Question 1

Do you only get paid if you recover money?

Accepted Answer

Yes. Recoup works on contingency — we take a share of what we actually recover for you, and nothing if we recover nothing. There’s no setup fee, no monthly software cost, and no upfront commitment to find out how much you’re owed. The teardown that shows you the leak is free.

Question 2

Do I have to switch my EHR or replace my current biller?

Accepted Answer

No. We work across the systems you already use and layer on top of your current setup. There’s nothing to install and nothing for your staff to learn. We go after the denials, authorizations, and aged claims slipping through — alongside whatever biller or platform you already run.

Question 3

What happens in a free aging-report teardown?

Accepted Answer

You send your aging report. We go through it and come back with a straight read on what’s recoverable, where it’s stuck, and what it would take to collect it — specific to your numbers. It’s free and carries no obligation. If there’s nothing worth recovering, we’ll tell you that too.

Question 4

Can I still recover a behavioral health claim that’s past timely filing?

Accepted Answer

Often, yes. Timely-filing denials can frequently be appealed when you can document timely submission, a payer error, or another valid exception — but the window to act is short. The older a claim gets, the harder recovery becomes, which is why aged AR is usually the first thing we work.

Question 5

Why do behavioral health claims get denied more often than medical claims?

Accepted Answer

Behavioral health carries a heavier authorization burden — continued-stay and concurrent reviews, medical-necessity criteria like ASAM, and level-of-care rules across PHP, IOP, residential, and detox. Each is a point where a payer can deny care you’ve already delivered, and generalist billing shops routinely miss these BH-specific steps.

Question 6

What is a concurrent (continued-stay) review, and why did mine get denied?

Accepted Answer

A concurrent or continued-stay review is the payer’s mid-treatment check on whether ongoing care still meets medical necessity. Denials usually turn on documentation and which criteria were applied (ASAM, MCG, or the payer’s own). Many are defensible on appeal when the clinical record is presented against the right standard.

Question 7

How does mental-health parity (MHPAEA) help me appeal a denial?

Accepted Answer

Parity law requires behavioral health benefits be no more restrictive than medical and surgical ones, which can be grounds to challenge a denial. Note: as of May 2025, regulators paused enforcement of the 2024 Final Rule’s new provisions — but the underlying parity statute and 2013 rule remain in force.

Question 8

What’s the difference between a behavioral-health biller and a generalist RCM company?

Accepted Answer

A generalist handles claim volume; a behavioral-health specialist knows where BH revenue actually leaks — concurrent review, medical-necessity denials, level-of-care and per-diem billing, and BH carve-outs. We came up inside behavioral health billing, so your payers and denial patterns aren’t a learning project for us.

Question 9

What share of claims actually get denied — and appealed?

Accepted Answer

Denials are common and badly under-worked. According to KFF, roughly 19% of in-network ACA marketplace claims were denied in 2024, yet fewer than 1% of denials were appealed. Most denied dollars are simply written off — which is exactly the gap Recoup exists to work.

Question 10

Which facilities is this for?

Accepted Answer

PHP, IOP, residential, and detox programs — the levels of care where dollars per case are high and the authorization burden is heaviest. If you’re running one of these and watching denied continued-stay auths and aged claims pile up, that’s exactly the leak we work.

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