Denied claims and repayments can take a toll on your profits and negatively affect your reputation and trustworthiness. The Government Accountability Office reports that 25 percent of claims get denied. Industry standards reveal that emergency medicine denial rates are two percent on average for hospitals and around five to ten percent for other medical practices. If they happen frequently, it’s time to examine the reliability of your ABA coding procedures.
How ABA coding is different
ABA billing codes significantly changed in the last 10 years. The initial codes were undefined and resulted in unreliable reimbursement and coverage. As a result, the AMA established Category III codes to standardize a set of ABA CPT codes. Currently, there are eight Category I CPT Codes for Adaptive Behavior Services, which became effective on January 1, 2019.
How ABA coding should be done
Your clinical and billing teams should clearly understand the Category I ABA codes to accurately document and bill for services. To save time and reduce overhead costs, you may consider hiring medical coding companies. It’s also a way to improve denial management in medical coding. They have the training and up-to-date knowledge of policies to ensure accurate billing every time.
3 ways it decreases denials
1. Ensures complete documentation
Outsourcing ABA coding to a qualified company can prevent missing documentation about the case.
2. Identify payer issues
Sometimes, the issue is not on your end but the payer. Knowing the correct ABA billing codes makes you more confident in your data and may help dispute issues with the payer’s working system or framework.
3. Improve doctor documentation
Medical coding companies can discuss documentation protocols with physicians who may need help. Their intervention helps doctors make better decisions with their documentation and be more open to data to improve precision.
Proper coding can improve denial management in medical coding and increase revenue. However, it should prioritize staff education, performance tracking, and establishing a standard process for identifying and following up on denials.
Plutus Health offers revenue cycle management services that are HIPAA-compliant. We have medical coding experts to help with ABA coding and denial management.