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.
Keep up to date on insurance guidelines, state regulations, and contract amendments from insurance companies
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 therapy 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. Craft your medical record documentation to comply 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:
- Weekly claim submission ensures consistent and timely claims, allowing you to maintain a steady flow of revenue.
- Monitor authorization usage:
- Careful scheduling and tracking of prior authorizations is 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 save time and cut down on paper waste.
- Utilize insurance portals for faster payment updates and claim status follow-up.
Boost your ABA billing practices with Your Missing Piece
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. 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!