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March 19, 2024

Streamlining Cashflow for Your ABA Practice with ABA Billing Services

Balaji Ramani has more than 20+ years of experience in Healthcare Revenue Cycle Management. Balaji has expertise in building, training, mentoring, and managing end-to-end healthcare RCM teams. He has experience using the Web for information sourcing, research & analyses to enable ‘patient and payer satisfaction’ in the healthcare space.

ABA Providers Recover Dues From Patients To Efficient Your Account Receivables

In this article:

Applied Behavior Analysis (ABA) therapy, used for treating autistic individuals and other developmental disorders, is a science-backed treatment process. This treatment helps the affected patients learn new social skills, address behavioral challenges, and improve attention.

However, clinics providing ABA therapy encounter several challenges, particularly those threatening today's healthcare industry. The billing process is complex, so it's imperative to use robust ABA therapy billing software. Other challenges include increasing demand for ABA therapy and financial pressure.

In this blog, you will learn how sophisticated ABA billing solutions can enhance such treatment practices and streamline the cash flow to overcome these challenges.

The Growing Demand for ABA Therapy

The Centers for Disease Control and Prevention (CDC) released its latest Community Report on Autism in 2020. This report reveals that around 1 in 36 cases, accounting for 2.8% of 8-year-old children, were diagnosed with ASD in 11 communities in the US. Besides, the prevalence of other conditions like attention deficit hyperactivity disorder (ADHD) has risen in recent years. These conditions can also benefit from ABA therapy.

With the demand for this treatment rising, healthcare clinics look out for advanced ABA billing software. Besides managing billing, some of the other challenges include:

  • Hiring qualified staff and retaining them
  • Ensuring high-quality service and compliance
  • Appointment management
  • Handling the billing process and collecting payments

What makes ABA billing a complex process?

The prime reason behind hiring an ABA billing specialist is the complexity of the billing process. The procedure involves several steps, which have been outlined below.

  • Different licensing requirements: At the outset, the licensing requirements vary from state to state. Thus, ABA therapists encounter logistical challenges when they practice in multiple states.
  • Varying insurance requirements: It's worth noting that insurance requirements like claim submission procedures, modifiers, and billing codes vary significantly across players and states. This can lead to errors or confusion among the practitioners.
  • Varied Medicaid programs: The state runs Medicaid programs, encompassing different rates and rules for ABA therapy. This calls for a thorough understanding of the Medicaid program in each state.
  • Explicit billing codes: In some states, practitioners come across explicit billing codes necessary for ABA therapy. These codes may vary from the standard CPT codes necessary for ABA medical billing.
  • Documentation and justification: Providing ABA therapy involves detailed documentation and formalities. Insurance providers understand the treatment's necessity, importance, and impact. However, extensive documentation processes turn out to be time-consuming and tedious. This consumes valuable time and resources from the core functions of the practitioners.

Considering these challenges, practitioners often outsource the billing tasks.

ABA practices and financial challenges

Billing issues involved with ABA practices can also be financially demanding. For instance, claim issues can lead to loss of revenue for the practitioners. Here are some of the common cash flow challenges associated with ABA practices.

  • Denial of claims or delays: Different issues can lead to claim denials or delays. These include coding errors, missing or wrong information, payer policies, or the lack of authorization. This can result in delayed or reduced reimbursements, affecting the cash flow significantly.
  • High accounts receivable (AR): Account receivable is the amount of money that clients or payers owe to ABA practitioners. A high AR points to poor medical billing performance or inefficiency. Besides, it can affect the profitability and cash flow of ABA practices.
  • Low rates of collection: Collection rates refer to the percentage of billed charges that clients or payers transfer to medical professionals. Low collection rates mean that ABA practices are not getting timely or full payments. It can affect the cash flow and revenue, too.

