Total Client Impact: Over $620,000 in Recovered Revenue | Two States, Two Systemic WinsKey Outcomes: Misrepresentation Corrected in FL | DOI Intervention in IN Florida: Correcting Misrepresentation and Securing Full-Year Coverage The ChallengeIn 2013, families affiliated with the Florida Institute of Technology (FIT) purchased Golden Rule insurance plans based on broker assurances that ABA therapy […]
Category: Missing Piece News
Case Study: Correcting Systemwide Denials for CPT 0373T with Indiana Medicaid
Client Impact: $500,000 in Paid Claims | Resolution Time: 4 MonthsIndustry Impact: Statewide System Fix for All ABA Medicaid Providers The ChallengeIn Indiana, ABA providers faced a critical billing disruption when CPT 0373T—a Category III code essential for adaptive behavior treatment with protocol modification—was excluded from Indiana Medicaid’s provider-to-procedure code linkage system. This oversight resulted […]
Case Study: Bridging the Gap Between Blue Cross Blue Shield of Texas and Blue Cross Blue Shield of South Carolina
Client Impact: $350,000 in Paid Claims | Resolution Time: 1 year and 35 Days The ChallengeA provider partnered with Missing Piece ABA Billing experienced claim denials from Blue Cross Blue Shield of Texas (BCBS TX) for CPT 97153, an essential ABA therapy code. While BCBS TX requires specific modifiers on these claims, all submissions were […]
Key Metrics for Behavioral Health Billing
Running a successful behavioral health practice involves much more than providing excellent care to your clients. Behind every therapy session and treatment plan lies a complex revenue cycle management process that directly impacts your practice’s financial health. For behavioral health providers, especially those offering ABA therapy services, understanding and tracking key billing metrics is extremely […]
What is Balance Billing, and How Does it Affect Behavioral Health Services?
Balance billing is a financial hurdle that often surprises patients and complicates operations for healthcare providers, quickly turning a positive healthcare experience into a stressful financial puzzle. It can be an extremely frustrating process for patients and practices, especially within behavioral health services, largely due to misconceptions about how it works. This guide explains what […]
Telehealth Trends for Behavioral Health in 2025
Technology and innovation have been the driving forces behind improvements in healthcare for decades, improving diagnostic accuracy, treatment methods, patient outcomes, and access to care worldwide. From the development of advanced diagnostic and treatment tools to the rise of telemedicine platforms that help patients connect with healthcare providers remotely, technological advancements have transformed nearly every […]
How to know when it’s time to consider outsourcing revenue cycle management
Managing your revenue cycle effectively is vital for any behavioral health practice, but knowing when to consider outside help can be challenging. As practices grow and the healthcare landscape becomes increasingly complex, many providers find themselves at a crossroads: continue handling revenue cycle management (RCM) in-house or partner with specialized experts? This guide will discuss […]
How to Maintain Therapeutic Progress in Telehealth ABA
The increasing use of telehealth in ABA therapy has transformed the behavioral analysis landscape. While in-person therapy sessions remain the cornerstone for most clients, virtual ABA therapy has opened the door for underserved and geographically distant communities. Telehealth provides a flexible and accessible alternative to traditional in-person sessions. However, the virtual format of telehealth ABA […]
Strategies for Engaging Young Children in Telehealth ABA Sessions
Keeping young children engaged throughout a face-to-face ABA therapy session can be challenging, which is exacerbated when implementing telehealth ABA therapy. Many behavioral health practitioners use telehealth services to provide ABA services, but it has its own hurdles and benefits. Is it possible to keep a young child engaged within the context of virtual health […]
The Key Differences Between Behavioral Health Billing & Medical Billing
Medical billing and behavioral health billing are interconnected components of healthcare billing. Both require submitting requests to insurance providers and other payers, utilizing coding systems and precise documentation and processes. However, there are also major differences between billing for behavioral health services and general medical billing. The services rendered by behavioral health practitioners are diverse […]