Many of us feel caught when it comes to billing: We feel overwhelmed trying to keep up with insurance-related paperwork and phone calls, yet we may be hesitant to join a large national online platform like Headway, Alma, Sondermind, Grow Therapy, or Talkspace to take care of these headaches for us (if you missed my article on these platforms, click here). There is another option you may not have considered, or thought you couldn’t afford: hiring a billing service.

Not to be confused with a billing computer program (like SimplePractice or TherapyNotes) or an online clearinghouse, a billing service is a live human being (or group of human beings) that you hire to handle your claims submissions or client billing for you.

For this article, I interviewed three experienced billers: Christine Verdult of NewMed Billing, Stone Taylor of Psyche Associates, and Susan Frager, of Psychbillingcoach.com, a former biller who now coaches therapists on how to do their own billing (you can find Christine and Stone listed on my new Billing Service List in my online store – click here).

Q: Why do you think therapists DON’T hire a biller?

Christine: Therapists believe billing is something they should be able to handle on their own. They call me to take over their billing because they come to understand how time-consuming it is, and find their focus has been pulled away from their clients.

Stone: It can be hard to trust that someone else will take as much care with your practice as you do. Letting go of that control isn’t easy, especially when it involves the financial and administrative heart of your business.

Q: What are some common myths about hiring billers?

Christine: Providers may assume it will cost too much. Once they look into it, they realize it’s more reasonable than they think, and they understand all the benefits, and how it can allow them to focus on clients and building their businesses. They come to understand that the cost is worth it.

Stone: Some therapists think that all we do is submit insurance claims and send patient statements. But billing is just the beginning – good billers are deeply involved in the overall health of a practice.

Susan: Thanks to online platforms and software, therapists may no longer find claim submission time-consuming, but billers do so much more than this. They may be able to verify eligibility and coverage, review and correct rejected claims, dispute denials, follow up on unpaid claims, reconcile remittances with banking, charge credit cards, handle out-of-network billing, and help with the development of forms and policies. Additionally, many billers also help with credentialing and contracting.

Q: What are some of the benefits of hiring a biller – practically and emotionally?

Christine: Immediately you should feel relief from time-consuming work, allowing you to spend more time on patient care. Providers can feel overwhelmed when dealing with billing on their own, especially if they are inexperienced and claims are not getting paid. By working with a biller, you can make a clear distinction between you as a provider and you as the business owner. Also, having an experienced Medicare biller can lead therapists to feel happy they have contracted with this plan. Billers get to know the intricacies of each insurance plan. They will often have key contacts at the plan so they can assist when there is an issue.

Stone: The benefit of hiring a biller is that you gain a team member. You’ll gain a person to vent to when dealing with a difficult administrative situation. Someone to ask whether a new industry requirement applies to you. Many billers will help you attract patient referrals. A biller can help you understand insurance benefits, track authorizations, create office policies around things like out-of-network charges or missed appointments, and if needed, communicate directly with the patient. Hiring a biller means insurance claims get paid or followed up until they are paid. When claims don’t process as expected, your biller can investigate.

Q: When does it make sense to hire a biller, and when doesn’t it?

Christine: Some providers think outsourcing billing means giving up control. For most practices, they actually feel more in control when adding an expert billing service, utilizing a team approach to progress toward goals. Finding a biller who is also qualified to provide credentialing will benefit even the smallest practice looking to grow.

Stone: It probably doesn’t make sense to hire a biller if your billing and administrative tasks take less than five hours a month, if you’re making the income you want, and if you’re not running into questions or problems with claims or practice management.

Susan: Add up the income you would have received from claims that you’re not collecting on due to lack of time, frustration, or lack of knowledge. Then compare that amount against the price a biller charges. If those numbers are close, you should probably get help. Hiring a biller can also just be a personal choice, and that’s OK. If billing intimidates you, if you get easily frustrated, if you procrastinate – all those are good reasons to hire a biller.

Q: What should a therapist consider before hiring a biller?

Christine: Hire someone that has a lot of experience, a good reputation, and references so you feel comfortable and less worried. Try to hire a certified biller so you know they have the necessary education and credentials to handle your billing. Medical billing and coding require a special set of skills with hours of training. There has been a steep increase in the complexity and compliance issues in the medical billing field. With the ever-changing healthcare system, it is crucial to hire experienced, certified professionals who understand the rules and standards.

Stone: Ask yourself if you’re willing to invest in building a collaborative, ongoing relationship. Hiring a biller doesn’t make all the administrative work disappear. A strong therapist-biller relationship takes upfront effort: Learning about each other, aligning on processes, and establishing communication habits. That foundation is what makes things smooth and sustainable in the long run.

Susan: Identify the services you need, and get a list of specific tasks that will be included with your billing contract. If the biller’s services don’t include something you need, then no matter how competent they are, their service might not be a good fit for you. Don’t be afraid to ask a lot of questions – and let the biller interview you, as well. Be sure to ask who will be handling your account. How accessible is the company owner once you’ve been handed off to an employee? Ask about HIPAA compliance, and how employees are trained.

Q: When working with a biller, how does the billing work?

Christine: There is an initial set up process that takes place. Providers should review the agreement carefully to see what they are responsible for and what the biller is responsible for. An established, experienced biller should have a set of procedures and forms for the provider allowing for a smooth, stress-free transition.

Stone: Each therapist’s billing process is different in frequency and how and where data is communicated. The therapists and biller will work that out together for what makes the most sense for their practice.

Susan: Every biller is different, so this is something you need to thoroughly interview the biller about before hiring them – make sure they’re a good fit with what you need and with your way of doing things.

[Note from Barbara: Typically you would regularly provide your biller with a log of clients seen, with session dates and procedure codes. The biller would then format the claims, billing the appropriate health plan or client on your behalf.]

