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March 15, 2022

Top ABA Claim Denials and How to Avoid Them

by Plutus Health
Essential Tips for Handling Cardiology Medical Billing and Coding

Getting credentialed by an insurance provider doesn’t automatically translate to smooth ABA billing. Denials may still occur due to different reasons. Understanding the top causes of ABA denials can help you identify if your practice needs to make improvements and take steps to avoid them. Here’s a quick list:

Expired eligibility

ABA claims can be denied if the patient is not enrolled or ineligible to enroll. Some patients are unaware of their enrollment status until they see their practice. Sometimes your billing team could also make a mistake and put patients under insurance plans where they may not be enrolled. Using a dependable and proven practice management solution will help you manage your billing and avoid these problems as it tracks prior authorization and conducts eligibility management.

Improper coding

ICD-10 coding issues are among the most common reasons for ABA denials. Practice must be specific with its coding and ensure accuracy. The codes are updated now and then, and practice needs to keep up with them to avoid claim denials. The most recent CPT codes for ABA billing became effective in January 2019.

Missing or inaccurate client information

Small mistakes like misspelled names or a wrong initial can negatively impact your practice’s ABA billing process and result in claim denial. You should ensure sufficient and correct information on your applied behavioral analysis.

Late filings

Most ABA claims must be submitted within a specific period after rendering the services; else the claim will be denied. So, be sure to file insurance claims promptly and consider using billing software that can help you meet deadlines.

Plutus Health is an expert in managing and resolving ABA denials. We provide ABA billing and custom RCM solutions to help you overcome your practice’s challenges in revenue flow. Our dedicated in-house team of eligibility, payments, billing and insurance experts will help you decrease your rate of rejections and denials. So, you can improve your failing cash flow and eligibility and pre-authorization processes.

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