Managing ABA authorizations is one of the more common pain points with ABA billing. Despite the hurdles of this process, authorization management is necessary to service your patients most effectively and increase financial efficiency within your organization. Two authorization issues to watch out for are over-utilization and under-utilization.
Over-utilization, on the one hand, can result in services being provided that cannot be collected. On the other hand, under-utilization of authorization can result in patients not receiving the full medically necessary services for which they are approved. To a further extent, continuous under-utilization holds the potential for reductions in future authorizations.
There are three focus areas that we encourage you to keep at the forefront of your thought process to help reduce and even eliminate authorization issues:
- Consistent monitoring
- Clear communication
- Schedule accessibility
Let’s take a closer look at these functions.
Monitoring
The key to successful ABA benefits and authorization management is consistently monitoring your active authorizations. Weekly status check-ins are imperative to maintain a current understanding of authorization usage. We encourage you to designate a single team member responsible for monitoring and obtaining ABA authorizations, maintaining awareness of usage, and reviewing the start and end dates. If your organization works with a revenue cycle management partner or ABA managed-billing company, or has specialized management software, this may be a service that you can take advantage of. Maximizing begins with monitoring and ensuring you know the ins and outs of ABA therapy insurance.
Communication
In the same way that monitoring can lead to successful authorization management, communication is an essential factor. Frequent communication should occur between all parties involved to ensure that neither over-utilization nor under-utilization pitfalls come into play. Including therapists, BCBA(s), administrators, caregivers, family members, and internal teams in part of the bigger conversation is the best way to ensure everyone is on the same page.
If a family is having trouble maintaining a consistent schedule, this could prevent the patient from receiving the full services for which they are approved. Clear communication with the family will help address attendance issues, improve their understanding of why they should use authorized services, and highlight the importance of insurance reimbursement rates for ABA therapy.
Scheduling
Scheduling is a key task to prioritize when managing authorizations, and it goes hand in hand with good communication. Give your scheduling department access to authorization usage information so that adjustments can be made in accordance with timeframes and usage. Open lines of communication between the billing team and scheduling department will help ensure that scheduling complies with ABA billing rules, requirements, and other authorization usage factors.
Despite the more common difficulties associated with the authorization process, prioritizing these three focuses can help minimize obstacles and prevent lost revenue from developing into larger issues. Monitor consistently, communicate clearly, and stick to your schedule.
The benefits of receiving prior authorizations from insurance companies
Insurance authorization is a key component of providing services, but it can be confusing and difficult to manage in some practices. Many health insurance companies require prior authorization. Without it, the patient’s procedure, medication, or service may go unpaid. In most situations involving ABA authorizations, it is critical to have a behavioral health plan that demonstrates the need for these services as medically necessary for the patient. There are various steps to this process.
1. Verify benefits
The first step is to verify that the provider is within the insurance carrier’s network (or considered out of network with benefits). Providers must gather proof of insurance that covers ABA therapy from the patient to start the authorization process. This process must happen before the patient receives any treatment or care.
2. Assessment authorization
The next step involves obtaining assessment authorization through a “treatment request form.” This form lists all background information about the child and the service provider. It may also include credentials and the necessary service codes for the type of therapy being provided. The correct billing codes reflect the ABA therapy, including the hours required to complete the assessment.
3. Assessment
The next part of the process is approval for the assessment. This is not full approval to provide care but just to provide an assessment based on the insurance provider’s approved number of hours. This step lets the provider begin working with the patient for a formal evaluation.
4. Treatment plan creation
After the assessment, the provider develops a treatment plan for the patient. This is an elaborate document that outlines the services to be provided, along with goals for the future. The provider can meet with the parents and the patient at this time to go over the treatment plan. That is an important step because it enables good communication of the expectations of care. If everyone agrees to the plan, it is signed by all, and the next step in authorization can occur.
5. Ongoing authorization
Obtaining authorization for ongoing care is much the same as the previous step to receive approval for the assessment. This step involves getting authorization to provide care for a set number of hours over six months. This may take more time than other authorizations for ABA insurance due to the need to determine if the care is medically necessary. In some situations, the insurance provider may require a peer or live review. A case manager may want to review the treatment plan to ensure it is the best choice.
6. Treatment starts
Once authorization occurs, treatment can begin on an ongoing basis. It is possible that authorization to continue care will be necessary over time. Usually, after six months of care, the authorization process must begin once more.
Get the best ABA billing services at Missing Piece
Despite the often complex nature of the approval process for ABA authorizations, a strategic focus on key areas can dramatically smooth out challenges, curtailing the risk of revenue loss and turning potential obstacles into manageable tasks. Missing Piece has over a decade of specialized experience in medical billing and consultations, emerging as a pivotal ally for practices aiming for operational efficiency and financial health.
With Missing Piece, you gain a partner equipped with payer and billing expertise that assures timely reimbursements and accurate claim submissions. This comprehensive support allows ABA providers to concentrate on delivering outstanding patient care, knowing the financial aspects are managed adeptly.Additionally, the flexibility and scalability of Missing Piece’s services ensure they can be tailored to meet the unique needs of your practice. If your organization is looking for an ABA billing company that will help alleviate the burden of managing authorizations, contact us today.