As a smaller ABA practice, you’re working with limited resources: time, staff, and probably an operating budget. You don’t have a lump sum of money to outsource every task, yet you’re not entirely sure of the best way to do everything yourself. And, unfortunately, billing is no exception.
But with billing being arguably one of the most important admin tasks within your practice, getting it right is important. Let’s look at some billing tips for small and solo practices, as well as dive into important aspects of the billing process itself.
What is Claims 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 spend 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 Claims Management Mistakes
- 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.
- 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.
- 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.
- 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 billing 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. However, due to the time commitment and level of expertise needed to handle ABA billing efficiently, this can add tension to already strained workloads.
What Smaller ABA Practices Should Know About In-House Billing
In-house billers (having someone on payroll who handles your claims processing) can be a great resource for any therapy practice. However, when you’re a smaller practice, there are some caveats:
Onboarding & Training
The average cost of onboarding a new employee across all industries is over $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.
Costly Errors
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.
Improve Claims Management with ABA Practice Management Software
With all the caveats that exist for implementing an in-house billing team, you might be wondering what options you have to make billing easier as a small ABA practice. Well, this is where many BCBAs rely on ABA therapy software. More specifically, ABA practice management software.
This software is specifically designed by and for ABA practitioners to make the burdensome (yet important) administrative tasks like billing, scheduling, documentation, etc., quicker and easier.
With practice management software, you gain access to automated billing features such as:
- Eligibility Verification: Verify insurance coverage in real-time to avoid denied claims due to expired benefits or incorrect plan information.
- Electronic Claims Submission: Submit claims electronically directly to payers, eliminating the need for paper forms and speeding up the reimbursement process.
- Detailed Reporting: Gain valuable insights into your practice’s billing performance. Generate reports to track key metrics like claim turnaround times, denied claim rates, and collection rates. This data can help you identify areas for improvement and optimize your billing processes.
However, the most important callout is that you can easily manage this all yourself, in a literal fraction of the time. And that doesn’t just go for billing. As mentioned, you can handle billing, documentation, and data analysis, all from one software – significantly faster. To learn more about how aba therapy software can be leveraged to improve your day-to-day, read our eBook How to Maximize Your Time as a BCBA & Practice Owner.
Practice Management Software Designed for Smaller ABA Practices
WebABA’s practice management software is designed 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 an inside look!