Applied Behavior Analysis (ABA) therapy is a treatment that has been developed and proven to assist autistic patients with learning, communication, and social skills through positive encouragement and behavioral reinforcement. However, until recently, medical insurance providers did not cover this type of treatment in their policies. Although services have come a long way in the last few years, accessing funding for them can be time-consuming, confusing, and problematic.
One of the biggest hurdles that providers of ABA face is that insurance companies are continually moving the goalposts. Coding, billing, and authorization rules constantly change, making the reimbursement process an uphill struggle. Advancements in technology, such as online health services, have added further complications to an already challenging process.
What Is a BCBA?
A Board-certified Behavior Analyst (BCBA) works closely with patients with an autism spectrum disorder to offer guidance, support, and structure. In addition to the fact that they may lack the specialist knowledge and resources to administer the correct ABA billing procedure, spending time with patients is a more beneficial use of their time. Therefore, it is prudent to outsource the billing process to a third-party billing services company.
What Should a Billing Service Company Provide?
In addition to a comprehensive knowledge of insurance claims management, a billing organization should understand the diagnostic, treatment, and support services offered by the BCBA and provide complete Revenue Cycle Management (RCM) to ensure streamlined claims management. It should ensure all compliance requirements are met throughout the claims process and that industry standards are maintained from start to finish. A third-party provider should manage patient billing for insurance claims and any unpaid balances if patients do not have the required coverage.
Benefits of Using a Billing Service Company
Outsourcing the ABA billing process is beneficial in maximizing reimbursement of claims, enabling BCBAs to spend more time with patients than on paperwork, providing peace of mind that procedures are being followed correctly, and reducing costs that would have been spent on in-house billing services. Moreover, there is the added reassurance that specialists have up-to-date knowledge of medical billing, and — consequently — there should be a reduction in the number of denied claims.
Common Pitfalls and How to Avoid Denied Claims
Even with a designated ABA billing service in place, things can still go wrong, resulting in claim denials. Although many claims are correctable, rewriting and submitting them is a lengthy and time-consuming process that is avoidable. Here, we will look at the main reasons why claims are rejected.
It is relatively common to miss an expiration date unwittingly. Some places require coverage up to 18 years of age, while other states cut off requirements at only six years of age.
It is essential to check insurer eligibility before signing on the dotted line. Some states do not require ABA coverage for specific plans. However, insurers will deny all medical claims from parents without ABA coverage, irrespective of their child’s needs. It is also imperative that referrals are obtained from health professionals to ensure the prerequisites for coverage are met according to location.
Despite all efforts to ensure insurers communicate with their members, it is not uncommon for them to change their provision without prior consultation. Often, customers think they have coverage for medical conditions when they do not.
Another common issue for denied claims is due to simple documentation errors. Typos, sloppy handwriting, and incorrect information, which should be reasonably straightforward to fix, are often time-consuming and laborious.
A good billing service should be familiar with these common pitfalls — which result in denied claims — and should have dedicated staff in place to look out for any of the aforementioned problems before submission.
Conclusion: The Future of ABA Billing
In conclusion, even if you have an in-depth understanding of ABA billing, it is an extraordinarily challenging and ever-changing process that is fraught with potential pitfalls. By outsourcing the process to a third-party billing organization, you can reduce staff administration costs and remove some of the headaches of trying to keep abreast of the continual coding changes and authorization rules.
Going forward, we should be open to the possibility that further advancements in technology will continue to change the landscape for ABA Billing processes. However, by implementing a knowledgeable billing service with a denial management strategy, we can eradicate mistakes in the claims process before they are made.
About the Author
Jacob Thomas writes on health and wellness topics, including aging, caregiving, insurance, and long-term care.
Contributor since August 10th, 2023
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