PsychBilling Coach

08/13/2026

Attn: Illinois clinicians!

It's not too soon to learn about preparing for the launch of the landmark IL 1085 which goes into effect on January 1, 2027.

Yes, the bill is wonderful, it drastically improves rates, allows for supervisory billing, shortens credentialing timeframes, sets limits on 90837 auditing...and more.

However, there are also built-in limitations that have to do with the way our healthcare system legally operates. If you don't understand these limitations, you stand to end up losing money.

And then of course, there are the insurance payer shenanigans. Which I can confirm have already started. So the blog includes suggestions on how to read the amendments you'll be sent in November or December.

Please repost to channels specific to Illinois clinicians. We want to get the word out so that the positives of 1085 benefit you, and the drawbacks don't hurt you. ❤️

https://psychbillingcoach.com/news/il-1085/

07/03/2026

Most of us are like this guy in the photo when it comes to the "incident-to" or supervisory billing. Is it covered? How do I bill it so that my supervisee and I can both be paid? Are there risks? How do I document to avoid or pass audits? What are the unforeseen ethical issues?

I'm offering a webinar "Stop Stumbling Over Supervisory Billing!" on July 17th. For more information and how to register, click here: https://psychbillingcoach.com/product/supervisory-billing/

But here's a FREE sneak preview, TODAY, on the Therapists Unchained podcast. Thanks Sivie Suckerman for having me back! We always have a lot to say, don't we?

https://www.therapistsunchained.com/therapistsunchainedpodcast/episode/800e36e5/billing-under-fire-supervisory-billing-explained-and-more-with-susan-frager-msw-part-2

07/01/2026

Attention, Pennsylvania clinicians:

https://www.facebook.com/share/1GKM4DSg2p/

PENNSYLVANIA PROVIDERS! Please join us for a free educational one hour Provider Roundtable on Tuesday 7/14 at noon ET! All provider disciplines are welcome!

During this session, we will cover:

❤️‍🔥Key issues impacting behavioral health reimbursement and access
❤️‍🔥What parity laws are in place and current challenges with enforcement
❤️‍🔥Emerging insurance, platform and market trends affecting provider sustainability and client access
❤️‍🔥Our National Strategy for responding to these changes
❤️‍🔥Ways providers can stay engaged within the broader state and national insurance reform movement

Please register here: https://us06web.zoom.us/meeting/register/QQTo5GnXSiqaKbzbgrSWpA

06/19/2026

Thank you Sivie Suckerman for having me on your podcast!

It was a lot of fun! And a big cheer that we were able to go live with this given the many weird tech issues.

Which just goes to show, I still believe that if we all work together, we can push back on the venture capital takeover of our field and build something better than we've ever had before.

Have a listen:

06/08/2026

I'm already hearing panic about CAQH rebranding to DataSpring and "oh the insurers are involved and own it."

Newsflash: the insurers have ALWAYS owned CAQH. They're the ones that started it in the first place, back in 1998.

The original goal was to consolidate and streamline required administrative processes such as credentialing and standardizing electronic data interchange (the EDI portion is known as CAQH CORE: Committee on Operating Rules for Information Exchange).

The board members have always been high-level executives at the various large insurance payers. The current board has representation from: UHC, Centene, Humana, Aetna/CVS, Cigna, Elevance, and Horizon BCBS (who stands for all other Blues). https://www.dataspring.com/about/board-members

So what's the change (aside from the name?) I believe the bigger issue is the shift from CAQH from a non-profit to an openly for-profit corporation. This change was announced back in January: https://www.beckerspayer.com/.../major-insurers-take.../

But the CAQH revenue in 2025 was $20.2 million, and they've always derived revenue from services sold directly to the insurance industry:

*a database tracking all license board & governmental provider sanctions. Pull out that CAQH release of information you had to sign to create an account. It protects you not at all. Never did.

*a primary source verification tool for insurers to use during credentialing.

*a database that plans use for Coordination of Benefits. When you get a clawback for services that took place over a year ago, saying "so sorry for the inconvenience but this other insurer was primary," they're getting the other plan information from CAQH, now DataSpring: https://www.dataspring.com/.../memb.../coordination-benefits

NO, I don't know how they can legally get that COB tool past HIPAA, I really don't.

So at least from where I sit, it seems more honest that they're openly admitting that they're for-profit. Just another way to extract money from American healthcare. That's hardly a new concept...!

I think the big question here is: at some point, will CAQH ProView require a paid subscription from underpaid healthcare professionals?

05/26/2026

Last week, Alma announced devastating reimbursement decreases for clinicians accepting Aetna through their platform.

What significance does this now-viral announcement have for the industry as a whole?

Why would this happen in an era of so-called "therapist shortages?" (Meaning a shortage of therapists who can or will accept low insurance reimbursement).

Particularly from a platform whose stated mission has always been to increase access to care?

Is Aetna really to blame? Or, is this a calculated gamble by Alma and their new owners, Spring Health?

I don't have the answers, but I do have some reasoned speculation. Read and find out what the possible future might hold!

https://psychbillingcoach.com/news/aetna-alma-therapist-shortage/

05/21/2026

Just when you think you've heard it all from insurance...!

I received a text from a client of mine going through an appeal. Appeal manager calls her and says "box 41 on the claim form was blank."

My response: "yes, I'm sure it was, since claim forms only have 33 boxes."

(True story!)

05/08/2026

Are you wondering what this craziness is about something called a "HETS attestation" for Medicare eligibility and a deadline this coming Monday?

Read this, if you submit Medicare eligibility inquiries through your EHR/clearinghouse. Failure to jump through this hoop will result in your eligibility access being cancelled. 👎

Your clearinghouse may have been bugging you for the last month about a deadline on May 11, 2026, with respect to Medicare eligibility and something called

04/29/2026

Connecticut therapists!!! Now's your chance to step up and demand better reimbursement.

The state has taken action and fined not just Aetna, Cigna, and United for parity violations, but also Anthem & ConnectiCare.

If you're being underpaid, there's no better time than right now to do a dive into the price transparency files, see how you stack up against others in the network in your market, and demand better. Parity and the state is on your side, and timing matters with these requests.

"According to the report, these carriers had "non-comparable and inadequate [mental health and substance use disorder] networks because of more stringent and limiting reimbursement rate structures demonstrated through disparate reimbursement rates, disparate out-of-network utilization rates, disparate new patient acceptance rates and disparate patient wait times."

Contact me if you need any help. And please repost to your colleagues so the word gets out to Connecticut clinicians.

Connecticut Insurance Department cited five major insurers — Aetna, Anthem, ConnectiCare, Cigna, and UnitedHealthcare — for failing to provide mental health and substance use coverage equal to their medical and surgical benefits.