ABA & autism services
Unit-level authorization tracking, CPT 97151–97158, rendering-provider and supervision rules, CentralReach-native workflows.
ABA billingRemote staffing & revenue cycle management
Get paid for the care you have already delivered.
Dedicated remote billers, prior-authorization specialists and AR staff placed inside independent behavioral health and ABA practices — taking ownership of the outcome, not just the hours.
Denied16%
Denial rate
12–20%
Behavioral health vs 5–10% medicalNever reworked
~60%
Of denied claims, industry-wideDays in AR
47
Typical independent practiceOur fee
4–8%
Of net collections
Direct answer
Recura Health provides remote staffing and revenue cycle management for independent behavioral health and ABA practices in the United States. Dedicated offshore specialists handle eligibility, prior authorization, coding, claims, denial management and AR follow-up inside your existing EHR. Pricing is a percentage of net collections, so we are paid when you are paid.
97153Adaptive behaviour treatment — unit overage$41,200
97155Protocol modification — supervision mismatch$28,900
90837Psychotherapy 60 min — carve-out routing$44,900
12–20%Behavioral health initial denial rate
5–10%Denial rate for medical & surgical claims
~60%Of denied claims never resubmitted
4–8%Typical outsourced RCM fee
The problem
Why are behavioral health claims denied more often than medical claims?
Because behavioral health billing is a different discipline, not a harder version of the same one. Authorization limits, time-based unit coding, medical-necessity review and managed behavioral health carve-outs each create a failure mode general medical billing simply does not have.
Billed annuallyA four-clinician practice
DeniedAt a 16% denial rate
Never reworkedSix in ten denials
That last bar is not lost to bad payers. It is lost to nobody having the time to chase it — and it is usually several times the entire annual cost of outsourcing the revenue cycle.
Where it leaks
Seven stages. Two of them cost you the most.
Most preventable revenue loss happens before a claim exists. We run the whole cycle, or just the stages that are bleeding.
01
Eligibility
Behavioral health carved out to a separate MBHO the member's card never names.
Highest leak02
Prior auth
Authorizations tracked by expiry date instead of remaining units.
Highest leak03
Coding
Time-based units mis-derived from session notes; supervision mismatched to code.
04
Submission
Clearinghouse rejections sitting in a queue nobody owns.
05
Denials
Blind resubmission of denials whose root cause repeats every month.
06
AR follow-up
Payer calls placed outside US business hours, or never placed.
07
Patient balances
Deductible-season balances left uncollected.
Where most practices lose money
Standard cycle stage
Honest comparison
How practices handle billing today, and what breaks
Four realistic options. Each works for somebody — including the ones that are not us.
| Approach | Works well when | Where it breaks |
|---|---|---|
| In-house biller | One person can hold every payer rule in their head, and they stay. | $55k–70k fully loaded for one seat, no coverage during leave, and the payer knowledge leaves when they do. |
| Billing built into the EHR | Claim volume is low and payers are few. CentralReach, SimplePractice, Qualifacts and Netsmart all submit claims competently. | The software submits. It does not call Carelon about a medical-necessity denial, and it does not notice an authorization is three units from expiring. |
| Generalist billing company or a low-cost VA | Budget is the binding constraint and claims are simple. | A generalist treats 97153 like any other CPT code. ABA authorization limits, rendering-provider rules and carve-out routing are learned on your denials. |
| Enterprise RCM vendor | You are a multi-site group with tens of thousands of claims a month. | They will not take a three-clinician practice, or they take it and you become a ticket number. |
| Recura Health | Independent 1–10 provider behavioral health, ABA, mental health or SUD practice doing $500k–$5M in collections. | We are not the right answer below roughly $300k in collections — at that size an in-house part-timer is genuinely cheaper. |
Who we bill for
Built for the practices too small for Optum and too complex for a generalist
Independent, owner-operated, one to ten providers. The specialties that are still growing while the rest of medicine consolidates.
Mental health & therapy
Session-limit tracking, telehealth modifiers, place-of-service accuracy, and medical-necessity documentation that survives concurrent review.
