This case study will demonstrate how Therapy Brands’ RCM services have unraveled complex billing and revenue collection methods to create an efficient and seamless process for healthcare agencies. This is especially true amongst the growing Applied Behavior Analysis (ABA) community, as one ABA organization, Autism House, has experienced firsthand.

Autism House provides behavior analytic services to children diagnosed with developmental and learning disabilities. Autism House was created with the mission to provide a fun and supportive environment for children to learn while participating in ABA therapy. An instrumental piece of providing any health care service, such as ABA therapy, is to ensure timely and accurate medical billing. These processes need to work seamlessly to avoid lapse in service or other serious financial losses. RCM services appear to be the most intuitive decision an ABA organization can make to safeguard their business.

In-House Billing Challenges

Prior to 2017, Autism House had managed their medical billing process in-house. In the beginning phase of a start-up ABA business, it seems to be the right move to keep the overhead cost down. However, it can quickly become a formidable task and actually wind up more costly, as Autism House has experienced. Autism House reached out to Therapy Brands in April 2017 to learn about their Revenue Cycle Management (RCM) services after some billing challenges were encountered. Some of these challenges included things such as:

• denied medical claims
• inaccurate and delayed accounts receivable reports
• incorrectly utilizing billing code modifiers
• rates entered incorrectly into NPAWorks

While one or two of these errors occurring occasionally wouldn’t hinder the financial stability of an agency, frequent errors for extended durations across all the abovementioned categories could potentially result in detrimental financial repercussions.

Seeking Solutions to Seamless Revenue Management

Autism House was proactive with their approach to tackle billing complexities head-on by deciding to locate a reputable Practice Management Software provider to support with vital billing processes. The leaders of Autism House knew taking this step would assist in increasing financial stability and the longevity of their ABA business for many years to come. Inevitably, this is what led the leaders of Autism House to Therapy Brands. Eager to get started, both teams quickly connected and scheduled the exploratory meeting to discuss the benefits of using Therapy Brands’ RCM services.

After learning of the billing challenges brought forth by Autism House, Therapy Brands’ dedicated Account Manager went straight to work. To start, the Account Manager identified errors with billing codes and specific modifiers and quickly had those errors remediated. Account receivable (AR) reports were previously inaccurate due to billing errors with reimbursement rates and fee schedules, which resulted in more costly tax returns as proper deductions were not accounted for. The Account Manager quickly recognized these errors and personally worked with Autism House’s accountant to rectify claims and resubmit their taxes to which reportedly resulted in a sizable return. Other principal aspects of RCM services and benefits offered by Therapy Brands, and their Dedicated Account Managers include:

• quick turnaround of insurance verifications

• accurate and efficient claims submissions, including missed and/or corrected claims

• adhering to individual funder’s billing policies and guidelines to avoid denied claims

• proper use of clinical codes and modifiers

• accurate clinical notes and documentation of services rendered

• available to provide live support as needed

• once per month account receivable (AR) report provided

• frequent and consistent communication regarding any updates related to funder billing policies and guidelines

Statistical Overview

The chart below depicts the average revenue increase from the baseline in 2017 when Autism House began their partnership with Therapy Brands.

The results depicted in the chart demonstrate the success Autism House has experienced over the past 4, almost 5 years, since beginning their journey with Therapy Brands and their personal Account Manager. Something even more commendable is the fact Autism House not only weathered the COVID-19 storm, but also managed to keep their revenue growth increase up by 50% of their initial baseline levels averaged in 2017. During a time when many ABA companies and other small businesses around the nation had to close their doors, Autism House was fortunate to have access to their Dedicated Account Manager.

“It’s been great; lots of communication [and we] always have a good turnaround time. [We] are not left waiting and wondering what happened to this or that. [There is] less anxiety and worry if you know you have a dependable person you can contact about your billing (recorded interview, 2021).”