Essential Questions to Ask Technology-Focused Behavioral Health RCM Companies

In 2024, the global healthcare revenue cycle management (RCM) market was valued at over $343 billion, according to Grand View Research. By 2033, that number is projected to grow to $894 billion — a compound annual growth rate of 11.12%.

Why such dramatic growth in less than a decade?

The complexity of managing unique insurance payer rules, ever-changing coding requirements, and clinical documentation requirements is likewise growing. In this environment, technology-focused behavioral health RCM companies are playing a critical role in helping providers improve their revenue cycle performance.

Rather than deliver outsourced coding, billing, and collections services, these companies are providing behavioral health organizations with software platforms that help power better in-house and outsourced RCM by automating claims management, improving reimbursement, and ensuring compliance.

With demand for behavioral health care rising and provider shortages persisting, organizations cannot afford to manage the complexities of revenue cycle manually. Doing so increases the risk of denials and lost payments. The path to improved performance begins with choosing a behavioral health software solution — and that starts with asking the right questions.

Here are key considerations to raise with potential behavioral health RCM software vendors to get the most out of your technology investment.

Questions About Behavioral Health RCM Technology Solutions

What kinds of technology integrations do you offer?

Ideal answer: Our RCM capabilities are embedded into a comprehensive electronic health record (EHR), which uses Fast Healthcare Interoperability Resources (FHIR) support interoperability, streamline workflows, and enable collaboration across systems.

If their answer sounds generic, ask next:

“Can you name two behavioral health organizations you’ve integrated with, and walk me through what data actually flows between systems via FHIR?”

Vendors that are truly FHIR-native can point to specific data items (eligibility, claims status, clinical notes) moving between systems – not just the standard’s name.

Layering technologies on top of one another can lead to time-consuming hurdles and inefficient workflows. Look for behavioral health RCM companies with strong EHRs and integrated RCM capabilities. By combining an all-in-one solution and effective integrations, you can better manage your administrative, clinical, and RCM needs from a single central resource.

Does your behavioral health technology provide reporting and analytics?

Ideal answer: With our advanced behavioral health EHR with integrated RCM solutions, you can access an intuitive dashboard with data based on industry-specific key performance indicators (KPIs), such as claim denial rates, first-pass claim rates, authorization utilization vs. approved units, documentation completeness rates, denial rates by category, collection percentages, days in accounts receivable by payer, and noncompliance rates.

If their answer sounds generic, ask next:

“Can you show me that dashboard live, and how often is the underlying data refreshed? In real time, daily, or batched?”

A vendor that can’t demo the dashboard on the spot, or that hedges on refresh frequency, is likely describing a roadmap item rather than a shipped feature.

Organizations need insight into their clinical and RCM performance to effectively manage their mental health billing process. Without access to relevant KPIs, behavioral health organizations risk making the wrong RCM decisions that could waste time, money, and resources. Analyzing data through an advanced EHR enables teams to quickly pinpoint and address gaps that could be impacting their revenue.

Does your technology support telehealth billing?

Ideal answer: Clients can set and attend telehealth visits directly through their easy-to-use EHR portal, while providers can generate draft documentation via automated notetaking, which clinicians review and finalize during secure Zoom-integrated visits.

If their answer sounds generic, ask next:

“What happens if a telehealth session is interrupted or runs short? How does that affect documentation and what gets billed?”

This surfaces whether the vendor has actually handled real-world telehealth disruptions or is only describing the ideal-path demo.

In 2023, telehealth comprised 58% of all mental health visits — and demand for virtual care shows no sign of stopping. When scoping out potential tech-based behavioral health RCM companies, ensure they offer not only integrated telehealth services, but also telehealth billing capabilities. Automated virtual notetaking, for example, streamlines the documentation process, helping ensure claims are accurate and complete before submission.

Does your platform use AI, and how is it used responsibly?

Ideal answer: Our platform uses AI where it removes manual work without removing clinician judgment – for example, ambient listening that automates notetaking during secure, Zoom-integrated telehealth visits, and AI-powered tools that surface RCM insights inside the EHR. Every AI-generated output is reviewable and editable by a clinician before it becomes part of the record, and we can show you exactly where AI touches the workflow versus where a human makes the final call.

If their answer sounds generic, ask next:

“Which specific features use AI today – not on your roadmap – and what’s your process for a clinician to review, correct, or reject AI-generated content before it’s finalized?”

Vague answers here (“we use AI throughout the platform”) without naming specific features or a review/oversight process are a red flag, especially for anything touching clinical documentation or billing codes.

Consolidating AI into a single, direct conversation – rather than treating it as a scattered feature mention – makes it easier to evaluate whether a vendor’s AI is embedded and accountable, or just a marketing checkbox.

Questions About Staying Current With a Shifting Landscape

How frequently do you update your behavioral health coding libraries and payer rules?

Ideal answer: Our RCM engine is regularly updated to reflect the latest payer and regulatory requirements, reducing the risk of inaccuracies that can lead to payment delays or denials.

If their answer sounds generic, ask next:

“What’s the typical lag between a payer publishing a rule change and it appearing in your system? And how do you notify customers when it happens?”

