We begin by verifying each patient’s insurance coverage for TMS, including diagnostic eligibility, session limits, frequency rules, and any special payer criteria. This upfront step reduces surprises and helps set realistic expectations both clinically and financially.
Our team handles the entire prior-auth workflow: collecting required clinical documentation, ensuring the diagnosis meets payer criteria, tracking authorisation status, and coordinating with your clinical team to maintain continuity of treatment. We also track session counts and monitor progress to flag when cases may encounter payer review or exceed frequency limits.
Our coders specialise in behavioral health and TMS. We ensure correct use of CPT/HCPCS codes, modifiers, supervision and monitoring codes, and we align the documentation with payer audit expectations. We also provide guidance to your clinical team so that treatment notes support the coding strategy and payer requirements.
Claims are submitted using best-practice workflows, and we monitor them closely for denials, underpayments, or payer trends. We provide root-cause analysis for recurring issues and engage with payers on your behalf to resolve outstanding A/R. This ensures you maintain healthy cash flow and fewer surprises in your revenue cycle.
You get dashboards and monthly summaries that track claim pass-rates, days in A/R, denial reasons, revenue per session, and payer performance. These insights help you make data-driven decisions, whether you’re expanding your TMS program, refining your scheduling model or negotiating with payers.
Practice intake support and scheduling workflow alignment to align clinical and billing operations.
Insurance eligibility and benefits checks specific to TMS treatment protocols.
Prior authorization management across payers (commercial, Medicare/Medicaid) including tracking and appeals.
Coding and documentation oversight for initial and continuation TMS sessions, supervision, monitoring, modifiers and frequency rules.
Claims submission, denial appeals, payment posting, under-payment analysis and A/R recovery.
Monthly review meetings, KPI tracking, revenue cycle optimization recommendations.
Audit support: documentation review, compliance checks, payer communication support, audit-readiness planning.
