Answers for a Multi-Provider Behavioral Health Group's Close

Because insurance claims for behavioral health sessions can sit in adjudication for weeks, and a session held in one month might not generate recognized revenue until the claim clears in the next. A practice that books revenue on the session date regardless of claim status will show revenue that doesn't match cash collected, which is fine as long as everyone understands why, but it means your close needs a claims-aging view sitting next to the revenue report, not a revenue number alone, especially when comparing month-over-month trends to actual clinician caseload.

A newly hired therapist waiting on insurance panel credentialing often can't bill certain payers for weeks or months after starting, during which sessions might be billed under a supervising provider's number instead, if your state and payer rules allow it, or held until credentialing clears. Either approach needs a documented policy applied consistently, and the close checklist should include a review of any provider still pending credentialing so held revenue doesn't quietly disappear from view.

Most practices charge a no-show or late-cancellation fee, but whether that fee is billed to insurance, billed directly to the client, or simply not collected varies by payer contract and practice policy. Revenue from these fees should sit on its own line, not blended into session revenue, since mixing them distorts your actual clinical productivity numbers and makes it harder to see whether cancellation rates are a real operational problem.

For a single-entity practice group with a handful of locations and one billing system, yes. FloQast's checklist model can enforce monthly review of claims aging, credentialing status and cancellation fee tracking as three standing tasks, without requiring the practice to reconfigure how it bills or documents care. That's usually enough discipline for a group running under a dozen providers.

Mainly once the group operates under multiple legal entities, common after a private equity-backed roll-up of several practices, or once claims volume across many payers makes a monthly manual aging review genuinely unreliable. Provider count alone isn't the trigger; entity structure and transaction volume are, and a group should watch for those specifically rather than upgrading just because it feels bigger than it used to.

National wage data puts the median salary for accountants and auditors at $83,680 a year, with the 25th percentile at $67,020 for a more junior hire¹. For a group running a lean back office, adding a dedicated biller or accountant to own claims aging and credentialing tracking is often the more immediate fix, with a close platform layered in once that role is established and the manual process is already working well. A biller who understands behavioral health billing specifically, including how different payers treat telehealth sessions and group therapy codes, tends to close more of the claims-aging gap than a generalist accountant would, which is worth weighing against a broader accounting hire.

Many behavioral health groups now bill a mix of in-person and telehealth sessions, and some payers reimburse the two differently or require distinct billing codes. A practice that doesn't separate these two revenue streams in its reporting can miss that telehealth reimbursement rates have shifted for a specific payer, since the blended average hides what's actually happening underneath. Whichever close process a group runs, splitting revenue by session modality, at least at the payer level, makes it much easier to catch a reimbursement change before it erodes a full quarter of margin.

Start with the worksheet, not the software: track claims aging, credentialing status and no-show revenue as three separate, clearly labeled lines for two full close cycles, done by hand if necessary. That exercise alone usually surfaces which of the three is genuinely the group's biggest time sink, and it gives a concrete, specific reason to bring in FloQast, add headcount, or, for the rare multi-entity group, look seriously at BlackLine.

Track these as separate, clearly labeled lines for two close cycles:

• Claims aging, shown next to the revenue report rather than replaced by it.
• Credentialing status for each new therapist, including sessions billed under a supervising provider or held until credentialing clears.
• No-show and late-cancellation fee revenue, kept apart from session revenue.
• Telehealth and in-person revenue, so a payer's changed telehealth rate doesn't hide inside a blended average.