Billing code errors can cause a major interruption in your practice’s revenue stream, leading to delays and potential claim denials. Making yourself aware of the common causes of billing errors will go a long way toward implementing protocols and procedures to prevent them from happening in the future.

Procedural Issues That Can Cause Billing Errors

The following are common procedural issues that can occur in-house, which increase your risk of experiencing claim denials and delays in your practice’s revenue stream.

Not Verifying A Patient’s Insurance Coverage

Coverage for ABA therapy can vary from one insurance company to the next. Oftentimes patients are not aware of their ABA therapy coverage, and merely assume that all aspects are fully covered. This can later lead to a claim denial or a claim rejection for a new patient or one who has recently changed coverage policies. Whenever possible, your staff should take the time to double-check the patient’s coverage as part of the scheduling process. This simple coverage verification will make sure that their maximum benefit cap hasn’t been met.

Incorrect Patient Identification Information

Typos and incorrect data entry errors are an unfortunate reality for many different medical practices, especially ABA therapy practices. Sometimes something as simple as a misspelled name, incorrect date of birth, or a policy number error can easily lead to a claim denial. Accuracy training and routine spot-checking for accuracy will help foster a detail-oriented data entry process, while also helping to reduce simple errors. It will also go a long way toward ensuring that the Primary insurance information is correctly noted, including any group numbers.

Duplicate Billing

Duplicate billing and duplicate record generation caused by human error is an all too common medical billing mistake leading to claim denials and general delays in your practice’s revenue stream. Accidentally resubmitting a claim without careful follow up with the insurer is a common error. So is a canceled session or some type of testing without removing it from a patient’s claim can also be treated as a duplicate billing error. You can help prevent this by encouraging your administrative staff to implement a system that includes proper coding of services as well as all the applicable modifiers. This will go a long way toward catching potential duplicates and other suspicious entries before they are submitted to the insurance provider.

Failing To Meet The Deadline For Submitting A Claim

Many insurance providers have a deadline set in stone for when you can file a claim for services rendered. Even if the claim itself is properly documented and accurately filled in, it can still be denied if it isn’t submitted within the deadline window. Some payers offer a forgivingly large window, such as Medicaid which allows a full calendar year to submit a claim from the day of service. Yet most private insurance providers might only allow a 60 to 90-day maximum window to file a claim on the patient’s behalf. As a point of internal policy, you should double-check the deadline windows with each insurance provider you work with, and always check with a new provider should you encounter a new type of policy.

Failing To Obtain Referral Authorization

When it comes to specialty services like many of the treatment processes in ABA therapy, an outside referral is required by insurance providers before care can be provided under the stated coverage. This can vary from one insurance provider to the next. It’s best to understand coverage and referral policies. Then make sure that all pertinent referral information is included when you submit the claim to the payer. This is typically a referral directly from the primary care physician or perhaps another specialist providing care for the patient, who feels that ABA therapy will improve treatment outcomes.

Illegible Handwritten Documentation

The old adage about the unreadable doctor’s handwriting is not a joke. Sometimes something as simple as poor penmanship can lead to coding errors later on when the data is entered. This could be as simple as treatment notes that are misinterpreted by the data entry personnel, or something like inadvertently assigning the wrong CPT code. When this misinterpreted information is entered into the patient’s claim, the insurance provider might deny coverage, seek further information or other means which cause a delay in the payment process. The end result of poor handwriting could ultimately interrupt your revenue stream.

Entering Incorrect Codes

The medical billing and coding system can sometimes be complex. Especially with some of the newer codes flooding the industry. Sometimes following the current CPT system can be a bit complicated. It can be especially challenging for inexperienced coders, or solo practitioners who don’t specialize in medical billing coding. Sometimes something as simple as an outdated codebook can lead to inputting the wrong CPT codes, or point of service codes, incorrect treatment codes, or diagnostic codes. Any one of these simple errors, can all lead to the patient’s claim being denied by their insurance provider.

Tips For Implementing A System To Prevent ABA Therapy Billing Errors

There are several things you can do to help prevent ABA therapy billing errors. When set up as an in-house policy with your administrative staff it can go a long way toward maintaining a consistent revenue stream for your practice by reducing claim denials and other potentially costly delays.

Verify Patient Insurance Information

This should be a standard procedure as part of the patient intake and scheduling process. It includes validating policy numbers and confirming coverage with the patient’s insurance provider.

Coordinate With The Provider & Your Medical Billing Staff

Many small to medium ABA therapy practices have an administrative team who are responsible for ensuring that information is being handled properly and being passed along correctly. Assigning an individual to compile the information stream will help streamline every step of the process.

Encourage Staff Training & Continued Education

Medical billing codes are always in flux. Making sure that your staff periodically is trained on new codes and procedures will go a long way toward preventing errors, as well as catching medical billing errors before they are submitted to the patient’s insurance provider.

Spot Checking Policies

Spot checking claims periodically, before they are submitted can help catch an error. It also develops a greater sense of accountability in your administrative staff.

Follow Up With Insurance Providers

Set a standard timetable for following up with insurance providers on a set number of days after submitting a claim. This proactive approach will help catch errors and answer questions when there’s a potential problem.