Think Beyond Practice
Practice Lab
Choose a simulator to begin. Each one teaches a different layer of psychiatric private practice billing and coding.
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Billing Simulator
Code the visit, submit the claim, interpret the ERA, post the payment. The full billing cycle from chart to zero balance.
Available
⚠
Denial Drills
The claim already went out. The ERA came back wrong. Figure out what happened and fix it.
Available
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Paper Remittance
Your payer doesn't send ERAs. A check arrived in the mail with a paper EOB. Read it, post it, reconcile it.
Coming soon
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Chart Coder
A full chart note, no billing context. Read it, pick your codes, find out if the documentation actually supports what you billed.
Coming soon
🧠
MDM Foundations
What counts as low, moderate, or high in each MDM domain — and does your note actually prove it?
Available
🗨️
Psychotherapy Documentation
Did therapy happen? What kind? Can you prove it? Three stages: recognition, classification, and building an audit-defensible note.
Available
🧪
Sandbox
Enter any clinical scenario and see what the ERA would return. Free exploration, no teaching targets.
Coming soon
Practice Setup
Configure your billing software before your first scenario. Settings auto-populate into every claim. Errors here cascade forward. If you would rather not enter your own values right now, click the demo button below and it will autofill everything so you can jump straight in.
Provider information
Provider name
Full name as on your NPI registration
NPI number
Payer reps require this before pulling any claim
Taxonomy code
PMHNP taxonomy: 363LP0808X
Default place of service
Most telehealth providers: POS 10
Preferred telehealth modifier
Premera, United, most commercial payers use 95
Fee schedule -- your billed rates
One or more billed rates is below the contracted allowed amount. ERA will pay only what you billed.
Premera
United
Kaiser
CodeDescriptionYour billed ratePremera allowed
Billing Simulator Scenario 1 of 1
Scenario 1 -- Established patient, telehealth
Payer: Premera Blue Cross
In progress
Visit & provider information
Patient
J. Mercer, est. 3 yrs
Date of service
--
Place of service
POS 11 = office. POS 10 = patient home via telehealth. POS 02 = telehealth originating site. Wrong POS triggers automatic denial.
10 -- Telehealth, patient home
Visit mode
Synchronous telehealth = real-time audio/video. Determines which modifiers apply.
Telehealth -- synchronous
Type of service
Should be 1 - Medical Care for psychiatric E/M visits.
1 -- Medical care
Rendering provider
--
NPI
--
Diagnoses
F31.81 -- Bipolar II, current depressed
F41.1 -- GAD
Chart note
Prep
8 min
Face-to-face
22 min
Documentation
10 min
Total encounter
40 min
Follow-up on lamotrigine titration. Mood 5/10, sleep improved, no SI/HI. Two active chronic conditions managed (Bipolar II, GAD). Reviewed CBC and metabolic panel from 03/01/2026. Dose increased from 150mg to 200mg -- discussed rash monitoring protocol and titration schedule. Adherence counseling provided. 17 minutes of psychotherapy performed using CBT techniques targeting anxiety and mood regulation.
Patient benefits -- Premera Blue Cross PPO
J. MERCER
Member ID: --
Plan
Premera Blue Cross PPO
Status
Active
Effective
01/01/2026
Group
GRP-44921
Copay
$55.00
Per visit
Deductible
Met
$1,500 used
Coinsurance
0%
After deductible
OOP max
$4,500
$2,100 used
TH parity
Yes
WA state
Auth required
No
Outpatient MH
Collect $55.00 copay at time of service. Deductible met.
Visit & provider information
Date of service
--
Rendering provider
--
NPI
--
Place of service
Payer
--
Patient
--
Claim coding
Before you code: are you billing by time or MDM for this visit, and why?
In real billing there is no Time/MDM toggle. The debrief will show whether your method matched your codes and what it cost you.
Procedure code
E/M codes 99202-99215 bill the encounter. Add-on codes 90833, 90836, 90838, 99417 bill additional services in the same encounter.
Mod 1
For telehealth POS 10: enter 95 (most commercial payers) or GT (some Medicare Advantage). For in-person POS 11: leave blank. Required on EVERY line for telehealth claims.
 Mod 2
Units
Most E/M codes = 1 unit. 99417 bills per 15 min beyond 99215 threshold. 90833/90836/90838 always 1 unit.
Charges
Your billed rate from fee schedule. Must be above the contracted allowed amount to capture full reimbursement.
Dx 1
ICD-10 diagnosis code justifying this procedure. Auto-fills from the chart diagnoses. Your EHR does this automatically.
Dx 2
ICD-10 diagnosis code justifying this procedure. Auto-fills from the chart diagnoses. Your EHR does this automatically.