Behavioral health billingSUD & psychiatry
Levels of care and their authorization requirements, per-diem arrangements, and 42 CFR Part 2 record handling kept distinct from general PHI.
SUD billingWhat we run
The whole cycle, or the one seat you cannot fill
Most practices start with denials and AR, because that is where the recoverable money already sits.
Full revenue cycle
Eligibility through prior auth, coding, claims, denial management, AR follow-up and patient balances. One team, one weekly scorecard.
See the seven stagesABA billing
Unit-level authorization tracking, CPT 97151–97158, rendering-provider and supervision rules, CentralReach-native workflows.
ABA billing detailMental health & SUD
Carve-out routing, medical-necessity documentation, parity appeals, and 42 CFR Part 2 handling for substance use disorder records.
Behavioral health detailDedicated remote staff
Keep your process and fill the seat — a dedicated biller, prior-auth specialist, AR caller or intake coordinator on a fixed monthly rate.
Roles we placeA detail a generalist gets wrong
Carelon Behavioral Health is the current name of the organisation formerly called Beacon Health Options, rebranded under Elevance Health in March 2023. Remittance advice and older payer directories still carry the Beacon name in places — and a claim routed on the wrong name denies for what looks like an eligibility problem.
“Placeholder for a real client quote. This block stays empty until a named practice will go on the record with numbers — denial rate before and after, and dollars recovered from aged AR.”
Before you ask us
Common questions
How much does behavioral health RCM cost as a percentage of collections?
Outsourced behavioral health revenue cycle management typically runs 4–8% of net collections, with flat per-claim models at roughly $2–8 per claim. Percentage pricing means the vendor is paid only when the practice is paid. Smaller practices should expect a monthly floor beneath the percentage — without one, a vendor cannot afford to serve a small practice properly, and service quality is what quietly gives way.
Is it better to hire an in-house biller or outsource?
A single in-house biller costs roughly $55,000–70,000 fully loaded, provides no coverage during leave, and takes the practice's accumulated payer knowledge with them when they leave. Outsourcing converts that fixed cost into a variable percentage and removes hiring and turnover risk — but adds vendor-selection and data-security diligence you now own.
Below roughly $300,000 in annual collections, a part-time in-house biller is usually genuinely cheaper. We will tell you if that is you.
Can a remote or offshore team handle this under HIPAA?
Yes. HIPAA contains no geographic exemption — an offshore vendor is a business associate subject to the same Privacy, Security and Breach Notification rules, under a signed Business Associate Agreement that extends to any subcontractor.
Two caveats worth knowing before you sign with anyone. Florida limits offshore storage of records for providers using certified EHR technology, and Texas privacy law reaches organisations handling a Texas resident's records regardless of where they sit. And substance use disorder records carry obligations beyond HIPAA under 42 CFR Part 2.
What changed with 42 CFR Part 2 in 2026?
SAMHSA's final rule updating 42 CFR Part 2 took effect in April 2024 with a two-year implementation window. Civil enforcement began 16 February 2026, giving the HHS Office for Civil Rights civil money penalty authority over Part 2 violations for the first time.
Practically: if your practice touches SUD records, your billing vendor is now inside a regulation with teeth. Ask any vendor how they handle Part 2 records specifically, separately from HIPAA. Many cannot answer.
Does the 2024 mental health parity rule help me get claims paid?
Less than you may have been told. The Departments of Labor, HHS and the Treasury issued a non-enforcement statement on 15 May 2025 covering the portions of the 2024 MHPAEA final rule that were new relative to the 2013 rule, pending litigation plus a further 18 months.
What still applies: MHPAEA's statutory obligations, the 2013 regulations, and the comparative analysis requirement for non-quantitative treatment limitations added by the Consolidated Appropriations Act, 2021. Parity remains a real tool in appeals — just not the expanded 2024 version. Any vendor selling you on "the new parity rules" has not read the file.
Start here
Start with the number, not the pitch
Give us read-only access to your practice management system. Within five business days you get a one-page finding: your denial rate by payer and by code, your aged AR, and what it is costing you annually.
No obligation, no contract
Read-only access only
The findings are yours to keep