Today we will dive into credentialing and billing. You can check out articles on getting started/first steps as well as data collection and staffing questions.  

How Will Your Practice Handle Billing? 

How your ABA practice handles billing is essential. Insurance billing is incredibly complex and requires specialized knowledge and experience to do well. Smaller practices often have the primary clinician (or solo practitioner) handling billing themselves. Some ABA superheroes have family members or part-time employees to handle the intricacies of billing. Some practices outsource their billing to a specialty team. Let’s explore! 

There are many questions and factors to consider when determining how you want to manage your billing. 

Insurance? 

One of the first you should ask is whether or not you will accept insurance. Most ABA practices depend upon private insurance and government reimbursements. Some providers decide not to accept insurance because they do not want to spend time joining provider panels, going through the credentialing process, and staying on top of the ever-changing policies of each company. This is not common, however. 

 Many clients and their caregivers are looking for an ABA provider who takes their insurance and will bill secondary providers as well. 

Other providers choose to become credentialed with as many insurance providers in their areas as possible to try and cover all of their bases, but this is hardly necessary. 

Usually, there are a few big-name insurance providers in the area where you are planning to practice. Providers should do their research to determine which payers are popularly used in their region and go through the credentialing process if they want to accept insurance. This limits the number of relationships, payer requirements, and other details that you have to keep track of while optimizing coverage for clients in your area. 

Revenue Cycle Management Services? 

Revenue Cycle Management (RCM) services, also known as managed billing services, can be an incredible resource if you are not an expert on insurance billing and don’t have an in-house billing team. Hiring an RCM partner can be the thing that sets your ABA practice up for financial success. 

The right partner will offer services and tools like: 

A Team of Trusted Billers: You have access to world-class billing team members with extensive ABA experience  

Streamlined Claim Submission:  The team handles both electronic and paper claim submissions depending on your funding source, as well as secondary insurance or payers.   

Hassle-free Claim Follow-up: Your RCM team follows up on claims so you do not have to. They will work with insurance companies and funding sources on all unpaid and denied claims to ensure you receive proper payment for your services.  

Comprehensive Reporting: You receive account ledgers and claims denial reports that create an action trail, documenting all follow-up correspondence with insurance companies and funding sources.  

Client Benefit Verification: Verify your client’s coverage before a single service is rendered so everyone is aware of their billing responsibilities upfront.  

Authorization Management: The team ensures you get paid on time by completing the appropriate criteria sheets and authorization forms. They will also contact insurance companies on your behalf to obtain approval for authorization requests.  

Billing Software?  

Will your organization implement the use of automated billing software? (The tool is one of the primary features of PMS systems.) This can be used on its own (to help automate your team’s billing procedures) or synced with managed billing services. 

 ABA billing software can help create claims, document, create invoices, create electronic reports for uploads to electronic clearinghouses or other digital tools, and more. The best solution for ABA providers looking to stay on top of their billing is to find a PM software solution that offers integrated billing components.  

This way, you are only implementing one software solution rather than multiple.  

 The right combination of software and services can help your organization effortlessly stay on top of your revenue cycle. From the time a client sets an appointment to the time their bill is paid in full, you will be covered. 

Credentialing 

Becoming credentialed with insurance companies is vital, and can be a bit of a mystery to new practice owners. The process takes several months if all goes smoothly and requires a financial and time commitment. 

The basics: provider credentialing is the process in which a behavioral health insurance carrier assesses an ABA provider’s qualifications and competency. If approved through this process, a provider can bill to that specified payer. 

If you are planning to accept insurance at your new ABA practice, you will need to complete the credentialing process with each payer you wish to bill to. The process might be different for each payer and can take anywhere from 60-120 days officially. Often, the time frame is longer if there are processing delays or any additional information is needed. 

Challenges 

It Takes Time 

This process can last months on end depending on how tedious each step is with the payer. From the time you start the process to when you are actually able to bill that payer for services provided to clients could be as long as 6 months. This is ok though. As a provider, you can still utilize superbills (forms that detail what you charged your client, the insurance codes, identification numbers, and dates so that the client can take it to their insurance) until you are approved.  

Staying Organized  

This process can feel monotonous at times and so it is important that ABA providers stay organized throughout the journey. This means keeping folders, logs, and notes for where you are in the process with each payer and what you still need to complete on your end. There are also credentialing services that can help you streamline the process.  

Payer Requirements 

Wouldn’t it be nice if you could just fill out one set of forms and send them out to each payer you are wanting to earn credentials for? Unfortunately, that is not how it works. Each payer has their own set of requirements that must be met in order to get approved.  

Overhead 

This process takes time and it takes money. ABA providers starting their own practice need to consider what it is going to cost them out of pocket to join each different panel.  

Credentialing Benefits 

More Clients 

 If there is one thing that clients look for in a provider it is that they accept their insurance. By joining the most used provider panels in your area, you open up your pool of clients and are able to grow at a much faster rate.  

Client Satisfaction 

 Clients who see the cost of services after the first visit and feel that weight lifted off their shoulders when insurance has covered some or all of the cost is enough for them to feel comfortable accepting the curriculum and treatment plan for their child. ABA therapy is intensive; it’s not like traditional psychotherapy where an adult might see a therapist for 50 minutes once a week. Clients and their parents need to feel comfortable with the financial side of treatment.  

Marketing/Referral Opportunities 

Often, parents start their search by contacting their insurance to see who is in-network. Other clinical and medical professionals do the same. Joining a provider panel is a great way to get your name out into the community and meet clients in their search for an ABA provider.