheet

Prepared by ePsych Billing for practice owners comparing billing providers, including us. This worksheet is a due-diligence tool, not an independent provider ranking, a client case study or a claim about our measured performance. Copy the questions into your own notes and request the same evidence from each provider.

How to use the worksheet

1. Ask each provider the same questions and keep a dated copy of its answers.
2. Mark an answer as documented, verbally stated or not supplied. A missing answer is a reason to follow up, not proof of misconduct.
3. Compare equivalent service scopes and measurement definitions rather than headline rates alone.
4. Check the signed agreement against the proposal before committing.

For HIPAA-covered practices, HHS explains business-associate obligations and identifies billing and claims processing among activities that can make a vendor a business associate when PHI is involved. Consult the HHS business-associate guidance and obtain appropriate advice for your circumstances. This worksheet is not legal advice.

For ePsych-specific questions, see client support, read ePsych Billing client reviews and video testimonials, review About ePsych Billing and our service overview, or contact our team.