ABA (Applied Behavior Analysis) therapy is one of the most effective methods of treating patients with detrimental behaviors that hinder learning. This includes individuals on the autism spectrum, or who have developmental or behavioral concerns. However, since ABA is such an intensive practice that often requires time and effort to modify the program to suit the patient’s needs, it may be difficult for practitioners to find the time to spend on proper ABA insurance billing. Here are 4 ways to save time on ABA insurance billing:
As an ABA therapist, you would not want to be caught in a situation where you realize your patient’s insurance plans turn out to be unable to cover applied behavior analysis therapy. With every new patient, you should be mindful to check if you are permitted to receive reimbursement from the insurance company for your services.
In the process of checking your patient’s insurance coverage, also note that different areas may subscribe to different regulations; Some states such as Delaware, California, and Maryland may have age restrictions to take into consideration. Other states like Florida may have coverage limits for the total costs of services per year or lifetime. Being familiar with your state’s regulations for ABA therapy coverage will greatly help in the process of accepting new patients.
Although many patients are covered by a plan which allows them to receive treatment from any doctor or therapist, some patients have plans that only cover PPOs (Preferred Provider Organization) or HMOs (Health Maintenance Organization). For these policies, the patient must go to a preferred provider, also known as an In-Network Provider for them to be able to claim payment.
In order to become recognized as an In-Network Provider ABA therapist, you will need to sign a contract with the health insurance carrier and provide services to patients at a negotiated rate. In return, you get access to a stream of patients who only go to therapists that are on the insurance company’s preferred provider list.
Submitting a claim is usually a very systematic procedure that would definitely benefit from having an organized system to deal with claims submissions and billing. This will reduce the risk of claim rejections and denials.
Insurance companies generally have their own specific claim forms that need to be properly completed. These include the correct documentation such as medical coding and patient information. Hence, you should keep yourself updated with the latest Current Procedural Terminology (CPT) codes regarding ABA therapy services.
To be credentialed is to have your ABA therapy practice recognized by insurance companies. Insurance carriers usually have their own procedures and criteria for ABA therapists to meet before they will pay for ABA therapy by that practitioner. Usually, this requires important documents to be submitted, such as your medical licenses, education records, and your CV.
The credentialing process which includes the verification of your medical practice may take a while to go through and you may need to wait a whole month before approval. Therefore, it is recommended that you get credentialed with major insurance providers beforehand, which would make it easier to accept new patients.