Mental Health Clinic Reclaimed $198K by Fixing Payment Posting Backlogs
A leading outpatient psychotherapy provider reached out to MBW RCM in early 2025 after identifying major inconsistencies in their payment records. Despite steady patient volume and timely claim submissions, the clinic had unknowingly accumulated over $198,000 in missing payments—primarily due to payment posting errors tied to recurring therapy sessions and bundled CPT codes.
Through a targeted audit and structured process overhaul, MBW RCM identified and corrected the root causes, helping the provider recover the full amount within 90 days and restore clarity to their revenue cycle.
Client Overview
Location: Pennsylvania, USA
Specialty: Behavioral & Mental Health Billing Services (Outpatient Psychotherapy, Psychiatry, and Counseling)
Monthly Patient Volume: Approximately 200
Monthly Revenue Cycle Volume: $400,000
Average Monthly Collections: $260,000
The clinic faced revenue cycle issues stemming from payment posting errors, including mismatched EOBs, missed adjustments, and delayed payment entries. Over time, these small issues added up—resulting in $198,000 in unreconciled revenue, uncovered through MBW RCM’s audit. This case shows how minor posting mistakes can lead to major losses in high-volume mental health practices.
Challenges:
During a detailed audit of the clinic’s payment posting process, MBW RCM identified five critical issues that directly contributed to the $198K in missing revenue—each affecting revenue tracking, financial reporting, and overall billing transparency.
Untracked Payment Posting Errors
Lacking centralized EOB tracking led to $198K+ in unposted payments across 6 months. Over 300 small errors and unrecorded adjustments stacked up—preventing leadership from accurately reconciling A/R or spotting collection gaps.
Recurring Denials for Approved Services
Despite prior authorizations, over 120 claims were denied for “medical necessity” or “invalid coding.” Without time to appeal, $45K+ in approved sessions were lost due to lack of follow-through from the in-house billing team.
Time-Based CPT Code Errors
CPT 90834 was frequently downcoded due to missing session times or vague notes. Around 70% of 45-min therapy sessions were paid as 30-min, costing the clinic an estimated $22K in reduced reimbursements over one quarter.
Missed Authorization Renewals
Authorization expirations caused nearly 200 sessions to go unpaid. Without alerts or tracking, the clinic missed $38K in ABA and psychotherapy billing during active treatment periods.
Patient Coverage Lapses
Failure to reverify insurance during repeat visits led to 40+ denials for one patient alone. In a single month, this issue affected 17 patients and resulted in $16K in lost or delayed revenue.
Our Approach:
To address these challenges, MBW RCM implemented a targeted, multi-step strategy focused on standardizing payment posting workflows, enhancing system automation, and ensuring alignment with payer-specific posting and reconciliation requirements.
Analysis:
Our audit identified that over $198,000 in payments were unposted, misposted, or written off due to inconsistent EOB handling and manual reconciliation delays. Missing adjustment codes and workflow gaps led to inaccurate balances, which we corrected through system fixes and staff retraining—resulting in immediate improvements in billing accuracy and revenue visibility.
| Challenge | Solution Implemented |
|---|---|
| Untracked Payment Posting Errors | Payments were received but not properly posted due to missing EOB tracking, leading to $198K in unaccounted revenue. MBW implemented a centralized payment posting system with automated EOB matching and reconciliation alerts. |
| Recurring Denials Not Reflected in Posting | Denied claims were marked as unpaid without further follow-up, distorting revenue data. MBW introduced a workflow to flag and track denials within the posting system for timely appeals and accurate reporting. |
| Time-Based CPT Downcodes Misposted | Downcoded claims were incorrectly posted at lower reimbursement rates. MBW trained the billing team to match posted amounts to the expected allowable and flag underpayments for review. |
| Posting Delays Due to Authorization Gaps | Payments were delayed or misapplied when sessions lacked valid authorization at time of posting. MBW synced the authorization tracker with payment posting, ensuring services were matched to current approvals. |
| Coverage Lapses Not Caught in Posting | Claims for patients with lapsed insurance were posted as pending, creating false receivables. MBW aligned real-time eligibility checks with payment posting to reduce misclassification of claims. |
Results:
Recovered $198,000 in previously unposted and misposted payments within 75 days.
Increased payment posting accuracy from 74% to 96%, minimizing EOB and adjustment errors.
Reduced reconciliation time by 45%, streamlining month-end closing and financial reporting.
Improved denial tracking, resulting in a 28% reduction in ignored or unworked denials.
Identified over $34,000 in underpayments, now systematically flagged and appealed.
Achieved 94% ledger accuracy, ensuring clean, audit-ready financial records.
By partnering with MBW RCM, this Behavioral & Mental Health clinic not only recovered $198K in missed payments—but also transformed its payment posting process to prevent future revenue leakage. With improved accuracy, automation, and oversight, the clinic gained stronger financial visibility and reduced the administrative strain on its team—ensuring more time and focus could be dedicated to delivering quality patient care.
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