A guide for practitioners to reduce denied claims and maximize revenue
Because of the relatively short amount of time payers have covered ABA therapy in the US, Board Certified Behavioral Analysts (BCBAs) often have a particularly challenging time dealing with how to bill insurance for ABA therapy.
ABA claims can be quite complex, so BCBAs tend to experience a higher rate of denied claims than other professions. As a result, practice owners and clinicians can end up investing a lot of resources into managing insurance claims.
However, this investment doesn’t always pay off.
Often, problems like poorly designed practice management software, using clinical time to manage the claims process, and choosing a billing partner who doesn’t specialize in ABA end up hurting revenue. And when left unaddressed, these difficulties can even impact service quality and patient care.
Fortunately, as ABA has become a more established and accepted therapy, the billing support options available to providers have improved in quality and affordability.
To help you better understand how to bill insurance for ABA therapy—and whether a billing partner or revenue cycle management service might be suitable for your practice—we’ll give an overview of the ABA claims process below.
The ABA Insurance Claims Cycle
While there is some variation between practices, the claims cycle for ABA business generally consists of 5 steps.
Either during intake or before the first appointment, it’s best practice to verify a client’s insurance eligibility to determine their coverage for ABA. This enables both client and clinician to gain clarity around the likely cost of treatment. Plus, understand any limitations there might be in terms of coverage.
After verification, if the client chooses to proceed with therapy, the initial appointment can be booked.
- Patient Contribution
Many clients will have a copay for ABA treatment. You don’t have to collect this before the appointment, but we recommend having a policy that any patient contributions must be received after each session.
Of course, you may choose to allow some leeway on occasion. However, not promptly collecting copays can result in difficulty reconciling claims (step 5) and place clients in a difficult financial position.
- Claim Generation
After each appointment or occasion of service, a claim must be generated. This is where it really pays to know how to claim for ABA therapy!
To successfully be reimbursed, you’ll need to use the right CPT code for your client’s diagnosis and the service provided, then submit a “clean claim” in an acceptable format to the relevant insurer. A clean claim is one that includes all the necessary information and is free from errors.
- Claim Follow Up
A busy practitioner will quickly have dozens, if not hundreds of insurance claims underway. Hopefully, a large proportion of these will be processed quickly without any issues. But some will inevitably be queried, require further information, or be denied.
ABA insurance claims should be tracked daily or weekly to check progress. This is very important because the longer a claim with problems gets left, the lower the likelihood is of a favorable outcome.
Finally, once an ABA insurance claim has been reimbursed and any client contributions are received, the claim should be reconciled in the practice owner’s accounts software and EMR. Sending the client confirmation of the resolution is also a good idea, so they have peace of mind and clarity about the status of their account.
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Common Challenges with ABA Claiming
Even when a practice has good systems in place and a thorough understanding of how to bill insurance for ABA therapy, several common challenges are faced by most practitioners.
Depending on the nature of your business, the software tools you use, and the support team in place, you might struggle with one or all of the following:
- Errors on claims delaying reimbursement – By far the most common (yet easiest to prevent) challenge with ABA insurance claiming is delays due to preventable errors. These are usually simple billing mistakes, like listing an incorrect date of birth, diagnosis, or patient address on the claim.
- High rates of claims denials – Sometimes, rather than sending a query for clarification or further information, an insurer will deny a claim. Denials are time consuming to address, so focusing on avoiding claims denials in the first place is the best strategy.
- Lower than expected rates of reimbursement – One of the biggest benefits to understanding how to bill insurance for ABA therapy is knowing how to maximize reimbursement. This isn’t about “cheating the system.” Maximizing reimbursement means you strategically use relevant CPT codes related to your client’s diagnosis to fund the maximum amount of therapy they’re entitled to.
- Difficulty reconciling patient accounts – One of the most challenging aspects of ABA billing is when an account for an occasion of service can’t be reconciled. In this case, an error made earlier on—perhaps in determining coverage or calculating a copay—means that the clinician is reimbursed less money than expected. The only option here is to accept the loss or renegotiate payment terms with your client, neither of which is ideal.
