Applied behavioral analysis therapy (ABA) practices often find themselves repeating the same traditional claim submissions formula that they were taught back at the university level. Though sometimes consistency can give an ABA provider a false sense of security against claim rejections, denials, and potential payer institution audits.
More than one ABA therapy practice that made a change in their claim submission practices found that their previous stagnation was directly contributing to a loss of revenue or unnecessary delays in their revenue stream. Oftentimes these instances were attributed to a general failure to adopt superior filing methods.
If this sounds like something you suspect is going on in your medical billing practices, or you’re just ready to break out of the old mold in search of industry-best practices, then you might want to read further.
Different Ways To File an ABA Therapy Claim
You might be surprised to hear that there are four generally accepted ways to file an ABA therapy claim. The one that might be best for your practice can vary depending on your scale, the size of your staff, and just how much you want to improve the turnaround time for claims in your revenue stream.
Yes, it’s true physical mail-in claims are still alive and well in the twenty-first century. You might be surprised at just how many practices are still using traditional physical mail to submit paper documents directly to a patient’s insurance carrier.
In a lot of these cases, they opt for certified mail to ensure prompt delivery to the payer or public health institution. Modern tracking systems also make it easy for them to confirm their submission’s current location and status at any time.
One of the great things about sending physical mail-in claims is that the payer institution is receiving verifiable hard copies that they can keep on file. It’s great for the first step of patient onboarding or to ensure long-term preapprovals for recurring medically necessary treatments.
The risk with mail-in ABA claims is that if an in-office staffer accidentally fails to attach necessary documents to physical submissions, it can cause massive delays in the claim approval process.
This means that physical mail-in claims tend to be the least time-efficient submission method. Especially if the system’s slow pace starts to cause delays in the collection process. Additionally, physical submissions are more likely to disappear than digital ones. Only use snail mail when the Payer offers no other alternative.
Online Digital Claim Submissions
One of the most popular methods for submitting claims is via online digital portals. These are sites that will inform billers and administrative staff of their formatting requirements. Pretty much all major insurance carriers have their claim portals. They are designed to be intuitive and easy to use, which is a major benefit for solo ABA practitioners and small practices where clinical staff is tasked with helping with the medical billing practices.
Though some insurance payer portals are graphically very similar. This can lead inexperienced medical billers to erroneously assume that all payers have the same standards and formatting requirements.
This simple assumption can lead to a lot of formatting mistakes, which in turn leads to a higher risk of claim rejections, claim denials, or questions, which can further slow the reimbursement process.
Submitting Claims Via a Clearinghouse
Some ABA practices require or feel that they would benefit from the additional layer of oversight that comes with submitting claims via a clearinghouse.
Under this model, the ABA practice submits the entire claims to the clearinghouse via a PMS or similar type of billing system. These systems are designed to allow the two organizations to network before a claim reaches the insurer.
At that point, the clearinghouse conducts its own rigorous review and will scrub the submitted claim thoroughly before transferring it to the insurance carrier or payer institution. If a payer happens to reject the claim, they might opt to send it back through the intermediary. At that point, the clearinghouse will charge a set fee regardless of the claim being paid or denied.
With this clearinghouse model of claim submission, you get the peace of mind that comes with knowing a third-party professional is scrubbing the claim for you. Though you’re also losing a substantial amount of potential revenue in the fees. Especially if there are multiple questions, due to errors on your part.
This also tends to be slower in terms of reimbursement flowing into your revenue stream compared to using an online digital portal. However, it’s still going to be faster than any physical mail claim submission.
Outsourcing to a Third-Party Professional Billing Service
One of the fastest-growing ways to ensure accurate claim submission and fast reimbursement to an ABA practice’s revenue stream is to use a third-party billing service like Operant Billing Solutions. You get the peace of mind that comes from knowing that highly trained medical billing experts are handling the filing process for your ABA practices.
We take into account patient notes, treatment plans, and documentation to create airtight, error-free claims that are submitted according to each insurance carrier’s preferred formatting. This greatly reduces the risk of errors, claim rejections, denials, and other delays that can affect your revenue stream.
Medical billing services also tend to use insurance payer’s online portals. This means you get the scrubbing and accuracy of a clearing house, with the scrutiny of true medical billing experts, at the speed and efficiency of using an online portal. All at a very small cost that dwarfs the often escalating fees that clearinghouses charge to scrub claims.
Mos ABA practices that outsource their claim submission and medical billing need to Operant Billing Solutions find that they can free up administrative staff. Solo ABA practitioners also tend to be able to allocate their time to treating patients, or even onboarding new patients. It’s a great way to reduce your patient wait list while maintaining an even more consistent revenue stream.