If you’re looking for ways to enable growth and reduce stress with consistent reimbursement, becoming knowledgeable about each patient’s contract and insurance policy is the most effective way to prevent denials. The provider manual released by insurance companies contains rules to ensure you submit clean claims. Make it happen with the following tips.
What is medical billing?
Medical billing is the process of submitting and following up on claims with health insurance companies in order to receive payment for services provided by a healthcare provider. This procedure involves translating healthcare services into billable claims, ensuring accuracy in patient information, and maintaining detailed records of all billing activities. Medical billing professionals like Missing Piece navigate the complexities of insurance company policies and healthcare regulations to secure timely and correct payments for services rendered. Effective medical billing is crucial for the financial health of ABA practices, as it ensures that providers are compensated for their services and patients accurately fulfill their financial responsibilities.
Stay updated on insurance guidelines, state regulations, and contract changes
Insurance companies will make major changes to your existing contract through network/provider updates and amendments. These changes can include anything from CPT code billing guidelines to reduced reimbursement rates.
Connect your clinical department with your billing and administrative department
When the administrative and clinical teams work together, there are fewer denials and corrective claims, saving everyone time. Regular communication and up-to-date ABA billing software will result in a more knowledgeable and effective team.
Analyze and audit to prevent recoupments
Perform clinical audits
- Confirm that all clinical documentation complies with audit requirements and the ABA insurance billing codes for each insurance company. Ensure your medical record documentation complies with the most stringent insurance company’s policies.
Perform regular billing audits
- Validate that all billing is completed promptly and with no duplications.
- Verify that the correct rendering provider, procedure code, and modifier were billed according to the insurance company’s ABA standard billing codes and requirements.
Develop a revenue cycle schedule
Maintain a consistent schedule of revenue cycle tasks and assign staff-specific responsibilities to ensure a healthy stream of reimbursement.
- Complete eligibility checks on every patient’s ABA therapy insurance coverage policy:
- Research each patient’s specific policy for benefit and coverage details and/or exclusions.
- Submit claims weekly:
- Help increase efficiency with your medical bills with weekly claim submissions, which can ensure timely, consistent claims and allow you to maintain a steady flow of revenue.
- Monitor authorization usage:
- Careful scheduling and tracking of prior authorizations are imperative to ensure patients are maximizing — but not exceeding — their approved services.
- Develop an accounts receivable team:
- An internal or external billing and accounts receivable team is crucial to avoid denials and resolve outstanding claim issues.
- Automate the payment process:
- Enroll in electronic remittance advice (ERA) and make use of electronic funds transfer (EFT). Electronic payments to save time and cut down on paper waste.
- Utilize insurance portals for faster payment updates and claim status follow-up.
Avoid common billing misconceptions
Billing for ABA therapy is a complex and often misunderstood process. Due to constantly changing billing requirements, codes, reimbursement rates, and authorization needs, the process can often take up several hours each day. This complexity means that ABA billing is akin to other types of medical billing, which are known for their challenges.
Another misconception is that outsourcing ABA billing is prohibitively costly. While it may seem more economical to manage billing in-house, the hidden costs of software licenses, scaled pricing with practice growth, and the additional time required for billing tasks can accumulate significantly. This makes outsourcing an appealing option, as it often turns out to be more cost-effective in the long run.
Finally, the idea that an in-house billing team is quicker or more cost-effective is also misleading. While hiring dedicated billing personnel improves process efficiency, it introduces new challenges. These include escalating software costs, physical space requirements, the need for constant training, and the risk of employee turnover. Comparing these factors, it becomes evident that a specialized therapy billing provider can offer more resources and expertise than an in-house team.
Learn more about how to overcome these ABA therapy billing misconceptions.
Streamline your billing with Missing Piece’s ABA billing services
What is the best way to handle ABA billing? After all, communicating with insurance companies about authorizations, claims, and contracts can be time-consuming and daunting. Managing all these moving parts while still providing exemplary service to your patients is a difficult balance to maintain. One way to reduce stress, reduce administrative costs, manage your time successfully, and maintain a healthy stream of revenue is to outsource as many of these processes as possible. If you’re looking at how to effectively bill insurance as a BCBA or ABA therapist, Missing Piece provides contracting, authorization, eligibility, billing, accounts receivable, patient statements, and patient collection support. Contact us today for your free revenue and billing analysis.