Applied Behavioral Analysis “ABA” billing and coding has changed significantly in the last ten years. The initial billing codes were undefined, leading to unreliable coverage and reimbursement. To create a standardized set of ABA CPT codes, the American Medical Association (AMA) established temporary Category III codes that were effective mid-2014. The Steering Committee for the […]
MUEs can impact daily billing for ABA therapy. ABA providers should be familiar with the rules and regulations of CMS and NCCI.
For an ABA practice, an audit from a health insurance company can seem intimidating, especially for smaller practices without the manpower or technology to handle bigger claims. Being audited by a health insurance company isn’t just a possibility — it’s a certainty. Health insurance companies use audits as a common strategy to ensure operations and claims are […]
All healthcare providers must be very familiar with the basics of HIPAA and state confidentiality regulations, as well as the requirements of their certification or licensure regarding confidentiality. In addition, as a practice, a comprehensive HIPAA analysis should take place regularly to ensure all required safeguards have been put in place to minimize risks.
Initiating ABA services can be a cumbersome and time-consuming process for both the patient and the provider. Documenting medical necessity and the need for services andthe proper consents, are a critical part of a patient’s medical record. Most of this information is gathered during the intake process, which starts before the patient’s first appointment.
Many steps are involved in the revenue cycle management process. Posting payments and reconciling accounts is necessary to ensure that a provider is receiving all payments to which they are entitled.
Have you or your patients struggled with finding or maintaining health insurance? Many new options are available currently for coverage between COBRA, marketplace and Medicaid.
Coordination of Benefits for ABA therapy. One more step in understanding how to get paid.
TRICARE has several changes in store for ABA patients and providers in 2021. Review this for more insight.
Applied behavioral analysis or ABA therapy is considered medically necessary by most, but certainly not all, insurance companies or plans. Payers require that services they approve and reimburse are medically necessary, and providers must have documentation to justify these services. Review these guidelines to help prepare treatment plans.