Billing Services for Psychiatric Nurse Practitioners

Billing built for Nurse Practitioner owned practices

Psychiatric Nurse Practitioners (PMHNP) now provide a large and growing share of outpatient psychiatric care, and many own the practices they work in. A Nurse Practitioner practice has its own enrollment path, its own reimbursement rules, and its own denial patterns, and it deserves a billing team that knows them.

Resilience Billing is a mental health billing company founded by clinicians, providing revenue cycle management for psychotherapy and psychiatric private practices. The work reduces denials and increases collected revenue, and all of it is done by our in-house staff in Woodstock, Illinois.

Why Nurse Practitioner practices lose revenue

The most expensive denial is the enrollment denial. A Nurse Practitioner opens a practice, begins seeing patients, and learns weeks later that a panel had not finished enrollment, so every visit in that window denies. The second is the carve-out: a claim sent to the medical plan when the plan’s behavioral health administrator should have received it. The third is quiet underpayment, where a payer pays less than the contracted Nurse Practitioner rate and nobody compares the remittance to the contract.

Each of these is preventable, and preventing them is the ordinary weekly work of our denial management.

Practice authority, enrollment, and credentialing

Every state sets its own practice authority for Nurse Practitioners: full, reduced, or restricted. Those rules matter to billing because payers follow them. In some states a payer enrolls a Nurse Practitioner with nothing more than the license, NPI, and CAQH profile. In others, a payer asks for documentation of the physician relationship the state requires before it will activate the enrollment.

Enrollment itself has three parts: your own NPI, a complete and attested CAQH profile, and an application to each commercial panel and to Medicare as a Nurse Practitioner. During onboarding we review all of it and notify you of any problems before a claim goes out. Updates and new applications are processed through our credentialing service, under a separate credentialing fee structure.

How payers reimburse Nurse Practitioners

Medicare pays Nurse Practitioners 85 percent of the physician fee schedule amount. Many commercial payers follow a similar model and set Nurse Practitioner reimbursement as a percentage of their physician rate, though the percentage differs by payer and by contract, and some pay parity. What matters for your revenue is that the rate in your contract is the rate you are paid. We post each remittance line by line and compare it to your fee schedule, so a short payment is disputed rather than written off.

Full revenue cycle management, not claim submission

We manage the whole cycle: benefits verification and prior authorization, charge review, weekly electronic submission, ERA and EFT enrollment, payment posting, denial management and appeals, and patient billing. For patient billing, we send statements and run cards on file. We do not pursue collections on patient accounts. We do not sell the cycle in pieces; benefits verification is the one standalone service. The full list is on services.

We work inside the EHR you already use: TherapyNotes first, and also Tebra (formerly Kareo) and SimplePractice. Pricing is a percentage of net collections, so the fee grows only as your collections do.

Telehealth and prescribing rules

Many Nurse Practitioner practices are largely or entirely telehealth. Each payer has its own place-of-service and modifier requirements, covered on telehealth billing. Prescribing controlled substances by telehealth is governed separately by federal rules that have been extended in stages and continue to change, alongside state rules. We track those changes for our clients, because a prescribing rule change alters which visits can be delivered, and paid, as telehealth.

We serve practices nationwide, with the exception of New York and New Jersey. If you work alongside psychiatrists, see psychiatry billing; if you are building a group, see group practice billing. Request a consult to talk with the biller who would handle your practice.

Codes, briefly

Medication management visits, and visits that combine evaluation and management with a psychotherapy add-on, are reviewed against the note so each is billed at the level the documentation supports. For the codes themselves, see the mental health CPT code guide.