“Regularly” can mean anything from days to a full quarter; pin down the actual cadence and communication process.

Fast behavioral health reimbursement depends on accurate coding, yet organizations must juggle numerous coding standards and complicated guidance, often leading to errors. That’s why it’s critical to adopt EHR technology — backed by behavioral health RCM experts — that keeps pace with a constantly shifting coding and billing environment.

How do you ensure compliance with payer rules and help prevent claim denials?

Ideal answer: Our advanced EHR comes with integrated compliance tracking solutions.

If their answer sounds generic, ask next:

“Walk me through what happens end to end when a claim gets flagged. Who reviews it, how fast, and what’s our visibility into that queue?”

This is a short “ideal answer” by design. Press for the operational detail behind it.

Like behavioral health reimbursement and coding procedures, compliance rules are constantly shifting. EHRs with embedded compliance checklists help teams avoid errors that could result in fines or delay reimbursement.

Similarly, look for EHRs with proactive claim workflows. The right technology-based behavioral health RCM companies will offer systems with preloaded claim checks that automatically flag issues before submission. Claim-scrubbing capabilities streamline the process even further, helping organizations achieve cleaner and faster claim submissions.

Can your system support value-based care models and reporting?

Ideal answer: Our EHR supports value-based care by linking clinical outcomes data (e.g., PHQ-9, GAD-7 scores) to billing and reporting dashboards. This enables transparent performance tracking, outcome reporting for CCBHC and Medicaid quality metrics, and accurate documentation for incentive-based reimbursement.

If their answer sounds generic, ask next:

“Which specific quality metrics and payer programs have you supported in live production, not in a pilot or on a roadmap?”

Ask for a named program (a state Medicaid quality initiative, a specific CCBHC measure) rather than accepting “value-based care” as a category answer.

Value-based care requires organizations to submit detailed documentation alongside behavioral health reimbursement claims. Be sure to adopt an EHR that supports this shift in focus, enabling accurate, fast documentation and clear outcome tracking to cover all the model’s billing requirements.

Questions About Support and Service

What experience do you have with behavioral health reimbursement billing processes?

Ideal answer: Our technology is specifically built for the behavioral health and IDD space, offering key features that behavioral health and IDD providers and organizations require. Our team has experience with behavioral health reimbursement, such as Medicaid FFS and MCO billing, IDD waiver programs, and crisis/CCBHC funding models.

If their answer sounds generic, ask next:

“Can you connect me with a reference client that has a similar payer mix to ours – heavy Medicaid MCO, a CCBHC contract, etc.?”

A vendor with genuine behavioral health depth should be able to produce a comparable reference quickly, not a generic case study.

Too often, EHRs are built for the broader healthcare landscape, so behavioral health and IDD organizations spend unnecessary time tracking down the features they need for their specific care delivery needs. To ensure seamless workflows and results, look for a system that’s tailor-made for behavioral health reimbursement and mental health billing processes.

Do you offer coding support or guidance tailored to behavioral health?

Ideal answer: Since our EHR is made for the behavioral health care space, our team of experts is on hand to support with coding updates, billing, and overall RCM. We have in-depth CPT and HCPCS expertise — including H2019, H0032, 90837, 90846/47, 90785 — and we can assist your team in monitoring policy bulletins.

If their answer sounds generic, ask next:

“Who actually answers a coding question – a dedicated behavioral health coding specialist, or a general support ticket queue – and what’s the typical turnaround time?”

This distinguishes genuine coding expertise from a generic help desk.

Accurate coding is vital for fast, accurate reimbursement and compliance. The behavioral health EHR vendor you partner with should not only offer features that support proper documentation, workflows, and other RCM-boosting capabilities, but also help your organization stay up to date with evolving reimbursement requirements.

Do you provide dedicated account management and ongoing training?

Ideal answer: Our team supports onboarding, training, and ongoing optimization to help you make the most of your behavioral health EHR investment and continually optimize your RCM capabilities.

If their answer sounds generic, ask next:

“What does onboarding look like week by week, and who is my named point of contact once we’re live?”

“Always on standby” is a promise; a specific onboarding timeline and a named post-go-live contact is proof.

Search for behavioral health RCM companies that offer low- or no-code technologies so your team can implement and use the solution with little to no IT support required. Also, be sure that your selected vendor provides personalized support from onboarding to implementation and beyond.

One EHR, Endless Benefits

In a crowded market of healthcare technologies, the right tech-focused behavioral health RCM companies will offer fully integrated solutions that comprehensively solve your RCM challenges and drive faster, accurate payments. Ask potential behavioral health software vendors for references from organizations they’ve partnered with, as client success stories can tell you a lot before adopting new technology.

And don't settle for a solution with only some of the features you need. Instead, find a technology provider like Core Solutions. Cx360 Intelligence: The Intelligent Care Record streamlines workflows, enables effective collaboration, provides access to advanced data analytics, and offers artificial intelligence (AI)-powered tools and other integrated solutions that can enhance your organization’s RCM.

In a world inundated with complexity, the Intelligent Care Record makes things easy. Reach out for a demo today.