The Hidden Costs of General Billing Companies for Spravato® Providers

Spravato® has transformed the treatment landscape for patients with treatment-resistant depression, but it comes with unique billing and compliance challenges. While many practices assume any medical billing company can handle Spravato® claims, the reality is very different. General billing companies often miss the nuances of Spravato® billing—leading to underpayment, unnecessary delays, and costly denials.

At Finnastra, we specialize in Spravato® Billing Services, helping providers protect their revenue while expanding patient access. Here’s why relying on a dedicated Spravato® Billing Company is crucial for financial success.

Why General Billing Companies Fall Short

Spravato® billing is not like traditional E/M or psychiatry billing. The medication is FDA-approved under a strict REMS (Risk Evaluation and Mitigation Strategy) program, requires in-office monitoring, and must be billed under complex codes that combine drug administration, monitoring, and time.

Yet, general billing companies often:

• Misapply CPT/HCPCS codes for Spravato® treatments, leading to claim rejections.
• Fail to capture buy-and-bill costs, leaving providers under-reimbursed.
• Overlook REMS documentation requirements, exposing practices to audit risk.
• Ignore payer-specific nuances—every payer has slightly different coverage rules, and generic firms rarely have this depth of knowledge.

According to industry benchmarks, up to 20–30% of Spravato® claims processed by non-specialized firms face denials or underpayments, compared to <5% when managed by an experienced Spravato® Billing Company like Finnastra.

The Hidden Costs to Your Practice

On the surface, a general billing company may look “cheaper,” but the true costs are much higher:

1. Revenue Loss – Every denied or underpaid claim represents hundreds of dollars in lost reimbursement.
   • Example: If even 10 treatments/month are underpaid by $300, that’s $36,000 lost annually.
2. Cash Flow Delays – General firms often take 45–60 days to resolve denials, creating serious cash flow problems for practices relying on buy-and-bill models.
3. Compliance Risk – Incorrect documentation or billing puts you at risk of payer audits, clawbacks, and penalties.
4. Provider Burnout – Chasing denied claims drains staff time and energy that could be spent on patient care.

Why Specialized Spravato® Billing Services Work Better

Our Spravato® Billing Services are designed to simplify this process while maximizing reimbursement. At Finnastra, we:

• Ensure 98%+ claim pass rates with payer-specific coding expertise.
• Track drug acquisition costs vs. reimbursements to ensure profitability.
• Stay ahead of Medicare, Medicaid, and commercial payer rules for Spravato®.
• Provide audit-ready documentation support, protecting practices during reviews.

When you work with a dedicated Spravato® Billing Company like Finnastra, you’re not just outsourcing billing—you’re gaining a partner who understands the clinical, financial, and compliance demands of Spravato®.

Real-World Impact

One of our partner clinics treated 500+ Spravato® patients in a year and was struggling with 25% denial rates under their previous billing provider. After transitioning to Finnastra:

• Denials dropped to under 2%.
• Reimbursements improved by $400 per treatment on average.
• The clinic generated an additional $240,000 in revenue in the first year alone.

Key Questions for Providers to Consider

• Are your Spravato® claims being consistently approved on first submission?
• Do you know your true net reimbursement per treatment after medication costs?
• Is your billing company experienced in REMS and Spravato®-specific compliance requirements?
• Can your billing partner handle prior authorizations, audits, and payer policy changes quickly?

If the answer to any of these is no, your practice may already be losing money without realizing it.

The Finnastra Advantage

As a leading Spravato® Billing Company, Finnastra ensures that every claim is coded accurately, documented thoroughly, and reimbursed fully. Our expertise also extends to TMS billing and Ketamine billing, giving us a broad understanding of mental health billing challenges, that general firms simply don’t have.

✅ 98%+ claim acceptance rates
✅ Faster reimbursements—average of 14–21 days
✅ Revenue growth strategies tailored for Spravato® providers
✅ End-to-end support: prior authorization, credentialing, coding, AR follow-up

Final Thoughts

Spravato® is one of the most promising treatments in psychiatry today, but without proper billing, providers risk losing revenue, facing compliance issues, and even limiting patient access.

Don’t let a general billing company hold your practice back.
With Finnastra’s specialized Spravato® Billing Services, you gain the financial stability and compliance assurance you need to scale your practice and help more patients.

Learn more about how Finnastra can protect your revenue and expand patient access: Spravato Billing Services