When health insurance and government programs first acknowledged ABA therapy, there were no billing codes specific to it. As a result, many therapists experienced a confusing claims process that led to delays or denials for clients. Now, with 16 CPT codes available for ABA, the process has become easier, but it still involves many steps and can be complex to manage without the support of purpose-built ABA RCM services. Simple clerical errors such as missing or submitting illegible documentation can lead to a claim being rejected, which results in lost revenue. Find out: operantbilling.com
ABA Medical Billing: Reducing Errors and Increasing Revenue
In addition, maximizing reimbursement requires understanding the rules and procedures that vary based on whether an ABA provider is in-network or out-of-network with a specific payer. In-network providers have a contractual agreement with a specific insurer and therefore may receive higher reimbursement rates than out-of-network providers.
Lastly, ensuring the accuracy of ABA billing requires medical professionals to carefully track time spent on client care as well as accurately calculate service units. These data points are critical for ABA billing and help to demonstrate medical necessity. Without accurate and transparent records, medical professionals are at risk of being found in violation of the industry’s regulations. This can lead to harsh fines, a loss of medical licenses, and closure of clinics.
By partnering with a company like Plutus Health, ABA therapists can streamline their eligibility, billing, payments, and AR/denials processes. This way, they can focus on providing ABA therapy to their clients with peace of mind that the administrative side of their business is being taken care of.