Billing Tips for ABA Therapy Practices

Many ABA therapy practices struggle with insurance billing, especially during regulatory changes when denials tend to reach all-time highs. A couple of rejected claims daily may not seem much, but they can add up and have a massive negative impact on your practice’s financial viability and reputation. Hence, it’s necessary to take steps to improve your ABA billing process early on. This will let you avoid denials  and continue delivering the best care to your patients. Here are some billing tips to consider:

Get credentialed

If the practice is not recognized by an insurance company, your patient’s therapy won’t be covered. Insurance carriers have different terms and conditions that a therapist needs to meet. These conditions include credentialing—which means providing the documentation supporting your application for approval, such as your CV, education, medical licenses, proof of medical malpractice insurance, and others..

Understand the coverage

Not all insurance plans provide the same coverage for ABA therapy. To ensure your eligibility to receive payment, always confirm the patient’s health insurance and how it covers their therapy. It’s also essential to understand ABA insurance coverage, as it is related to your state. As of October 1, 2019, fifty states plus the District of Columbia have mandated insurance coverage for applied behavior analysis therapy, but not all 50 states cover these therapies at a ‘universal’ level.

Make sure you have an appropriate system for filing claims and getting paid

Becoming a credentialed provider is not enough. For a smoother ABA billing process, you need a practice management system to simplify payments and claims submission. Each insurance company uses unique forms for validation that require accurate medical coding for the services provided and detailed information about your practice and client. Ensure you're updated on the Current Procedural Terminology codes to avoid denied claims. Meeting filing deadlines should also be a priority.

Don’t put off or ignore claim denials

Act as soon as possible to identify why the claim was denied and make an appeal. That way, you can minimize the chances of the same rejection reoccurring in the future.

Work with professionals

Many companies assist ABA service providers in their billing. They assure fast claim processing with minimum denials. Partnering with a qualified ABA billing expert can maximize revenue and minimize administrative burdens so you and your staff can focus on your patients.

Plutus Health offers revenue cycle management services to ABA therapy centers. Get in touch to find out how they can help. 

About the Author:

Thomas John leads a global team of 500 employees in 3 locations as the President & CEO of Plutus Health providing, RPA powered revenue cycle management services to healthcare organizations across 22 states. Plutus Health Inc. is a 15-year-old full-cycle RCM firm specializing in medical coding & billing, denial management, credentialing, prior authorizations, AR follow-up for both medical and behavioral health specialties. As the industry experts in revenue cycle management solutions, they've created a unique process that combines machine learning and robotic process automation to address the clients' most frustrating problems.

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