Psychiatric Connections Restores Cash Flow From $0 to $43,678 a Month
A practice billing $178,237 a month was collecting nothing at all.
Praveen Bodakunta, PMHNP-BC, runs a board-certified psychiatric practice delivering telehealth across six states. The clinical side was working. Patients were being seen, encounters were being documented, and claims were going out against an average of $178,237 in monthly charges.
Nothing was coming back. The practice was paying $4,000 a month to an in-house billing setup and had no visibility into what was happening to any of it.
How does a practice bill $178,237 a month and collect nothing?
A gross collection rate of zero is not a billing performance problem. It means money has no path back into the practice.
Two enrollments that should have been completed before the first claim went out had never been set up.
Electronic Remittance Advice was not enrolled
An ERA is the electronic explanation of payment a payer sends back. Without it, remittance data never arrives in a form the billing system can read, so payments cannot post automatically. Nobody could tell which claims had paid, which had denied, or why.
Electronic Funds Transfer was not enrolled
EFT is how a payer deposits money directly. Without enrollment, the payment pathway that should have been carrying revenue into the practice account simply did not exist.
Everything downstream failed as a result. Claims denied and nobody worked them, because nobody could see the denials. Balances aged without follow-up. Across six states, each with its own payer mix and its own enrollment requirements, the gap compounded every month.
The practice was paying $4,000 a month for a setup that was posting nothing, and had no reporting that would have shown the problem.
What we built
The foundation first, then the recovery, then the prevention.
ERA and EFT enrollment
We completed the enrollments across the practice payer set. Remittance data now arrives electronically and posts automatically. Payments deposit directly. This is the change that made every other change possible.
Denial recovery
With remittance data finally visible, the denial backlog became workable. Claims were categorized by root cause, appealed within each payer window, and the causes fed back upstream so the same denials stopped repeating.
Daily eligibility verification
Telehealth psychiatry has a specific failure mode: coverage lapses between sessions and nobody finds out until a claim is denied weeks later. A Daily Eligibility and Copay Action Report now reaches the provider before appointments begin, confirming active coverage, flagging out-of-network risk, and stating the exact amount due at time of service. More on behavioral health billing. Coverage is confirmed the morning of the appointment rather than discovered in a denial six weeks later.
Visibility
Collections, denials by payer, and AR aging are now reported continuously. The practice can see what is happening to its revenue in each of the six states it serves.
The results
The results
| Metric | Before | After | Change |
|---|---|---|---|
| Average monthly charges | $178,237 | $178,237 | Unchanged |
| Monthly collections | $0 | $43,678 | +$43,678 |
| Gross collection rate | 0% | 24.5% | +24.5 points |
| ERA and EFT enrollment | Never configured | Active across payers | Established |
| Monthly billing cost | $4,000 | Lower | Down $1,800+ |
Why it worked
Why it worked
The charges did not move. $178,237 a month before, $178,237 a month after. No additional patients, no new providers, no change to coding.
What changed is that the money had a path back. ERA enrollment meant payments could post. EFT enrollment meant they could arrive. Once those two things existed, the denials became visible, and once the denials were visible they could be worked.
It is worth noticing how ordinary the failure was. No fraud, no catastrophic system error. Two enrollment forms that were never completed, and a practice delivering care for free as a result.
Common questions
Common questions
Who is responsible for completing ERA and EFT enrollment?
The provider or their billing representative submits the enrollment to each payer. It is not automatic. Opening a contract with a payer authorizes claims. It does not activate the return channel for payments or remittance data. ERA and EFT are separate applications, filed separately, and confirmed separately. At Psychiatric Connections nobody had filed either one across the full payer set, and no part of the onboarding workflow required checking.
Why does ERA enrollment matter separately from EFT?
EFT moves money. ERA moves information. A practice can have EFT active and still be blind to denials if ERA was never enrolled, because the billing system has no electronic remittance to read. The reverse is also possible: ERA data arrives but payments do not deposit. Both channels have to be open for claims to close properly, and enrollment status needs to be confirmed payer by payer rather than assumed.
Is your remittance data actually posting?
Is your remittance data actually posting?
If your billing team cannot tell you which claims paid and which denied this week, check whether ERA and EFT enrollments were ever completed for every payer you bill. It is a quick thing to verify and an expensive thing to miss.
The revenue assessment reviews denial rates, AR aging, payer mix, and billing workflow. No sales presentation. If the numbers show an opportunity, we build a custom engagement. If they do not, we say so.