Healthcare organizations can adopt certain strategies to overcome these issues. These include:

  • Pre-billing audits: One of the proactive ways to address these financial concerns for ABA practitioners is to carry out pre-billing audits. This ensures that the claims are accurate and compliant before practitioners submit them to their clients. A foolproof audit ensures that the errors, discrepancies, and gaps are identified and eliminated.
  • Real-time access: Access in real-time refers to the ability to access the billing software and update the revenue cycle data and information from any device and location. The best ABA billing companies use sophisticated software and tools to ensure real-time access.
  • Sophisticated billing software: Successful practitioners and healthcare organizations use sophisticated ABA billing software to streamline the billing and revenue processes through automation. Thanks to advanced analytics, they can identify potential issues, provide feedback, and generate reports.

What are the benefits of ABA billing services?

With outsourced ABA billing solutions from specialized service providers, ABA practitioners can enjoy several advantages. These include:

  • Saving time and resources
    Billing for ABA services can be a tedious and time-intensive process. It involves a lot of expertise and attention. Outsourcing ABA billing ensures that professionals can free up their time and resources. This way, they can focus on their core competencies like training staff, providing quality therapy, and expanding their services. ABA RCM solutions make the billing and handling tasks efficient and accurate. This mitigates the administrative burden and overhead costs for ABA practices.
  • Boosting cash flow and revenue
    One of the key perks of ABA billing services is that it helps practitioners increase their cash flow and revenue. Professionals can benefit from accurate and timely claims submissions, which, in turn, can reduce denials and rejections. Advanced software also sends reminders to follow up on unpaid or underpaid claims. Besides, these services provide updated reports and insights into the billing performance to identify possible opportunities for improvement.
  • Compliance and security
    With ABA billing solutions, practitioners can ensure security and compliance with ABA billing norms. These include the Affordable Care Act (ACA), the Health Insurance Portability and Accountability Act (HIPAA), and guidelines specific to payers. Besides, ABA billing practices help therapists protect their information from unauthorized access, loss, or theft. The data remains secure through advanced encryption, backup, and recovery systems.
  • Better customer satisfaction
    Collaborating with an ABA billing company ensures better customer satisfaction and service. They can access accurate and transparent billing statements that answer all their queries and resolve potential billing issues.

ABA billing companies also help therapists discuss important issues with their customers. These may include deductibles, copayments, insurance coverage, or other matters related to billing. It ensures that the clients understand the financial responsibilities and agree with the same.

How important are efficiency and automation?

For ABA practices, the challenge is to streamline operations and curtail costs. They need to optimize their workflows and processes, eliminate inefficiencies and redundancies, and boost their productivity. You can automate processes and functions with efficient ABA billing software, as explained below:

Insurance verification: ABA billing software can automatically verify insurance eligibility, benefiting clients before they seek the service. This goes a long way in avoiding claim rejections and denials stemming from the lack of coverage or authorization.

Coding and documentation: One of the prime benefits of using ABA billing software is to validate the right codes for the services delivered. Besides, it can help practitioners maintain and access the required documentation for every service. These include treatment plans, progress notes, and letters of authorization.

Claim submission and tracking: Thanks to advanced ABA billing solutions, you can automatically submit claims and track their status for various clients. Besides, these tools alert therapists of any issues or errors affecting payment or claim processing.

Payment posting: Today, most successful practitioners use these tools as they automatically post and reconcile client payments. It also helps ABA practices identify discrepancies and resolve underpayments, if any.

Analytics and reporting: ABA practice management using modern software involves the automatic generation of different reports and analytics. These reports help improve billing performance and financial health. For instance, the software reports KPIs like collection rates, AR aging, denial rates, and revenue earned per visit.

Therefore, efficient and automated ABA billing tools can save time and money while reducing risks and errors. Practitioners using such tools can focus more on their core competencies and deliver quality care to their clients.

Understanding ABA Billing Processes, Codes, and Regulations

To make the most of ABA billing services and solutions, ABA practitioners must also understand the ABA billing processes, codes, and regulations. This can help them communicate and collaborate effectively with their billing partners and ensure the quality and compliance of their services.