- Disputes between patient, insurer, and clinician – Clients coming for ABA are often under a lot of emotional and financial stress. And uncertainty or surprises around billing can quickly result in communication difficulties and conflict. To avoid this, it’s important to have a predictable, well-organized, and transparent claiming and billing system. When everyone understands how the financial side of ABA therapy works, disputes are far less likely to occur.
Gaining a better understanding of how to bill insurance for ABA therapy can help avoid some of the above challenges. But when you’re a solo or small practice operator—looking after all these tasks in-house often becomes too much. It’s also worth keeping in mind that many of the steps within the ABA claims cycle can be automated through the use of intelligent software.
As a group, these software and services are known as revenue cycle management, or RCM.
Let’s take a look at how RCM services, like those available through WebABA, could help your practice run more smoothly and increase profits.
Benefits of Revenue Cycle Management Services
RCM services can benefit BCBA practices in two ways:
- They take the headache and hassle out of managing insurance, reducing the internal resources you need to allocate to billing and claiming
- They can increase profitability, by maximizing reimbursement, freeing clinical staff up from administrative duties, and streamlining patient billing processes
The RCM services that typically provide the best return on investment (ROI) for BCBAs are:
Intelligent EHR Software
An intelligent behavioral health EHR allows many steps of the ABA claims process to be automated and streamlined, like patient intake, insurance verification, submission of insurance claims, and invoicing.
When you no longer have to spend so much time on the financial aspects of running a BCBA practice, you’ll have more time to do what you do best—caring for patients.
EHR software can also help reduce burnout in ABA clinicians, by reducing the amount of administrative tasks that need to be attended to.
Mobile Data Collection Tools
Sometimes, insurers might ask for justification or clinical reasoning for funding a service. When this occurs, leveraging data to show your client’s progress can be incredibly powerful.
Catalyst is a one-of-a-kind mobile ABA data collection app that digitally captures all the data BCBAs need to record to demonstrate patient progress. It then seamlessly integrates this into an EMR, like WebABA. When using these tools, sending a patient progress report to an insurer is as simple as pressing a button.
Specialized Claims Support
ABA insurance claims support ranges all the way from using an EHR to auto-populate CPT codes and claims data, to partnering with a medical billing clearinghouse to “scrub” claims and ensure they’re free of errors, to dedicated assistance from specialized medical billers and coders.
The key to choosing the right claims support is working with a flexible partner who can tailor their input according to your needs. That way, you can ensure that specialized claims support results in a net financial positive for your business.
At Therapy Brands, we provide the full suite of ABA practice management and RCM software, so you’re sure to find a combination of products that meet your exact needs.
Online Patient/Parent Portal
Understanding how to bill insurance for ABA therapy looks after the claims and reimbursement side of things, but there are still copays and patient contributions to consider. And when you’re busy delivering therapy all day—the last thing you want to do is spend time sending out invoices and manually collecting payments.
The secure parent portal in WebABA allows you to securely send an automated invoice to patients and parents, which they can then pay by credit card online. They can also view appointments and statements of accounts, so there’s never any confusion about when sessions have taken place and what has been paid for.
Advanced Reporting Tools
Keeping track of KPIs and the financial health of a BCBA business can be very time consuming, but it’s essential to avoid cash flow and profitability problems.
The difficulty is, most practitioners have a hard enough time keeping up with delivering therapy and submitting insurance claims—let alone monitoring the overall financial health of their business.
Fortunately, when you use purpose-built ABA RCM services, like those offered by Therapy Brands, keeping track of things like claims denial rates, unpaid invoices, delayed reimbursement, and the profitability of specific services is a breeze. In most cases, these reports are available with the click of a button, giving you real-time data in an instant.
An All-In-One Solution
With increasing rates of Autism and neurological disorders in the US, there is an urgent need to improve access to ABA for those in need.
And unfortunately, due to the overly complex rules and processes around how to claim insurance for ABA therapy, many practitioners use clinical time to manage claims and billing.
This isn’t just bad for clients—it can also decrease your overall revenue.
While it’s no substitute for having a greater pool of BCBAs to meet client needs, intuitive, all-in-one practice management and RCM services like WebABA, can help clinicians take back time from administrative tasks, to reallocate it to patients.
To see how WeABA can help your practice today, sign up to start your free trial.