What Your Billing Service Needs From Your EHR
An EHR billing service handoff is the point where your electronic health record (EHR) feeds data to the people who bill your claims. Done well, claims go out clean and fast. Done badly, the billing team chases missing details for weeks. This guide lists what to share, what to hold back and how to keep it secure.
What is an EHR billing service handoff?
Your EHR holds your schedule, client details and notes. A billing service needs a slice of that data to build claims. The handoff can be a report, a shared login with limited access or a direct feed. Look up the basics in our EHR terms glossary.
8 items your billing service needs
- Client demographics. Name, date of birth, address and contact details exactly as on the insurance card.
- Insurance details. Payer, member ID, group number and subscriber information.
- Appointment data. Dates of service, provider and location.
- Procedure codes. The CPT code and units for each visit. See the CPT code hub.
- Diagnosis codes. The ICD-10 codes tied to each visit.
- Place of service and modifiers. See place of service codes and CPT modifiers.
- Authorizations. Any prior authorization or referral numbers.
- Signed documents on file. Consent and assignment of benefits, when required.
What should you share, and what should you hold back?
HIPAA’s minimum necessary standard says to use or disclose only the information needed for the purpose. The HHS minimum necessary guidance explains it. Billing needs codes and demographics. It rarely needs the full clinical narrative. Share only what the claim and any payer record request require, and set up a business associate agreement first. See HIPAA for billing.
How do you keep the handoff secure?
The HHS Security Rule sets standards for protecting electronic health information. In practice, use named logins instead of shared passwords, limit access to what each person needs and remove access when someone leaves. Avoid sending client data by plain email.
Private payers vs Medicare vs Medicaid
Private payers. Each plan may want different identifiers or authorization numbers on the claim.
Medicare. Medicare claims need accurate enrollment and provider details. See our Medicare behavioral health billing guide.
Medicaid. State Medicaid programs add their own IDs, codes and managed care rules. This varies by state, so share the plan name and not only “Medicaid.”
How the claim travels
After the billing team builds the claim, it usually goes through a clearinghouse, a service that checks and routes claims to payers using standard formats from X12. Read our clearinghouse enrollment guide, the clearinghouse glossary and electronic claims for therapists.
Before you hand off
- Test with a few real visits and compare each claim to the note.
- Agree who fixes demographic errors.
- Agree how often you send data.
- Confirm eligibility checks happen before visits. See eligibility verification.
For more, read what a billing service for therapists includes, outsourcing therapy billing and the behavioral health revenue cycle. See our services and who we serve.
Frequently asked questions
Does my billing service need access to my whole EHR?
Usually not. Limit access to what billing needs, such as demographics, codes and insurance, in line with the minimum necessary standard.
Should I share clinical notes with my billing service?
Only when needed, for example to answer a payer record request. Billing mostly runs on codes and demographics.
What if my EHR cannot export billing data?
Ask your EHR vendor about reports or an export. A billing service can often work from a standard report.
Who is responsible for demographic errors?
Agree this in writing. Errors in the EHR cause denials, so someone must own the fix.
Write the plan down. A clear EHR billing service handoff names who sends what and when. Review the EHR billing service handoff after the first month and adjust it.
Where MCM South Medical Billing Service Works
MCM South Medical Billing Service, LLC works with psychotherapists and psychiatrists in our ten currently served states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois.
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