Here are some of the key aspects that ABA practitioners and providers need to know and follow:

  • Billing processes: ABA billing involves several steps, such as verifying insurance eligibility, obtaining authorizations, coding services, submitting claims, tracking payments, and managing denials. Each step has its requirements and challenges, and ABA practices must follow them carefully and accurately to ensure successful billing outcomes.  
  • Billing codes and modifiers: ABA billing requires using specific codes and modifiers that describe the type, level, and duration of the services provided. ABA practitioners should use the appropriate codes and modifiers for their services to ensure they are reimbursed correctly and fairly. For example, ABA practitioners should use the Current Procedural Terminology (CPT) codes designated for ABA services, such as 97151, 97153, 97155, and 97156. They should also use modifiers as per the provider degrees and/or recommended by their payors such as HM, HN, HO, etc.
  • Billing regulations: It is important to note that ABA billing is subject to various regulations and policies of different payers and regulators, such as Medicaid, Medicare, and private insurers. These regulations and policies may vary by state, region, or plan and can change over time. As an ABA practitioner, you must know your practice's and clients' billing regulations and policies.

Some of the common ABA billing regulations include the Health Insurance Portability and Accountability Act (HIPAA), the Affordable Care Act (ACA), and payer-specific guidelines.

Get ABA therapy billing software to stay ahead of the curve

In this competitive industry, ABA therapists should look to stay ahead of the curve with effective billing software solutions. These tools go a long way in optimizing different aspects of ABA practices, including:

  • Scheduling appointments
  • Staff management
  • Payroll management
  • Client management
  • Seamless communication
  • Quality and Compliance

The top-notch RCM solutions company, Plutus Health, leverages state-of-the-art software like ArtemisABA. This cloud-based platform automates tasks and provides real-time insights into your billing performance.

Success stories and role of Plutus Health

Hundreds of ABA practices successfully streamline their billing processes by outsourcing the billing services to Plutus Health. As an established player in the industry, its experts and certified specialists are veterans in the ABA domain. They possess a comprehensive knowledge of the regulations and everything you may be concerned with.

They provide ABA billing solutions for companies of all sizes. For a large-sized ABA service expansion client, Plutus Health deployed advanced analytics solutions, reducing denial rates to less than 5% and boosting reimbursement to 98% of monthly charges. With days in AR reduced to approximately 21 days, our tailored interventions ensured timely follow-up. This significantly mitigated the risks of adjustments due to delayed filing.

Plutus Health partnered with an ABA therapy practice facing high denials and aging AR claims. We carried out a thorough denial trend analysis to identify key payer issues. After implementing corrective measures, we reduced denials from problematic payers by 41.6% in just 50 days. Consequently, the practice experienced a remarkable 23.3% increase in overall cash flow and a 33.2% reduction in 90+ AR days.

Have a look at the comprehensive range of services Plutus Health provides:

  • Pre-billing audits: We can help you stay ahead of insurance audits thanks to our proactive approach. We carry out thorough audits before billing, which reduces the risk of denials.
  • Payer audits: Our specialists will guide you over payer audits. The steps involved in the process include reviewing documentation and recommending necessary modifications. After contacting the payer representatives, we follow up with them so that you achieve the desired clearance level.
  • Monitoring payments: At Plutus, we have over 1,000 experts constantly monitoring payments and managing the revenue cycle against contracts. This helps prevent underpayments so that you get the right compensation for your services.
  • Priority A/R Management: We take care of your accounts receivable on priority. This ensures timely and efficient management so that your cash flow remains healthy.
  • Fast resolution of denials: We address instances of denials with a stringent timeframe of 72 hours. Swift denial management ensures minimal disruptions to your revenue system.

Outsourcing ABA billing to Plutus Health is about more than just saving money. Practitioners can save their precious time and resources as experienced professionals handle the financial challenges. Focus on your core competencies, as your patients expect exceptional care in a demanding industry. Reach out to the ABA billing company to streamline your operations.

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Balaji Ramani

Balaji Ramani has more than 20+ years of experience in Healthcare Revenue Cycle Management. Balaji has expertise in building, training, mentoring, and managing end-to-end healthcare RCM teams. He has experience using the Web for information sourcing, research & analyses to enable ‘patient and payer satisfaction’ in the healthcare space.