Consultant Needed – Outpatient Psychiatry Billing, Coding & Compliance (99213/99214/99215 & 90833)

I am seeking a highly experienced consultant with deep expertise in outpatient psychiatry billing, coding, compliance, payer audits, and medical necessity. Purpose of this project I have significant experience in outpatient psychiatry operations and finance and have analyzed one successful insurance-based psychiatry practice in depth. I am currently performing **fundraising and investment due diligence** for an outpatient psychiatry business model. My objective is **not** to learn basic coding rules. I need to determine whether the billing model I have analyzed is **common, replicable, sustainable, and fully compliant across multiple outpatient psychiatry practices**, or whether it is unique to a single practice. **This analysis is critical because the percentage of recurring medication-management visits billed as 99213 versus 99214 has a substantial impact on practice profitability and investment returns. A materially higher proportion of 99213 claims can significantly reduce profitability, so I need to understand what billing distributions are both common and supportable under payer rules and documentation requirements.** I am specifically looking for someone who has **worked with several outpatient psychiatry clinics** and has a deep understanding of billing utilization patterns, compliance, audits, and documentation requirements across multiple organizations—not just one practice. ### Topics I would like to discuss * Typical percentage of recurring medication-management visits billed as: * 99213 * 99214 * 99215 * Typical percentage of medication-management visits that also include **90833**. * How common it is for established outpatient psychiatry practices to bill **90% or more of recurring medication-management visits as 99214**, and whether this is generally sustainable when documentation is appropriate. * Whether practices with **90%+ utilization of both 99214 and 90833** are common, uncommon, or exceptional across the industry. * Whether this billing profile would generally be expected to withstand commercial payer and Medicare audits if documentation supports the services billed. * Common reasons payers downcode or recoup 99214 and 90833 claims. * Documentation standards necessary to consistently support **moderate medical decision making** for 99214. * How experienced psychiatrists and PMHNPs document visits to support compliant coding. * Internal audit processes, provider education, documentation templates, and quality assurance programs used by successful outpatient psychiatry groups. * Whether the billing and documentation structure I have observed (90% plus 99214) is representative of well-run outpatient psychiatry practices or is unique to a particular organization. ### Ideal experience * Has worked with **multiple outpatient psychiatry practices**, either as a consultant, compliance officer, coding auditor, revenue cycle leader, or senior billing executive. * Has firsthand knowledge of **actual coding utilization data** across several practices, including typical percentages of **99213, 99214, 99215, and 90833**. * Extensive experience with outpatient psychiatry billing, coding, and compliance. * Experience with commercial insurance and Medicare audits. * Experience implementing or overseeing compliant billing and documentation programs for psychiatry practices. * Certified coder and/or compliance professional (e.g., CPC, CPMA, CCS, CHC) is preferred. * Able to discuss real-world audit experience, benchmark utilization patterns across practices, and provide practical recommendations—not simply explain CPT coding guidelines. **Selection process** I would like to begin with an interview to discuss your background and experience. This initial conversation is intended to determine whether your experience is a good fit for this project. There is potential for additional consulting work afterward if we decide to move forward.