Simulation-based learning for billing, documentation, and clinical decisions. One scenario is unlocked in demo mode.
⚠
Denial Drills
The claim already went out. The ERA came back wrong. Figure out what happened and fix it.
Try free
💳
Guided Billing Training
From EHR setup to posting the ERA. NPI, fee schedule, eligibility, claim building, and patient billing.
New to private practice? Start here.
Try Step 1 free
📖
Note Building & MDM
Build a defensible psychotherapy note step by step. Understand MDM vs time and what your documentation proves.
Members only
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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.
Members only
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🧠
MDM Foundations
What counts as low, moderate, or high in each MDM domain, and does your note actually prove it?
Members only
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🗨️
Psychotherapy Documentation
Did therapy happen? What kind? Can you prove it? Recognition, classification, and building an audit-defensible note.
Members only
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🔍
Code Reference
What does this code mean and what do you do with it? Search any CO, PR, OA, or remark code instantly.
Members only
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📝
Chart Coder
A full chart note, no billing context. Read it, pick your codes, find out if the documentation supports what you billed.
Coming soon
Drill
Submitted claim
Adjudication detail
Take action
Corrected claim
Angela confirmed the denial reason. The path forward is a corrected claim resubmission.
Debrief
Pattern
Category
Modifier
Difficulty
Beginner
Teaching point
Key rule
You just completed one of 17 Denial Drills. The full Practice Lab also includes Billing Simulator, MDM Foundations, Psychotherapy Documentation, Code Reference, and more. All included with membership.
Every claim follows the same path. From setup to payment to patient billing. We are going to run that entire process using one real patient. You make the decisions. You see what breaks when they are wrong.
Patient: Maya Chen, 32F. Follow-up (Telehealth). Premera Blue Cross
Step 1
Practice Setup
Starts with setting up your billing system correctly. Your NPI, taxonomy, TIN, and place of service determine how every claim is routed. If these don't match your credentialing file, claims fail before they're even reviewed.
Step 2 🔒
Fee Schedule
Decide what you charge and what you will actually get paid.
Step 3 🔒
Credentialing & Enrollment
Make sure the payer recognizes you before any claim pays.
Step 4 🔒
Pre-Visit Eligibility
Verify coverage before the visit happens.
Step 5 🔒
Build the Claim
Document the visit and submit it correctly.
Step 6 🔒
ERA & Payment Posting
Read what the payer actually did and post payments correctly.
Step 7 🔒
Patient Billing
Close the loop with the patient.
Step 1 — Practice Setup
This is what every claim is built on.
Before a single claim goes out, your billing system needs four things configured correctly. If any one of them is wrong, claims deny. Sometimes silently, sometimes months later.
Here is what that setup screen looks like. Take a moment to read it.
Practice Setup
Rendering NPI
Type 1 — Individual
Box 24J on CMS-1500 · Identifies the rendering provider · Follows you across employers
Drives claim routing
Taxonomy Code
364SP0809X
Box 33b on CMS-1500 · Must match CAQH · Mismatch = CO-184 denial
Triggers denials
TIN / EIN
XX-XXXXXXX
Box 25 on CMS-1500 · Determines payment routing · Must match credentialing
Affects reimbursement
Place of Service
11 · 10 · 02
Box 24B on CMS-1500 · In-person vs telehealth · Wrong code = rate reduction
Affects rate
We are going to build this screen field by field. Each one has a denial waiting behind it if you get it wrong.
Step 1 — Practice Setup
Your NPI: the number on every claim you submit.
Every claim you submit must include it. Payers, clearinghouses, and EHRs all use it to route and adjudicate.
Type 1 NPI
Individual provider
Assigned to you personally. Follows you regardless of where you work. Goes in Box 24J (rendering provider) on every claim.
Type 2 NPI
Organization / group
Assigned to a practice or group entity. Goes in Box 33a (billing provider). Solo practice owners often use their Type 1 in both fields.
If you bill a telehealth visit using your Type 2 NPI in Box 24J instead of your Type 1, the payer may reject it because it doesn't match the rendering provider on file. Most solo PMHNPs in private practice use their Type 1 in both Box 24J and Box 33a until they have a formal group structure.
Enter your rendering provider NPI (Type 1, 10 digits).
Step 1 — Practice Setup
Taxonomy code: your specialty on the claim.
A 10-character code that tells the payer what type of provider you are. It lives in Box 33b and in your CAQH profile. If the taxonomy code on your claim doesn't match what's in the payer's credentialing system, you'll see a CO-184 denial.
Your license number is issued by your state board and is what authorizes you to practice. Your taxonomy code is a national standardized code used in the billing system to categorize your specialty. Payers use taxonomy to verify that your credential type matches what's on file from credentialing. They're separate systems, both matter, for different reasons.
Select the correct taxonomy code for a PMHNP in private practice.
163W00000X — Registered Nurse
364SP0809X — Nurse Practitioner, Psychiatric/Mental Health
207Q00000X — Family Medicine Physician
103T00000X — Psychologist
Step 1 — Practice Setup
Place of Service: where the visit happened.
Box 24B on the CMS-1500. Payers reimburse differently by site. Wrong POS triggers denials or rate reductions.
11
Office
In-person at your office. No telehealth modifier.
10
Telehealth — Home
Patient at home on video. Requires modifier 95 on every CPT line.
02
Telehealth — Other
Patient at a non-home site. Rare in solo outpatient.
Two scenarios. Pick the correct POS for each.
Get it wrong to see what happens on the ERA.
Scenario 1: Your patient drives to your office. You meet in person for 45 minutes.
Scenario 2: Your patient joins from home on a video call. You're at your office.
Step 1 — Practice Setup
TIN: how payers send you money.
Box 25 on the CMS-1500. Tells the payer what entity to send reimbursement to and issue 1099s under.
Option A — SSN
Your Social Security Number. Simpler to set up. But it puts your SSN on claims that pass through clearinghouses, increasing identity theft exposure.
Option B — EIN ✓ Recommended
Employer Identification Number. Free from IRS in minutes. Separates your personal identity from your business. Standard practice for solo providers.
Yes, and consistency matters more than the choice itself. Whichever TIN you use on your credentialing applications must match exactly what's in your billing system. A mismatch between your credentialing TIN and your claim TIN can cause payment routing failures and CO-16 denials. Pick one, use it everywhere, and never change it mid-contract without notifying payers.
Enter your EIN (format: XX-XXXXXXX).
Step 1 — Practice Setup
Your practice setup is configured.
Every claim you submit from this point forward will use this data. Here's what you built and what each field prevents.
Payment routes to correct entity · Prevents payment routing failures
✓
Place of Service — 11 (office) and 10 (telehealth) configured
Correct POS per visit type · Prevents rate reductions and CO-4 modifier denials
This setup carries forward through every module. When you build the claim in Module 5, these fields will pre-populate automatically.
You just completed Step 1 of 7 in the Guided Billing Training. Steps 2 through 7 cover fee schedules, credentialing, eligibility verification, claim building, ERA reading, and patient billing. All included with membership.