TMS Coverage Criteria for MDD: What Payers Expect and What Your EHR Must Enforce (2026)
CTMSS coverage guidance translated into practical documentation and workflow requirements for interventional psychiatry teams.
EHR Source Editorial Team
Regulatory & Reimbursement Updates
Federal rules and reimbursement changes that affect behavioral health billing, translated into plain-language explainers with concrete action items for your RCM team. No legalese, no fluff — just what changed, when it hits, and what you need to do.
Payer Change Intelligence Center
Match payer rule changes to your payer mix and workflow priorities.
Compliance Deadline Tracker
In Effect
Feb 16, 2026
42 CFR Part 2 Final Rule
All SUD programs must comply with new HIPAA-aligned consent and breach notification rules. OCR accepting complaints.
In Effect
Jan 1, 2026
CMS-0057-F Prior Auth Timelines
Payers must issue PA decisions within 72 hours (urgent) / 7 days (standard). Public reporting of denial rates begins.
In Effect
Jan 1, 2026
CY 2026 Physician Fee Schedule
New G-codes for Collaborative Care (G0568-G0570), DMHT device expansion, +3.77% conversion factor for APM participants.
In Effect
Jan 1, 2026
CY 2026 OPPS — PHP/IOP Rates
Updated PHP/IOP per-diem rates. CMHC IOP costs now 40% of hospital-based, fixing cost inversion.
Upcoming
Dec 31, 2026
DEA Telehealth Prescribing Extension
Fourth COVID-era extension expires. No permanent rule finalized. Prescribers must plan for in-person requirements.
Upcoming
Jan 1, 2027
CMS-0057-F FHIR Prior Auth APIs
Payers must implement FHIR-based PA APIs for EHR-integrated prior auth submission.
Upcoming
Jan 1, 2027
Medicaid Work Requirements (OBBBA)
80 hours/month documentation required. CBO estimates 11.8M lose coverage. BH/SUD services exempt from cost-sharing.
Regulatory Explainers
SPRAVATO REMS Operations Blueprint: Certification, Monitoring, and Reporting (2026)
A practical REMS operations blueprint for outpatient SPRAVATO programs, built from the official REMS program overview and monitoring form.
EHR Source Editorial Team
SPRAVATO REMS Audit Checklist for Outpatient Clinics (2026)
A compliance audit checklist built from the REMS Program Overview and Patient Monitoring Form, plus EHR controls that prevent gaps.
EHR Source Editorial Team
TMS Course Planning and Outcomes Tracking: A 36-Session Playbook (2026)
CTMSS coverage guidance translated into a practical course design and outcomes tracking workflow for interventional psychiatry programs.
EHR Source Editorial Team
ECT Patient Selection and Treatment Setting: A Documentation Blueprint (2026)
APNA’s ECT treatment considerations translated into a structured patient selection and setting checklist for program teams.
EHR Source Editorial Team
ECT Documentation and Billing in 2026: What Compliance Teams Must Enforce
A compliance-focused ECT guide using APNA clinical considerations and Medicare coverage references to define required documentation.
EHR Source Editorial Team
TMS Documentation Checklist: What Your EHR Must Capture for Clean Claims (2026)
A practical rTMS documentation checklist based on code definitions and coverage guidance, with the EHR workflows that prevent gaps.
EHR Source Editorial Team
ECT Program Readiness Checklist: What Your EHR Must Support (2026)
A program-level ECT readiness checklist based on professional guidance, with the documentation and workflow requirements an EHR should enforce.
EHR Source Editorial Team
The SPRAVATO REMS Checklist Your EHR Should Make Automatic (2026)
A compliance-first SPRAVATO REMS checklist for outpatient programs, plus the EHR workflows that prevent documentation gaps.
EHR Source Editorial Team
42 CFR Part 2 Final Rule: What Changed for SUD Programs on February 16, 2026
The 42 CFR Part 2 final rule aligning SUD records with HIPAA took effect February 16, 2026. Here is what changed, what your compliance team needs to do, and how it affects billing workflows.
Steve Gold, JD, MPH
MHPAEA Enforcement Paused: What the 2026 Delay Means for Behavioral Health Providers
CMS paused enforcement of the 2024 MHPAEA final rule NQTL comparative analyses. Here is what the delay means for behavioral health reimbursement, network adequacy, and parity complaints.
Steve Gold, JD, MPH
One Big Beautiful Bill: How OBBBA Medicaid Changes Affect Behavioral Health (2026-2027)
The One Big Beautiful Bill Act restructures Medicaid with work requirements, FMAP cuts, and eligibility changes starting 2027. Here is the behavioral health revenue impact and how to prepare.
Steve Gold, JD, MPH
DEA Telehealth Prescribing Rules 2026: Planning for the December Cliff
The fourth DEA telehealth prescribing extension expires December 31, 2026 with no permanent rule. Here is what behavioral health prescribers need to know about Schedule II-V medications, buprenorphine, and contingency planning.
Steve Gold, JD, MPH
CMS 2026 Physician Fee Schedule: Behavioral Health Billing Changes Explained
The CY 2026 Physician Fee Schedule introduces new Collaborative Care G-codes, expands DMHT device reimbursement, and updates conversion factors. Here is what behavioral health practices need to change.
Kori Hale
2026 OPPS Rule: PHP and IOP Rate Changes Explained for Behavioral Health
The CY 2026 OPPS final rule updates PHP and IOP per-diem rates, fixes the CMHC cost inversion, and introduces condition code 92 changes. Here is the billing impact for behavioral health facilities.
