Medical billing is a complex process that can be even more convoluted for behavioral health billing. The intricacies of behavioral health services, diverse payer requirements, and varying state regulations can result in several issues, including medical underpayment.
It’s one of the most common issues providers face and can have significant financial consequences. Behavioral health practices, such as ABA therapy providers, must have a clear strategy for dealing with underpayments and improve their revenue cycle.
In this blog post, we will examine some ABA best practices and strategies that your practice can implement to prevent and minimize revenue loss from underpayments.
What is underpayment in medical billing?
Medical billing underpayment is exactly what it sounds like — a partial payment where the payer fails to reimburse a practice the full eligible amount for the services that they have provided. Underpayment can occur due to billing errors, claim denials or insurance company mistakes.
Fortunately, with proper strategies, these issues can be minimized.
Identify and avoid common billing errors
The first step is to identify why your ABA practice is losing money and how to address these shortcomings. The most common cause of medical underpayments is billing errors. Behavioral health billing is often complex, involving different types of services (e.g., therapy sessions, group therapy, and medication management), and each may have different coding and documentation requirements. Here are some of the most common billing errors and how to avoid them:
- Incorrect codes: Behavioral health services require accurate coding for claims. Mismatched or outdated CPT (Current Procedural Terminology) and ICD-10 (International Classification of Diseases) codes can result in denials or payment reductions.
- Incomplete documentation: Almost all insurers require highly detailed documentation to support billing for services rendered. Incomplete or inadequate documentation and notes can result in underpayment.
- Missing authorizations: Behavioral health services have their own stringent pre-authorization requirements that set them apart from traditional medical billing. Failing to get the required authorization prior to providing a service can result in denial and underpayment.
Avoiding common billing errors
Proper staff training is essential to avoid these common billing errors. Keeping billing staff updated with the latest coding changes, regulations, and payer policies will reduce the likelihood of human error when entering claims.
Implementing electronic health records (EHR) with an integrated billing system will flag coding errors and incomplete documentation and ensure accurate claim submission. A verification process is also integral, as it ensures that all claims are double-checked before submission.
Preventing claim denials and rejections
Claim denials and rejections are undoubtedly the most common cause of underpayment for ABA therapy practitioners. These are mainly a result of the common billing errors mentioned above. Preventing denials at the source can significantly reduce the time and resources spent on claim rework and appeals. Here’s how to prevent claim denials and rejections:
- Verify patient eligibility and benefits: It’s critical that you verify a patient’s insurance coverage, benefits, and whether prior authorization is required. Implement a process that regularly checks your patients’ eligibility to avoid denials due to lapses in coverage or incorrect plan information.
- Submit clean claims: The best way to avoid denials and rejections is to submit a clean claim the first time. This means avoiding errors like coding mismatches, incomplete information, and more. Ensure all required fields are complete, coding is accurate, and any extra information and documentation is attached.
- Appeal denials quickly: Denials slow down the reimbursement process, but they happen occasionally despite having all the right billing strategies in place. When this does happen, it’s important to address them quickly. Assign a dedicated staff member to review denials, correct errors, and resubmit the claim as quickly as possible.
- Stay on top of payer policies: Ensure that you keep updated with insurance policies. Insurance companies regularly move the goalposts and change their requirements. Stay informed with every insurance provider you deal with to ensure compliance and prevent denials.
Conduct regular audits
Being proactive in your approach to underpayment is the best way to prevent it. Your practice should regularly audit your payments and billing process to catch anything before it becomes a significant issue. It can help to identify patterns in underpayments and denials, ensure that you are up to date with the most current compliance regulations, and help verify that you are being paid the right amount. Sometimes, insurance companies can incorrectly process and underpay claims, which could go unnoticed without regular auditing.
Schedule a regular audit into your practice’s calendar, such as quarterly or biannually, and create an audit checklist to ensure you are reviewing the most critical areas. Use these findings to drive continuous improvement, revise your processes, and refine your billing practices.
Outsource your medical billing to experts
One of the best ways to boost your ABA company’s billing practices is to outsource to a company specializing in medical billing services. Companies like Missing Piece are well-versed in the intricacies of behavioral health billing practices and requirements.
Our expert medical billing specialists can effectively navigate the intricacies of behavioral health billing and reduce the likelihood of denials, underpayments, and other billing errors that lead to revenue loss.
Prevent underpayments with Missing Piece’s ABA medical billing services
Preventing underpayment in behavioral health billing requires a comprehensive approach that can be overwhelming and time-consuming. Missing Piece provides contracting, authorization, eligibility, billing, accounts receivable, patient statements, and patient collection support as part of our medical billing services.
We handle the most pertinent and stressful administrative tasks so you can spend more time delivering the highest-quality client care.
Contact us today for a free billing consultation or to talk to a medical billing expert.