Billing is one of the more complicated aspects of running an ABA practice. Billing errors can cause significant interruptions, which in turn can result in delays or potential claim denials. Your primary objective as an ABA therapy provider is to deliver meaningful and high-quality services to your clients and manage your revenue cycle effectively at the same time to ensure you can maintain standards.
While ABA therapy codes and ABA-specific terminology have streamlined the process, it’s still not uncommon to experience medical billing errors that can impact insurance claims and your revenue cycle.
Let’s look at some of the most common medical billing errors and the best practices you can implement at your company to avoid them.
Common issues that cause billing errors
Many errors that lead to claim denials are procedural and a result of in-house oversight. Here are some of the common mistakes.
Failure to verify what a client’s insurance covers
Insurance coverage for ABA therapy can differ according to which insurance company clients are with. Much of the time, patients aren’t aware that some companies won’t cover all aspects of ABA therapy. This could lead to a claim denial or rejection down the line.
It’s essential that you or your staff know precisely what services are covered by a client’s insurance. This enables you to avoid providing services that aren’t covered or ensuring you stay within the maximum benefit cap that some insurance providers have. By taking the time to do some simple coverage verification, you can avoid a host of delays.
Incorrect information in reports
Reporting errors are another commonly encountered issue that can lead to denied claims. Simple mistakes like the incorrect spelling of a client’s name, a policy number error, or noting down the wrong birth date can easily cause claim denial.
Ensure that you have a double-checking policy in place and use software that inputs information for you. The majority of these types of mistakes are human error.
Failing to meet submission deadline
Almost every insurance provider will set out a submission deadline for filing claims. Even if everything was filled in accurately and there are no other errors, a claim is likely to be denied if it is not submitted within the stipulated time.
Make sure you know the submission window period for the client’s insurance provider, as some can be as much as a full year from services rendered, while others can be as little as 60 to 90 days.
Not identifying referral sources
While private, commercial policies do not require a referral on the claim, Medicaid does. A client must be referred for ABA therapy before they cover it. So, it’s essential to ensure that detailed information on the patient referral is included in the claim if it’s through Medicaid.
While doctors’ poor penmanship might be a running joke, it unfortunately can be costly when it comes to insurance claims. Illegible handwriting can lead to incorrect coding input or data entry. It’s as simple as the data entry personnel misreading treatment notes or assigning the wrong GPT code as a result of poor handwriting. At the very least, it could lead to the insurance company requesting further information and delaying the claim, but it could also easily result in a claim denial.
Using the wrong codes for ABA therapy coverage
One of the more complex areas of the billing process is the coding system. Newer codes are being introduced regularly, and it can be a bit complicated to keep track of everything. This can be particularly challenging for those just starting out with medical billing or solo practitioners whose areas of expertise lie elsewhere. It’s not uncommon for practitioners to enter the wrong CPT and service codes or treatment and diagnostic codes. All of these seemingly simple errors can lead to a claim being denied.
Best practices to prevent ABA billing errors
If you’re wondering how to correct medical billing errors, then chances are that these errors are already impacting your revenue stream. The best approach is to prevent these errors from happening in the first place.
The following system will help avoid medical billing errors.
- Use the dedicated software for patient information
- Coordinate with insurance providers and medical billing staff
- Continued staff training and education
- Double check everything
- Periodic spot-checking policies
- Outsource to a medical billing provider
An ABA billing provider is the most effective solution to billing errors
If medical billing errors are disrupting your revenue stream or you’re spending too much time trying to implement a behavioral health medical billing system for your practice, then it’s definitely worth considering the services of an ABA billing specialist.
A company like Missing Piece offers comprehensive, turnkey therapy billing services that enable you to devote more time to your clients. A medical billing provider aims to help you grow your business and increase your revenue by streamlining processes, such as eligibility and benefits, claims management, remittance posting, accounts receivable follow-ups, and appeal management.
Contact us at Missing Piece to find out how we can eliminate the administrative burden of in-house ABA billing operations, allowing you to give your clients the highest level of care.