Kori Hale
CMS Prior Auth Reform 2026: New Decision Timelines and What They Mean for Behavioral Health
CMS-0057-F requires payers to issue prior authorization decisions within 72 hours (urgent) and 7 days (standard) starting January 2026, with public denial rate reporting. Here is how behavioral health practices should respond.
Nathan Boyd, MBA
Medicare Telehealth Extended Through 2027: Behavioral Health Billing Updates
Congress extended Medicare telehealth flexibilities through March 2027, making audio-only permanent for behavioral health. Here are the billing codes, place-of-service rules, and originating site changes your practice needs.
Nathan Boyd, MBA
SAMHSA Grant Cuts 2026: RCM Strategies for Behavioral Health Programs Losing Federal Funding
SAMHSA terminated or reduced over $2 billion in behavioral health grants in 2025-2026. Here is how affected programs can offset lost revenue through billing optimization, payer diversification, and RCM improvements.
Kori Hale
State Medicaid Behavioral Health Rate Changes: 2026 Tracker and Analysis
After 23 states raised behavioral health Medicaid rates in FY 2025, only 14 followed through in FY 2026. Here is a state-by-state tracker of rate changes, FMAP adjustments, and what it means for your revenue.
Kori Hale
No Surprises Act and Behavioral Health: Billing Compliance Guide for 2026
How the No Surprises Act affects behavioral health practices — out-of-network billing rules, good faith estimates, Independent Dispute Resolution, and compliance requirements for therapy and psychiatry practices.
Steve Gold, JD, MPH
Medicare Advantage Prior Auth Denial Rates: What Behavioral Health Practices Need to Know (2026)
Medicare Advantage plans deny behavioral health prior authorizations at alarming rates. Here is how to use CMS transparency data, appeal effectively, and hold MA plans accountable under new rules.
Steve Gold, JD, MPH
CCBHC Certification and PPS Rate Guide: What Behavioral Health Organizations Need to Know (2026)
Certified Community Behavioral Health Clinics receive 20-40% higher Medicaid rates through prospective payment. Here is how certification works, what the PPS rate covers, and whether your organization should pursue CCBHC status.
Nathan Boyd, MBA
OIG Telehealth Audit Priorities for Behavioral Health: What to Expect in 2026
The HHS Office of Inspector General is intensifying telehealth audits for behavioral health. Here are the specific risk areas, documentation requirements, and compliance strategies to protect your practice.
Nathan Boyd, MBA
Medicaid Managed Care BH Network Adequacy: CMS Access Rule Changes for 2026
The CMS Medicaid access rule (CMS-2439-F) introduces appointment wait time standards and secret shopper audits for behavioral health networks. Here is what providers and MCOs need to change.
Kori Hale
Behavioral Health Value-Based Payment Models: A Practical Guide for 2026
Value-based payment is expanding into behavioral health through CCBHC PPS, BH ACO integration, and payer VBP arrangements. Here is how BH organizations can evaluate, prepare for, and succeed in VBP contracts.
Kori Hale
Split/Shared Visit Billing for Behavioral Health Practices: 2026 Rules and Revenue Impact
CMS split/shared visit rules affect how psychiatrists, NPs, and PAs bill E/M services in behavioral health. Here are the current rules, documentation requirements, and revenue optimization strategies.
Nathan Boyd, MBA
SDOH Z-Code Screening and Billing for Behavioral Health: 2026 Implementation Guide
CMS is expanding social determinants of health screening requirements and reimbursement. Here is how behavioral health practices can implement SDOH screening, code with ICD-10 Z-codes, and capture new revenue.
Nathan Boyd, MBA
Mental Health Parity Compliance Documentation Guide: Building Your NQTL Evidence File (2026)
Even with MHPAEA enforcement paused, documenting parity violations now protects your revenue when enforcement resumes. Here is how to build a compliance evidence file, track NQTL disparities, and use parity data in contract negotiations.
Steve Gold, JD, MPH
Behavioral Health Credentialing and Payer Enrollment Guide: Timelines, Pitfalls, and Revenue Impact (2026)
Provider credentialing and payer enrollment delays cost behavioral health practices $5,000-$15,000 per provider per month in lost revenue. Here is how to accelerate the process, avoid common pitfalls, and maximize reimbursable visits from day one.
Steve Gold, JD, MPH
Related RCM Guides
Intro to Revenue Cycle Management: Step-by-Step Guide for Healthcare Teams (2026)
A practical beginner-to-operator guide to RCM: patient access, eligibility, prior auth, coding, claim submission, payment posting, denials, and KPI management.
Kori Hale
RCM Front-End Playbook: Registration, Eligibility, and Prior Authorization (2026)
A practical front-end RCM operations guide with step-by-step workflows, role ownership, and daily controls for patient access, insurance verification, and authorization readiness.
Kori Hale
RCM Back-End Playbook: Claims, Denials, AR Follow-Up, and Patient Collections (2026)
A detailed back-end RCM guide covering claim submission controls, payment posting and reconciliation, denial work queues, AR strategy, and patient balance collections.
Kori Hale
Revenue Cycle Management Fundamentals: The Complete Guide for Healthcare Organizations (2026)
Revenue cycle management explained end-to-end: patient access, charge capture, claims, payment posting, denials, and A/R — with benchmarks and workflow maps.
Kori Hale
Charge Capture and Coding Accuracy: How to Stop Revenue Leakage (2026)
Reduce charge leakage and coding errors: superbill optimization, E/M leveling, modifier accuracy, and charge reconciliation workflows.
Kori Hale
Clean Claims Submission: How to Hit 98% First-Pass Rate (2026)
Build a clean claims workflow: eligibility verification, claim scrubbing, clearinghouse configuration, and pre-submission quality controls.
Nathan Boyd, MBA