Episode 24: Paperwork Meets Panic – Behavioral Health Billing Exploits

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Behavioral health is booming—but billing it wrong can break your practice. In this episode, Shannen and Nyleen unpack the growing wave of medical groups adding therapy, psychiatry, and counseling services—only to stumble into denials, audits, and compliance nightmares.

From the basics of CPT codes and payer carve-outs, to the credentialing pitfalls that practices overlook, this episode digs into:

• What behavioral health billing really means (and why it isn’t just “a few extra codes”).
• Why urgent cares, OB/GYNs, and pain clinics keep adding BH services—and the dangerous shortcuts they take.
• Red flags that trigger payer audits, clawbacks, and fraud allegations.
• Real-world mistakes: upcoding, wrong NPIs, and billing under the wrong taxonomy.
• A step-by-step breakdown of how to credential, enroll, and bill correctly.
• The compliance mindset that keeps paperwork from turning into panic.

💡 Whether you’re a provider, a biller, or a practice administrator, this episode is your survival guide to adding behavioral health services the right way—without setting off alarms.

Takeaway: Adding behavioral health can transform care, but if you cut corners, it will catch up to you. Audit early, credential properly, and protect your providers, your patients, and your practice.

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Resources Mentioned:

Verify your Nurses' Credentials:

https://www.nursys.com/

🔎 Verify Your Doctor’s Credentials

✔️ State-Specific Medical Board License Lookup:
Find your state’s board here:
https://www.fsmb.org/contact-a-state-medical-board/

✔️ Medicare Exclusions List (LEIE) – Check if your provider is federally excluded:
https://oig.hhs.gov/exclusions/exclusions_list.asp

✔️ Set Google Alerts on Your Doctor’s Name:
Create your own Google Alert here:
https://www.google.com/alerts

For Medical Staff Professional:

✔️ FSMB.org – Federation of State Medical Boards Physician Lookup:
https://www.fsmb.org/physician-license-lookup/

✔️ Hospital Websites:
Many hospitals have public directories listing credentialed medical staff. Look for a “Find a Doctor” or “Medical Staff Directory” page.

✔️ Set Google Alerts on Your Doctor’s Name:
Create your own Google Alert here:
https://www.google.com/alerts

🔎 Wanna know if your doctor is actually board certified?
Check for yourself right here:
👉 Verify a Plastic Surgeon

Because credentials do matter. 🩺✨

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