Behavioral Health Billing Case Study: Better Claims and Faster Payment
How a mental health practice improved claim performance and increased collections with a structured revenue cycle process.
In this behavioral health billing case study, a mental health practice working with Express MBS over six months reduced its claim denial rate from 16.2% to 4.8%, cut days in accounts receivable from 62 to 31 and raised its clean claim rate from 82% to 97.6% after Express MBS put a structured billing workflow in place.
Practice Profile
- Specialty: Behavioral Health and Mental Health
- Focus: Denial management, clean claims, accounts receivable and revenue cycle optimization
The Challenge
Behavioral health practices often face billing challenges related to insurance eligibility, authorization requirements, documentation, payer-specific rules and delayed reimbursements.
This practice needed a more effective revenue cycle process to reduce claim denials, improve clean claim submissions and speed up payments from insurance companies.
The Express MBS Solution
A structured revenue recovery and claims management process.
Check claims before they go out
Review claim accuracy before submission.
Fix repeat denials
Identify recurring denial reasons and correct the underlying issues.
Follow up on open claims
Monitor outstanding claims and follow up with insurance payers.
Improve submission and tracking
Improve claim submission processes and payment tracking.
Review accounts receivable
Review A/R to find delayed and outstanding reimbursements.
Results
Measured over six months.
| Performance metric | Before | After |
|---|---|---|
| Claim denial rate | 16.2% | 4.8% |
| Days in accounts receivable | 62 days | 31 days |
| Clean claim rate | 82% | 97.6% |
| Monthly collections | $24,926 | $155,605 |
What these results mean
- Denials: the denial rate fell by 11.4 percentage points, from 16.2% to 4.8%.
- Days in A/R: days in accounts receivable dropped by 50%, from 62 to 31.
- Clean claims: the clean claim rate rose by 15.6 percentage points, from 82% to 97.6%.
- Collections: monthly collections rose by $130,679, from $24,926 to $155,605, an increase of about 524%.
Results are the figures reported for this practice. Collections also depend on patient volume, payer mix and the starting point, so results differ from practice to practice.
The Takeaway
A disciplined revenue cycle process can help behavioral health practices improve claim quality, reduce avoidable denials and gain better visibility into outstanding reimbursements.
Frequently Asked Questions
Helpful Resources
Official sources for the rules we follow when we bill.
- CMS.gov: Medicare coverage, billing and payment rules.
- Florida Agency for Health Care Administration: Florida Medicaid information.
Want to improve your practice's billing performance?
Contact Express MBS to discuss your medical billing needs. Free practice audit and a free 30-day billing trial.