Role of technology in enhancing behavioral health billing services
Behavioral health billing is uniquely challenging. Mental health diagnosis codes make identifying mental conditions harder than physical ailments. So, insurers frequently deny claims in this sector due to insufficient eligibility verification.
Technology can help fix miscommunications between behavioral health payers and providers. By creating a seamless web of interconnected data, systems consistently transmit accurate information.
Here’s how machine-enabled billing services are boosting the behavioral health sector.
Automatic Check-ins
Patients must consistently enter accurate information to streamline the billing process. To achieve this goal, use automatic check-ins. These systems will walk patients through a questionnaire, ensuring that they enter every field before continuing. Before transferring the information, the program will allow users to review everything they’ve entered.
Get the most out of this setup by requiring patients to arrive at appointments 15 minutes ahead of time. For patients who sign up online, have customer service repeat some questions to establish accuracy.
Note Taking Technology
When practicing behavioral health, taking notes is critical. These observations are integral to forming a long-term patient improvement plan. Also, these recordings leave a verifiable diagnostic trail that supports claims. Note-taking technology embeds these observations into an easily reviewable program.
Eligibility Verification
Failure to establish eligibility is a key reason payers reject behavioral claims. Mental health diagnoses hinge on a physician’s judgment. As such, payers require credentialed pre-verification with accompanying documentation.
Some states have mandated that insurers provide coverage under certain conditions. These nuances, paired with insurers’ shifting standards, confuse many staff members. Thankfully, automatic programs can sort through a patient’s history and quickly determine eligibility.
Artificial Intelligence Coding
Modern artificial intelligence is sophisticated enough to sort through the thousands of codes in the ICD-10-CM coding system. Such programs excel at matching simple conditions and services with the appropriate number. Unfortunately, complicated scenarios still befuddle these AI. So, most practices assign experienced coders to review the software’s work.
Charge Entry
Charge entry is submitting figures to payers for them to reimburse. This step is critical, yet staff frequently mishandle it. A study of practices between 2016 and 2020 revealed how prevalent charge entry errors were. Researchers found that 17.2% of denied claims were rejected due to missing or invalid data.
AI systems can alleviate these mistakes by seamlessly copying patient data from registration portals. From here, they can take information from physician notes and patient charts to form an accurate, formal claim.
Incorporating technology is critical for behavioral health practices that want to improve RCM flow and maximum profitability. The easiest way to get this improvement is by hiring a professional biller. Plutus Health has built its service around pairing top-tier staff with top-tier technology. This combination has consistently improved practices’ incomes. Start your journey towards maximized reimbursements by contacting us today.
Key Takeaways
1. Automatic check-ins provide consistent prompts that help confirm accurate information.
2. Note-taking technology benefits claims by establishing a diagnostic trail.
3. Systems can quickly determine patient eligibility.
4. Coding AI excels at matching conditions and services with the appropriate code.
5. Software can create accurate claims based on limited information.
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FAQs


ABA providers are grappling with high staff turnover (up to 65%), rising burnout, administrative overload, and stagnant reimbursement rates. These challenges directly impact care continuity, clinical outcomes, and operational performance.


Operational inefficiency costs ABA teams up to 10 hours per staff member per week, contributing to burnout, denied claims, and longer accounts receivable (A/R) cycles. These inefficiencies ultimately result in reduced revenue and patient dissatisfaction.


Burnout leads to costly turnover, lower client retention, and decreased productivity. Recruiting and replacing a BCBA or RBT can cost up to $5,000 per hire, plus months of lost revenue and disruption to morale.


High-performing ABA organizations invest in clear career pathways for BCBAs and RBTs, align compensation with market benchmarks, and foster peer-led mentorship, flexible schedules, and wellness programs.


Automation tools like Plutus Health's Zeus streamline eligibility verification, denial management, and billing, reducing manual workloads by 5–10 hours weekly per clinician and improving clean claim rates by 95%.


Outsourcing revenue cycle management can improve collections, reduce denials by up to 30%, and free clinicians from billing-related admin tasks, resulting in better client care and financial outcomes.


One $200 million ABA network partnered with Plutus Health to automate eligibility and accounts receivable (A/R) processes. The result: $2M reduction in legacy A/R and a 97% Net Collection Rate.


By improving operational efficiency, investing in technology, and ensuring workforce stability, ABA leaders can align outcomes with reimbursement. Plutus Health supports this transition with scalable RCM and automation strategies.
FAQs


ABA therapy billing is the process of submitting claims to insurance or Medicaid for Applied Behavior Analysis services provided to individuals with autism or developmental disorders. It includes using correct CPT codes, proper documentation, and adherence to payer-specific policies.


Common CPT codes for ABA therapy in 2025 include:
- 97151 – Assessment and treatment planning
- 97153 – Direct therapy with the patient
- 97155 – Supervision and modification of behavior plan
- 97156 – Family adaptive training
- Always check with payers for any annual changes.


To bill Medicaid for ABA services, providers must ensure credentialing is complete, services are pre-authorized, and claims use the correct codes and modifiers. Medicaid requirements vary by state, so always follow state-specific billing rules.


Common ABA billing mistakes include:
- Incorrect or missing CPT codesplan
- Lack of documentation or treatment
- Uncredentialed providers rendering services
- Submitting duplicate or late claims


Without proper credentialing, providers can’t get reimbursed. Insurance and Medicaid require that BCBAs, RBTs, and organizations are credentialed and contracted. Delays in credentialing often cause revenue losses and claim rejections.
FAQs


CMS proposes a 2.4% increase in Medicare ASC payment rates, contingent on meeting ASCQR quality reporting requirements. Plutus Health helps ASCs meet these compliance benchmarks by integrating quality reporting data into RCM workflows, ensuring eligibility for full payment updates.


The ASC Covered Procedures List will expand by 547 procedures, including cardiology, spine, and vascular surgeries. Plutus Health supports expansion into new service lines by customizing RCM processes for high-acuity procedures, minimizing claim denials during the transition.


Site-neutrality narrows the payment gap with hospital outpatient departments, enhancing ASCs' cost-efficiency appeal. Plutus Health helps leverage this advantage in payer negotiations by providing performance dashboards and cost-justification analytics to secure stronger reimbursement terms.


Complex procedures increase denial risk and slow cash flow. Plutus Health's automation-first RCM model delivers 95%+ clean claim rates, reduces A/R days, and safeguards margins, even as your case mix becomes more complex.