Top Credentialing Related Denials & How To Avoid Them

Claim denials are one of the most common causes of inconsistent revenue streams throughout the medical and mental healthcare industries. Not only does it cause delays with incoming revenue, but many require a response to questions, or appeals, which further rob your thriving practice of valuable time that could be better spent treating patients. Of course, this also means that one of the top goals for any competent autism billing company, all healthcare providers, and administrative billing staff is [...]

By |May 3rd, 2022|Categories: Tips|Tags: |0 Comments

What Is the TRICARE Comprehensive Autism Care Demonstration?

Individuals with autism spectrum disorder typically need lifelong services to help them live their best lives. This typically starts in childhood, and there are many health plans and public health institutions that can help with the cost of providing critical services. Though in some cases the family and/or the child need to meet certain criteria. One of the most important options is known as the TRICARE Comprehensive Autism Care Demonstration (ACD). It specifically covers applied behavior analysis (ABA) services, [...]

By |April 30th, 2022|Categories: Tips|Tags: , |0 Comments

Code 97157, 97158 in ABA Therapy. How & When To Use Them

A Bevy of new CPT codes took effect on August 1st of 2021. Many beneficiaries are not eligible for these new codes until their next authorization period after that date. Two of the most common and critical codes affected include the following CPT codes. 97157 - multiple family group adaptive behavior treatment guidance 97158 - group adaptive behavior treatment with protocol modification This can include up to 8 families for up to 6 units, which translates into 1.5 hours [...]

By |April 28th, 2022|Categories: Tips|Tags: , , , |0 Comments

Retroactive Reimbursement Requirements For Credentialing

In many states, the law requires carriers to pay for covered services provided to the member during the credentialing process at the in-network benefit level and under the terms of the contract. To apply, the credentialing application must ultimately be approved by the carrier. Credentialing Requirements All health plans are legally required to use a database that is created and maintained by OneHealthPort/Provider Source for credentialing purposes. This includes non-delegated credentialing, where the medical staff services department of a [...]

By |March 6th, 2022|Categories: Tips|Tags: , |0 Comments

What is CPT Code 97151 for ABA Therapy?

After August 1st, 2021 all authorizations requested on or CPT code 97151, for assessment and treatment plan development, need to be authorized for up to 32 units. This translates into a total of 8 hours for an initial assessment, which is broken down into 24 units, comprising up to 6 hours for all subsequent authorization periods. Though it’s also worth noting that CPT code 97151 still needs to be conducted over 14 calendar days or less. This means that [...]

By |March 5th, 2022|Categories: Tips|Tags: , , |0 Comments

Federal No Surprises Act Explained. Consumer Protection Against Surprise Medical Bills

The federal “No Surprises Act” took effect on January 1st, 2022, which enforces a new set of balance billing requirements for providers as well as private insurance companies and health plans. Though there are several facets of this act that need to be understood. In some states like Washington, additional regulations might also apply. Though this starts with first asking and answering some important questions. What Is Considered A Surprise Medical Bill? Before the No Surprises Act was passed, [...]

By |March 4th, 2022|Categories: Tips|0 Comments

How To Start An ABA Therapy Practice: The Ultimate Guide

If you have a deep passion or calling for providing your community with specialized Applied Behavioral Analysis therapy services, and you have reached the point where you want to break out to start your own ABA practice, then this ultimate guide to starting an ABA Therapy practice is the perfect place to start. If you are a BCBA then you have likely had the chance to supervise behavior analysis as well as mentor other ABA therapy providers. Though when [...]

By |March 3rd, 2022|Categories: Tips|Tags: , |0 Comments

What Is Fee For Service vs Value Based in Healthcare?

Fee For Service or FFS is one of the most common payment methods in the healthcare industry. With this model, a healthcare provider, physician, therapist, or solo practitioner is reimbursed based on the number of services they provide. This includes therapy sessions and the application of specific treatments. Though it’s important to note that in an FFS model payments are not specifically bundled, which essentially means that the insurance provider, health institution, or the government payer agency needs to [...]

By |January 19th, 2022|Categories: Tips|Tags: |0 Comments

99211 CPT Code Use Case Scenarios For ABA Therapy

CPT codes play a critical role in medical billing. Using the wrong code in the wrong place or for an incorrect type of diagnostic or treatment process can lead to potential claim rejections and denials. Not to mention a very serious risk of delays in your practice’s revenue stream. One of the CPT codes that come under scrutiny by some insurance providers and public health institutions is the 99211 CPT code. Though knowing precisely when to use this 99211 [...]

By |January 18th, 2022|Categories: Tips|Tags: , |0 Comments

How To Prevent Burnout With Your BCBA / RBT Practice

Whether you are a Board Certified Behavior Analyst (BCBA), a Registered Behavior Technician (RBT) with years of experience, or you are new to the ABA field, chances are good you’ve heard people talking about feeling “Burned Out”. Of course, people working in Applied Behavior Analysis Therapy are well-known for experiencing this phenomenon. What Does It Mean To Be Burned Out? The Merriam-Webster dictionary defines “Burn Out” as “Exhaustion of physical or emotional strength or motivation usually as a result [...]

By |January 17th, 2022|Categories: Tips|Tags: , , |0 Comments