As the nation faces the end of the pandemic, the business of ABA practices faces yet another shift. After spending the last year and a half adapting to the financial climate of COVID-19, practice owners can finally see the light at the end of the tunnel.
Before providers can start to climb back up the financial ladder, they must transition their attention more heavily to their claim management process. The success of your organization depends on the health of your financial process, which hinges on the success of your claim reimbursements.
While many providers have spent years creating and filing their claims in-house, that is no longer the best approach for today’s top ABA practices in the business. Today, providers might need to consider utilizing different tools and resources to help them tackle their financial goals, adjust to life after COVID-19, and recenter their focus on their clients.
What is Claim Management? How Does it Impact Your ABA Practice?
In healthcare and behavioral health settings, claim management refers to the procedure in which a provider submits a claim for reimbursement to their client’s insurance company. Every ABA provider should be familiar with this process as long as they work with insurance. Those who are aware know just how complicated and frustrating it can be. Insurance payers have different requirements, billing procedural codes change all of the time, and rejections/denials make it feel impossible to get paid for the work you’ve done. Most ABA clinicians didn’t become therapists to spent their time with insurance claims after all!
Even though the process is frustrating, claim management is the backbone of the ABA practice business revenue cycle. The key to maximizing revenue is perfecting your claim management process through the submission of clean claims.
Clean claims are those that are submitted accurately (without errors) and approved by the payer after the first submission. These are vital to your bottom line.
Why are Clean Claims So Important to an ABA Practice’s Business?
To understand the importance of clean claims, you need to grasp their place in the revenue cycle. The revenue cycle involves the complete billing process from when the client schedules a visit to the time their balance is paid in full. The continued business of an ABA practice depends on client balances being paid on time. While providers cannot solve the cause of every late payment, they can take steps to prevent as many delays as possible on the insurance side.
Clean claims equate to timely payments. The faster you can get your claim approved by a payer, the sooner your practice will receive reimbursement for that claim. This is why clean claims are so vital to the business of ABA practices.
Common Claim Management Mistakes
1. Errors in Coding
The number one reason for a rejected claim (a claim that contains one or more errors) is that there was a mistake in coding that claim. Current Procedural Terminology (CPT) codes are the primary guidelines for the billing of therapy services. These codes are updated on an annual basis to reflect the current scope of the industry. If a claim is coded incorrectly, it will result in an immediate rejection.
2. Information Errors
The next most common reason for a rejected claim is that there were errors in the information listed on the claim. This might include a patient’s birthday that was off by a single digit or even a letter left out of their name. Insurance payers will search for any possible error as a reason to reject a claim.
3. Failure to Resubmit Within Time Window
Each payer has a rule for when a provider is required to resubmit a rejected claim for it to be eligible for reimbursement. If this window of time closes before the provider resubmits it, then it will not be paid. Providers who do not effectively track these windows of time let revenue slip through the cracks, hurting the business of their ABA practice.
4. In-House Billing at a Smaller Practice
In-house revenue cycle management can cost an ABA practice business thousands of dollars in revenue every year. A few reasons for this will be discussed later on in this article, but between the cost of onboarding and training billings staff and an increase in billing mistakes, in-house billing is not the way to improve your claim process.
At smaller ABA practices the in-house biller tends to be the therapist themselves, a family member, or a part-time employee. The level of expertise–and time–needed to submit and process claims correctly are simple to find in an outsourced ABA billing team. Save your clinician and administrative time for things that matter, like patient outcomes. Find a trusted biller.
Why Smaller ABA Practices Should Avoid In-House Billing
Onboarding & Training
The average cost of onboarding a new employee across all industries is $4000. This is even more expensive in the field of ABA because a wealth of time and resources must be invested into each employee in your practice. The field is increasingly more complicated compared to industries like retail. Due to how complex the billing landscape is for ABA practices, the turnaround rate for billing staff is high. Your administrative staff then invest more resources into finding new staff and training them, only to lose them shortly down the road.
Billing Staff Shortages
The nation is experiencing billing staff shortages across healthcare, mental, and behavioral health billing. It is an unnecessary burden for an ABA practice to deal with the administrative headache of being short-staffed with employees who are not advanced in the field.
Each of these issues causes an increase in costly billing errors. Without expert billers on your team, human errors increase. This is because those managing billing in-house end up having their attention pulled in dozens of different directions throughout their day. These errors, no matter how small, lead to lost revenue. Your ABA business depends on the accuracy of claims as they directly impact cash flow.
Increase Clean Claims with Managed Billing Services
The best way to avoid the struggles and headaches associated with in-house billing is to outsource your claim processes to an expert medical billing partner. Not every medical billing services vendor is the same, so it is essential to find the best one for your ABA practice business. Doing so casts a wide net for what your practice is capable of accomplishing with its bottom line.
Why Your Practice Should Work with a Quality Medical Billing Partner
Team of Trusted Billers
The best billing partners give your ABA practice business access to a team of world-class billers. This team is focused on one thing, and one thing only, the success of your claim process.
Streamlined Claims Submissions
Working with a billing partner will also ensure that your claims are always submitted on time. Work with a vendor that handles both electronic and paper claims submissions, no matter the funding source.
Hassle-Free Follow Up
Rather than having to track billing cycles, payer requirements, and rejection management, your billing services partner will handle all of the follow-ups. They will work one-on-one with insurance companies to make sure you receive the proper payment for services.
Rather than have to manually input Explanation of Benefits (EOBs) into your system, your billing services partner will do the grunt of the work for you.
Client Benefit Verification
One of the best ways to make sure your claim will get approved is to first verify your client’s coverage. A billing partner can verify client benefits before any claims are submitted to insurance so that your team can focus on client care without worrying about payment.
Getting paid on time every time is essential. The correct billing services vendor will not only complete appropriate criteria sheets and authorization forms on your behalf, but they will also contact insurance companies so that you can get approval for authorization requests.
The Key Takeaway
Every ABA practice depends on the timely reimbursement of insurance claims. Streamlining your claims process so that it is both accurate and efficient is critical to the overall financial health of your ABA practice business. The most effective way to optimize your claim process and get paid on time is to outsource medical billing services to a qualified vendor. To learn more about a Revenue Cycle Management partner that can help you, click here.
If you would like to learn more about selecting a billing partner, fill out the form below for your free guide.
Discover Our ABA Practice Management Software
WebABA is here with the tools you need to improve every aspect of your ABA therapy practice. Built for startups, solo practitioners, and smaller ABA practices: our tools save you admin time and increase your billing revenue. Get started today.