 Dx 3
Claim #
Your unique claim identifier. Required when calling the payer.
--
Member ID
Patient insurance member ID. Payer rep requires this before pulling any claim.
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NPI
Your rendering provider NPI. Payer rep will ask for this before revealing claim details.
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Billed
Total charges submitted across all service lines.
--
Paid
What the payer sent you. Difference between allowed and paid is your contractual adjustment.
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Adjudication detail
Processing...
How do you respond?
Service lines
DateCodeModChargesThis paymentBalance
EOB -- apply payment
Premera Blue Cross -- Primary
Allowed
Maximum payer will pay under your contract. Cannot bill patient for billed-minus-allowed difference.
Contracted rate. CO-45 = billed minus allowed.
Contract adj. (CO-45)
Your write-off. CO-45 = charge exceeds contracted rate. Never bill the patient for this.
Your write-off. Never bill patient for CO-45.
Insurance paid
What the payer sent you. Post this as an insurance payment.
What payer sent you.
Copay
Fixed patient amount per visit. Should be collected at time of service.
Collected at time of service.
Deductible
Amount applied to patient deductible. Patient responsibility -- bill the patient.
Patient responsibility.
Coinsurance
Patient percentage share of allowed amount after deductible.
Patient % after deductible.
Transaction log
-- Created
Service line created. Transferred to primary payer.
Charges --
Pat resp --
Balance --
-- Billed
Electronic claim submitted via clearinghouse.
Amount $0.00
Balance --
03/14/2026 -- Copay applied
Patient copay collected at time of service.
Amount --
Balance --
03/19/2026 -- ERA received
Awaiting posting.
Paid --
Balance $0.00 pending
Claim processed
Audit risk
Billing method
--
Pattern identified
--
Your reasoning
--
What you submitted
--
⚠ Time-based billing + psychotherapy add-on
Coding rationale
--
Billing method comparison
Documentation
--
What auditors look for
--
Key rule
--
Denial Drills
The claim already went out. The ERA came back wrong. Figure out what happened and fix it.
Drill
Submitted claim
Adjudication detail
Patient account
--
Take action
Fix the claim
EOB — apply payment
--
Allowed
Maximum payer will pay under your contract. CO-45 = billed minus allowed.
Contracted rate. CO-45 = billed minus allowed.
Contract adj. (CO-45)
Your write-off. Never bill patient for CO-45.
Your write-off. Never bill patient for CO-45.
Insurance paid
What the payer sent you.
What payer sent you.
Copay
Fixed patient amount. Collected at time of service.
Collected at time of service.
Deductible
Applied to patient deductible. Bill the patient.
Patient responsibility.
Coinsurance
Patient % share of allowed after deductible.
Patient % after deductible.
Transaction log
-- Created
Service line created. Transferred to primary payer.
Charges --
Balance --
-- Billed
Electronic claim submitted via clearinghouse.
Amount $0.00
Balance --
-- Copay applied
Patient copay collected at time of service.
Amount --
Balance --
-- ERA received
Awaiting posting.
Paid --
Balance $0.00 pending
Debrief
Pattern
--
Category
--
Difficulty
--
Teaching point
--
Key rule
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MDM Foundations
Medical decision-making: what counts, what your note proves, and where PMHNPs leave money on the table.
📖
Layer 1 — Domain Literacy
What are the three MDM domains? What counts as low, moderate, or high in each? Flash-card format with immediate feedback.
START HERE →
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Layer 2 — Documentation Translation
Given a real note excerpt, what MDM level does the documentation actually support? The skill that prevents audits.
APPLY IT →
Layer 1 — Domain Literacy
Question 1 of 12
Problems Domain
Clinical scenario
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Layer complete
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Psychotherapy Documentation
Recognition, classification, and documentation defensibility for 90833/90836/90838.
🤔
Stage 1 — Therapy or Not?
Read a session vignette. Decide: does this constitute billable psychotherapy? Recognition before documentation.
START HERE →
🏷️
Stage 2 — What Kind?
Given a session interaction, identify the modality and intervention. Classification before documentation.
Complete Stage 1 to unlock
✍️
Stage 3 — Build the Note
Given a clinical scenario, construct a defensible psychotherapy section. Evaluated on all five required elements.
Complete Stage 2 to unlock
Stage 1 — Therapy or Not?
Scenario 1 of 6
Clear
Session vignette
What modality is this?
What intervention was used?
Build the psychotherapy section — select one from each category:
Stage complete
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Premera Blue Cross -- Provider Services
Rep: Angela · Finally off hold
Connected
Premera Blue Cross -- Provider Services
Rep: Angela · Finally off hold
Connected