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Case study · Behavioral Health
$176K more in annualized collections for a 6 provider behavioral health practice
Denials were running at 16% and $165K sat in A/R past 90 days. Patients were paying only 68% of what they owed. Ninety days after WeBill Health took over the revenue cycle, every one of those numbers had moved.
6 providers$1M annual collections beforeResults measured at day 90
+$14.7KMonthly collections, from $83.3K to $98K
6%Denial rate, down from 16%
$80KCleared from A/R over 90 days
88%Patient balances collected, up from 68%
The practice
Care was delivered. Payment was not keeping up.
A six provider behavioral health group billing time based therapy across several payers, each with its own authorization and documentation rules. Sessions were delivered but the claims kept stalling.
| Specialty | Behavioral Health |
|---|---|
| Providers | 6 |
| Annual collections | $1M, about $83.3K a month |
What we found in the audit
16% of claims denied
Too many claims came back unpaid, with the same denials repeating month after month.
$165K stuck past 90 days
Earned money was sitting in aging A/R with no one working it by payer or by filing deadline.
88% clean claim rate
Too many claims needed rework before a payer would even process them.
68% of patient balances collected
Copays and balances were left behind at checkout and never recovered.
What WeBill Health changed
Six fixes before the visit, in the coding and after submission
Every claim received human pre submission review by behavioral health coding experts, checked against our payer rule libraries for each carrier this practice bills.
Before the session
Keep authorizations ahead of the schedule
- Authorizations tracked against visits used, so no session goes out past its approved limit
- A patient balance workflow so copays are collected at each session
Coding
Match session time to the code
- Payer specific behavioral health rules applied to each claim
- Documentation and coding workflow checked so session time supports the psychotherapy code billed
After submission
Recover stalled claims
- Every denial appealed and defended with the payer until paid
- Aging A/R worked in priority order by payer and by age
90 day results
Before and after WeBill Health
Denial rate
Lower is betterClean claim rate
Higher is betterA/R over 90 days
Lower is betterPatient balances collected
Higher is betterMonthly collections
Higher is betterEvery bar starts at zero. Figures come from the practice's own billing reports, comparing the baseline month with month three.
Where the $176K comes from
An extra $14.7K collected every month
Monthly collections rose from $83.3K to $98K by day 90. Held for a full year, that is $176K the practice collects on care it was already delivering.
The gain came from specialty specific coding and fewer days in A/R. Fewer claims were denied, and balances that had aged past 90 days were finally collected.
Monthly collections before$83,300
Monthly collections at day 90$98,000
Increase per month$14,700
Annualized increase$176,400
Net return on the WeBill Health fee200%
Net return is the annualized increase in collections, minus the annual WeBill Health fee, divided by that fee. It is calculated before any savings from the practice's previous billing arrangement.
The math
Where the $14,700 a month came from
Estimated breakdown, built from behavioral health billing benchmarks and 2026 Medicare rates, tied to this practice's measured before and after figures. Each line is a claim count multiplied by what those claims pay. A/R cleared from the old backlog is reported separately and is not part of this monthly gain.
| Change | Added a month |
|---|---|
| Denials stopped before they happenedAbout 744 claims a month at an average of $112 collected. Cutting the denial rate from 16% to 6% means 74 fewer denials a month. Before, about half of denials were never reworked, so 37 of those claims are now paid that were not. | $4,144 |
| Patient balances collectedPatients owe about $16,700 a month in copays, deductibles and coinsurance. Collection rose from 68% to 88%. | $3,340 |
| Psychotherapy add on billed with medication visitsPsychiatric NP visits with 16 minutes or more of documented therapy now carry 90833, 57 a month at about $69 each. | $3,933 |
| Underpaid claims recovered67 claims a month paid below the contracted rate, short by an average of $49, now appealed and recovered. | $3,283 |
| Added collections a month at day 90 | $14,700 |
Codes and conditions
The claims behind these numbers
| Visit type | Codes and rules | Typical conditions (ICD 10) |
|---|---|---|
| Intake | 90791 psychiatric diagnostic evaluation | Generalized anxiety disorder F41.1 |
| Therapy sessions by time | 90832 (16 to 37 minutes), 90834 (38 to 52), 90837 (53 or more) with start and stop times documented | Major depressive disorder, recurrent, moderate F33.1; PTSD F43.10 |
| Medication visit with therapy | 99214 plus 90833 when 16 minutes or more of separate psychotherapy is documented | ADHD, combined type F90.2 |
| Telehealth and screening | Place of service 02 or 10 and modifier 95 by payer rule; 96127 per screening instrument | Adjustment disorder with mixed anxiety and depressed mood F43.23 |
What it costs
The 5% fee against the cost of doing this in house
This practice's WeBill Health rate is 5% of collections. At $98,000 a month that is $58,800 a year. Here is what the same work costs a 6 provider practice that staffs it in house, before software and clearinghouse fees.
| Item | Per year |
|---|---|
| In house billing staff2.5 billers for 6 providers (MGMA: about one per two to three providers) at $73,160 each, the BLS median of $51,140 plus benefits | $182,900 |
| In house cost | $182,900 |
| WeBill Health fee, 5% of collections | $58,800 |
| Saved against in house staffing | $124,100 |
| Added collections a year | $176,400 |
| Better off each year with WeBill Health | $300,500 |
What other behavioral health practices can take from this
Three behavioral health billing gaps worth checking this week
Let the clock choose the psychotherapy code
Psychotherapy codes follow documented session time: 90832 for 16 to 37 minutes, 90834 for 38 to 52 minutes and 90837 for 53 minutes or more. A note without start and stop times puts the whole claim at risk.
Track visits used against every authorization
Many payers approve a set number of sessions. The session after the limit is denied unless a new authorization is in place before the visit.
Check telehealth rules payer by payer
Place of service codes and telehealth modifiers differ between payers. One wrong combination can deny every virtual session billed that month.
Your practice next
Find out what your behavioral health practice is leaving uncollected
The Revenue Defense Audit reviews your denials, aging A/R and patient collections the same way we did here. You get a written report that ranks the fixes by dollars at stake. We reply within one business day.
Questions
About this case study
How fast did the results appear?
Every figure on this page was measured at day 90, comparing the practice's baseline month with its third month on WeBill Health.
Why is the practice not named?
We protect our clients' privacy. The figures come from the practice's own billing reports.
What drove the biggest change?
The denial rate. Cutting denials from 16% to 6% meant far more claims were paid the first time, which lifted monthly collections and stopped new balances from piling up in aging A/R.
Does WeBill Health work with other behavioral health practices?
Yes. Behavioral Health sits in our Time Based Therapy billing group. Every account is handled by coding experts who work behavioral health claims every day.
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