Contracting vs. Credentialing ABA Therapy. What’s the difference? Which Comes First?
Contracting and Credentialing are critical components of any successful medical or psychological practice. It is especially important for small practices and Applied Behavioral Therapy practices. Though understanding the finer points of each, and which one needs to come first requires a little bit of a deep dive into some important details. What Is Credentialing? Credentialing plays a critical role in provider qualifications as well as reimbursement rates. Not to mention the licensing necessary to practice in most communities. It [...]
What Is The Birthday Rule For ABA Billing A Child’s Benefits?
Make sure you include Dual Insurance coverage - How do you determine which insurance plan is primary - Use the Birthday Rule Most insurance providers use a “Birthday Rule” as a key metric to efficiently coordinate a child’s benefits. In a case where a child is covered under both parents’ health plans, the birthday rule guides how the coordination of benefits works. The Birthday Rule is based on the primary coverage from the plan of the parent who has [...]
Top ABA Treatment Plan Items To Include For Maximum Payment
The term “Medically Necessary” plays a critical role in a lot of claims submitted to insurance companies, payer agencies, and public health institutions. Medically Necessary is broadly defined as “Health care services or supplies needed to diagnose or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine.” Medical Necessity Defined For ABA Therapy Service This large definition can be applied to medical healthcare services, diagnostics, and even mental healthcare therapy. In this [...]
Coordination Of Benefits In ABA Therapy. What Is It & Why Its Important?
ABA therapy is seen as the gold standard for treating individuals with Autism Spectrum Disorder, as well as many other serious mental health conditions. Many of these patients have a treatment support team that is overseen by a BCBA or similar expert in the ABA field. Of course, this also means that a lot of patients receiving ABA therapy need comprehensive coverage. Sometimes this can come from private or employer-sponsored insurance programs. Sometimes it comes from a combination of [...]
CAQH FAQ Guide For ABA Therapy Billing
A lot of ABA therapists and solo practitioners feel like they spend an uncomfortable amount of time working on paperwork and documentation when they would rather be focusing on their patients. The tedious nature of things like coding and medical billing documentation can rob small practices and solo ABA practitioners of too much precious time. In recent years CAQH has stepped up to help streamline these processes. Though how it works and how to become credentialed in their database [...]
Top HIPAA Violations ABA Therapists Should Be Aware Of
These days patient privacy is more important than ever. Especially in the mental health industry, where families, professionals, and individuals with autism spectrum disorder undergoing ABA therapy rely on a provider’s utmost discretion. The Health Insurance Portability and Accountability Act (HIPAA) was passed by the United States Congress in 1996 to ensure patient confidentiality. It specifically sets forth a series of critical regulations that impact providers of every discipline as well as health insurance companies. These regulations extend to [...]
How To Move Away From Manual ABA Billing
If you've been thinking about starting a new ABA therapy business as a solo practitioner or you have a thriving ABA therapy practice and you want to bring it fully up to the speed of 21st Century business, then you need to abandon the outdated paper or pencil form of documentation. This is an essential step toward a lot of other important innovations. Not the least of which is streamlining your medical billing practices for decreased errors, as well [...]
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 [...]
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, [...]
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 [...]
