How it runs for behavioral health practices
Client payments from the processor, portal and mailed checks are applied by client and session, secondary balances are moved to the next payer, and unapplied cash is cleared within two business days.
What is cash application?
Cash application means matching money received from customers to the invoices it pays and recording that in the accounting system. It covers bank receipts, checks, lockbox files, card payouts and remittance advices, including partial payments, deductions and payments with no reference. Done well, the aging is accurate and no customer is chased for an invoice they already paid.
What we handle for behavioral health practices
- Post ERA and paper EOB payments by session with the adjustment recorded by contract
- Capture denial reasons at posting so follow-up starts the same week
- Apply copays, coinsurance and no-show fees to the correct client and date of service
- Move remaining balances to secondary payers or client responsibility per the remittance
- Resolve unapplied and unidentified cash inside two business days
The KPI that matters here
Payer and client payments applied within two business days of deposit, with unapplied cash below one percent of monthly receipts.
Behavioral health compliance notes
HIPAA
Session notes, claims, ERAs and client ledgers are protected health information. We sign a BAA, staff are HIPAA-trained, access to the practice-management system is role-limited with MFA, and the accounting file receives batch totals and claim numbers rather than client names or diagnoses.
42 CFR Part 2
Records from a federally assisted substance-use disorder program carry stricter confidentiality rules than HIPAA alone, including specific consent before disclosure. For programs covered by Part 2, billing staff work only inside your system, no Part 2 record is exported to the ledger or to email, and any request for records is routed to your privacy officer.
Payer contracts and credentialing
Each payer contract sets allowed amounts by CPT code, timely-filing windows, telehealth rules and how recoupments are handled. We post adjustments by contract, log clinician credentialing effective dates so held sessions are billed once approved, and reconcile recoupments against the sessions they reverse rather than netting them silently.
Self-pay estimates and card on file
Self-pay and uninsured clients are entitled to a good faith estimate under the No Surprises Act, and card-on-file charges for copays and no-show fees require the client's written consent. We record estimates and consents with the client's financial arrangement, and our agents never take or store card numbers; charges run through your own processor.
Behavioral health software we work in
- QuickBooks Online
- Xero
- Stripe
- Gusto
- Bill.com
- TherapyNotes
- SimplePractice
- Valant
- Kipu
- All 50 platforms
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Frequently asked questions
Why does the adjustment matter when the payment is posted?
Because the adjustment sets the client's remaining balance. If a payer allows $120 on a $180 session and pays $90, the $60 adjustment and the $30 client portion must both be posted at the same time. Skipping the adjustment leaves a false $90 balance on the client, which produces wrong statements, a bloated aging and an inflated clinician split.
How do you post a remittance that covers several clients and clinicians?
Each 835 line carries the claim number, date of service, paid amount and adjustment codes, so payments are applied session by session to the right client and rendering clinician. Totals by clinician are then available for split calculations. A paper EOB is keyed the same way, line by line, and the batch total is checked against the deposit before it is closed.
How are copays applied when the client has several sessions open?
A copay charged at the session by card on file is applied to that date of service. A later portal payment without a stated session is applied to the oldest open balance unless your practice's rule says otherwise. We record the rule, follow it, and confirm the client's next statement reflects the application so nobody is chased for a balance already paid.
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