Posts by Barrett Merrill
How to Finance My New Behavioral Health Group Practice
Starting a behavioral health group practice is exciting—and daunting. You have a clinical vision. You see the community need. You may even have early referrals lined up. But at some point, nearly every practice owner and founder hits the same question: How do I actually pay for this thing? Financing a new group practice isn’t…
Read MoreReimbursement Rates: Different in Solo vs. Group Practices?
If you’ve ever compared notes with another therapist and thought, “Wait…how are you getting that rate?” — you’re not alone. Reimbursement can feel mysterious, even when you’re doing the same CPT codes, in the same city, for the same payer. Here’s the honest answer: sometimes reimbursement rates are effectively the same for group and solo…
Read MoreThe Top 10 Reasons Group Practices Have Slow Cash Flow
As crazy as it sounds, running a therapy business — whether as a small group practice or a larger mental-health clinic — isn’t just about helping clients. It’s also about staying financially healthy so you can keep helping people. Unfortunately, many behavioral health practices struggle with slow cash flow, and over time, this undermines sustainability.…
Read MoreHow Do Payers Determine Reimbursement Rates for Therapists?
Understanding the hidden formulas behind what insurers actually pay. If you’ve ever stared at an EOB and wondered, “How on earth did they land on that number?” — rest assured that you are not alone. Every behavioral health professional who accepts insurance or Medicaid eventually asks the same question: How do payers decide what they’ll…
Read MoreWhat is CPT Code 96127 and How to Use it?
CPT code 96127 is defined as a “brief emotional/behavioral assessment (e.g., depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized instrument.” (Source) In other words: when you use a validated screening tool (like a PHQ 9, GAD 7, ADHD rating scale, etc.), you score it, document it, interpret it, and it becomes…
Read MoreTop 7 Audit Red Flags for Behavioral Health Providers
If you’ve ever heard the word “audit” and immediately felt your stomach drop — you’re not alone. For many mental and behavioral health providers, the idea of someone combing through your charts, notes, and billing records can feel intimidating (and maybe even a little unfair). But here’s the truth: audits aren’t always about catching wrongdoing…
Read MoreWhat are CARC and RARC Codes?
CARC (Claim Adjustment Reason Code): These are standard codes used by payers. They explain why a claim was paid differently than you billed. This includes partial payments, reductions, or full denials. (Source) For example: “CO-45: Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.” They’re required on electronic remittance advice (ERA) and Explanation of Benefits…
Read MoreAre There Provider Taxes with Medicaid?
If you run a mid-sized or larger behavioral health agency, you’ve probably heard the term “provider tax” or “provider assessment” tossed around—usually in discussions about how states fund their share of Medicaid. Do these taxes affect mental and behavioral health providers? Sometimes directly, often indirectly, and always in ways that can influence Medicaid rates, managed…
Read MoreHow My EHR Can Reduce Denials
For mental and behavioral health providers, there are few frustrations more demoralizing than receiving a claim denial after investing time and resources into providing quality care. The cycle is all too common: you deliver services, submit claims in good faith, and weeks later you’re met with a denial notice. Multiply that by dozens or hundreds…
Read MoreThe Difference Between Benefits and Eligibility
Navigating insurance requirements can be one of the most confusing and time-consuming aspects of running a behavioral health practice. Whether you’re a solo mental health therapist or part of a larger behavioral health agency, understanding the difference between eligibility and benefits is essential to ensuring accurate billing, getting reimbursed on time, and preventing denials. While…
Read More