Most therapy and speech practices today run on an all-in-one platform: SimplePractice, PracticeQ (formerly IntakeQ), Tebra (formerly Kareo), TherapyNotes, or something similar. All of them can create an insurance claim from an appointment, send it electronically, and post the payment when the electronic remittance comes back. It's easy to conclude that the software is the billing.
It isn't. The software is the conveyor belt. It moves claims that are set up correctly and records what comes back. What it doesn't do is decide whether the claim was right, notice when one never got paid, or do anything about a denial except display it. That's the part of billing that determines how much of your revenue actually arrives, and it's the part no EHR automates.
What the major EHRs handle well
| Task | SimplePractice | PracticeQ | Tebra |
|---|---|---|---|
| Create claims from appointments | Yes | Yes | Yes |
| Submit electronic claims (837P) | Yes, through its integrated clearinghouse | Yes, through an integrated clearinghouse | Yes, built-in clearinghouse |
| Eligibility checks | Yes | Yes | Yes |
| Receive ERAs and post payments | Yes, once ERA enrollment is done per payer | Yes, once ERA enrollment is done per payer | Yes, once ERA enrollment is done per payer |
| Client statements and card payments | Yes | Yes | Yes |
| Best fit | Solo and group therapy practices | Therapy, speech, and multidisciplinary practices that want flexible intake forms | Medical and multi-specialty practices that need full practice management |
Feature sets change often, so check current capabilities and pricing with each vendor. The point isn't which one is best. All three are capable of clean claim submission. The difference between a practice collecting 85% of what it's owed and one collecting 97% almost never comes from the software.
What no EHR does for you
Setup that's right for each payer
Claims go out with whatever the EHR was configured to send: the billing NPI, the rendering provider, taxonomy codes, place of service and modifiers for telehealth, and the payer ID. If one of those is wrong for a given payer, every claim to that payer will reject or deny the same way. The software won't tell you the setting is wrong. It will just keep sending. (Our payer ID reference exists because this is the most common setup error we see.)
Following up on claims that went quiet
A rejected claim shows up in the EHR. A claim that was accepted by the clearinghouse and then never adjudicated often doesn't. It sits as "submitted" until someone runs an aging report and asks why a 75-day-old claim has no response. By then, some payers' timely filing windows are already closing.
Working denials
The EHR records the denial code. A person has to read it, figure out whether the root cause is eligibility, authorization, coding, or credentialing, fix it, and resubmit or appeal. Then they have to fix the upstream cause so it doesn't happen again next week. Our article on the denial codes that signal a front-office problem covers the patterns.
Authorizations and visit limits
Most platforms let you record an authorization. Few will stop you from scheduling the session after it expires, and none will call the payer or the Service Coordinator to get it renewed.
Credentialing and enrollment
Claims for a provider who isn't yet in network with a payer will deny no matter how cleanly they're built. Tracking enrollment status and effective dates is outside what an EHR does. See our credentialing guide for how long it really takes.
A useful test: run your EHR's aging report and count the claims over 60 days old. If nobody in the practice can say why each one hasn't paid, the software is doing its job and the billing isn't being done.
Platform-specific tips
- SimplePractice: complete ERA enrollment for every payer you bill, not just the big ones, so payments post automatically. Review the "unpaid" and "rejected" claim filters weekly, not only the denials.
- PracticeQ: double-check the claim settings for each provider (rendering vs. billing NPI and taxonomy) when you add a clinician. Group practices that add providers quickly often have one or two set up with the wrong defaults.
- Tebra: use the claim rules and scrubber edits, and keep payer-specific rules current. Tebra's flexibility is a strength for multi-specialty groups, but it means more configuration to keep accurate.
- All of them: when a code set changes, such as the 2027 speech therapy codes replacing 92507, update services and fee schedules before the first claim of the new year goes out.
Billing software or billing service?
For a solo provider with a light insurance caseload, the EHR plus an hour or two a week is usually enough. Once a practice has multiple clinicians, several payers, authorizations to track, or AR that's quietly aging, the work becomes a role. That role can be an in-house biller, or an outside team that works inside your existing EHR. We compare the costs in how much mental health billers charge.
Sharp Networks Group's team works inside SimplePractice, PracticeQ, Tebra, TherapyNotes, CentralReach, and other systems, so practices don't have to switch software to get the billing done. If you'd like us to look at your aging report, schedule a consultation.