Q: What are the biggest mistakes made when CHOOSING a biller?

Christine: A big mistake is to hire an inexperienced biller who does not have the education, experience, and customer service standards necessary. Therapists should interview a few billers and get a feel for their personality. Do they answer their phone? Do they call you back within 24 hours? Ask questions about their education and experience and always ask for references. Are they easy to talk to, and do you feel comfortable speaking with them? A biller should be happy and eager to answer your inquiry.

Stone: A big mistake is choosing someone you don’t see yourself working with long term. Onboarding a new therapist takes a lot of work, and once you find your rhythm, the relationship becomes much more efficient and enjoyable. So choose a biller whose values align with yours, and who you enjoy working with – you’ll likely be in each other’s lives for years.

Susan: Many clinicians only ask what the biller charges, but price is only one important consideration. A biller has the power to make your business succeed or fail, so choosing the lowest bidder may be risky. Conversely, don’t just use emotion to guide decisions – a strong personal relationship does not guarantee billing competence.

Q: What are the biggest mistakes made AFTER hiring a biller?

Christine: Billers have certain procedures they follow so that your claims can be paid as quickly as possible. Not following your biller’s process as outlined in your agreement will delay reimbursement.

Stone: A big mistake is not keeping the biller in the loop with changes or problems. If collecting copays is burdensome, your biller may be able to set up automatic credit card payments. A biller may be able to help you explore licensure in another state, or set up a single case agreement for a client losing insurance. If you aren’t sure how to raise your fee, or if your caseload is shrinking, your biller may be able to assist. Use your biller as a sounding board – they often have creative ideas or can flag potential pitfalls before they become problems. It is also a good idea to give your biller copies of your insurance contracts, so they know when you are in-network, when it’s time to request a rate increase, which codes are allowed, and who to contact at the plan.

Susan: It’s a mistake to drop everything into your biller’s lap and then never pay attention after that. It’s YOUR money, and YOUR license. While you should trust your biller, ultimately, it’s YOUR responsibility. Other mistakes? Being reluctant to ask questions – don’t worry about bothering or offending your biller. Not reading reports they give you. Not following up on things they ask you to do. Not sending correspondence from an insurer to your biller and asking “how does this affect me?” Talk to your biller about problems or concerns – they can’t fix things if you don’t let them know what’s going on.

Q: Can you address many therapists’ fears that a biller would cost too much?

Christine: Unpaid claims and patient balances have a significant impact on your monthly cash flow. When hiring a biller, you should feel confident knowing your claims are being transmitted on time and cleanly, eliminating rejected and denied claims, allowing for rapid claims payment. Your biller should proactively pursue denied or unpaid claims to ensure payment. The fee associated with hiring a biller pays off in the end, as the provider is able to take on more clients and build a successful practice.

Stone: You can handle your own billing – but unless you’re tracking data and keeping up with industry changes as a biller would, you won’t know how many mistakes you’re making, what standards you’re violating, or how much money you’re leaving on the table. There are so many things to deal with when running a practice. Having someone hold that with you, not being alone in it, is priceless. If your biller gives you peace of mind, helps maintain and even grow your income, and supports the overall integrity of your practice – then they pay for themselves.

Susan: Consider: 1) How much income are you losing in unpaid claims that a biller might have gotten paid? If it equals or is more than what a biller would charge, a biller won’t be too expensive. 2) How many hours a week does it take to do your billing? If you handed it off to a biller, how many more clients would you be able to see? Add up the total of what you’d make from those extra clients and determine if it offsets the cost of a biller. 3) Do you find billing stressful? Do you procrastinate, or miss out on family/personal time? Consider the quality of life aspects as well. If cost is a concern, you could hire a part-time biller or virtual assistant who only does the things that you lack time for or that you don’t do well.

Some final notes from Barbara:

Biller fees vary: Fees may be based on how much you have them do for you. Some billing services offer flat-fee pricing (a set amount per month regardless of number of claims filed), others offer per-claim fees, and others charge a certain percentage of reimbursements billed or received from the insurance plan. Susan points out that “percentage-based billing is illegal in some states, and about half the states forbid percentage-based billing for Medicaid, yet very few billers know this.” Be sure to research your state laws.

One provider’s view: Karen Rose, MFT, loves her billing service: “They do all paperwork for my practice, including billing, tracking claims, dealing with unpaid claims, and credentialing/recredentialing. I can just do therapy, which is the part of the job I love. Maybe I do one or two extra hours of therapy per month to pay for the service, but it is totally worth it.”

The takeaway: I have heard from providers all over the nation who have left thousands of dollars on the table or even have considered leaving the profession related to billing frustration. This may happen when there is a lack of time to do billing, lack of understanding about how to bill, and lack of follow up on denied or unpaid claims. Hiring an experienced biller and gaining the assistance of a team member can offer multiple ways for therapists to reduce stress, increase their income, and to find more time to focus on their personal lives as well as on client care. A billing service can also offer a more personal alternative to joining online platforms like Alma, Headway, Talkspace, Sondermind, and Grow Therapy (which have some downsides as discussed in this article.

Don’t know where to start to find a biller? Check out my brand new 2025-2026 Billing Service List. I’ve compiled a list of over 100 mental health billers nationwide to help you find and choose a biller. Each biller has a page where they give details about their services and fees, software they use, states where they operate, and where they explain why a therapist should choose their service. I then reached out to over 300 therapists who used these billers to get reviews, which are printed on the billers’ pages. But that’s not all! In this helpful packet, I’ve also included a list of the essential questions to ask when interviewing billers, and advice from therapists who work with billing services. Find out more – click here and then on the Billing Service List icon.