As an ABA therapist taking on a new patient and helping them get started on a journey toward living their best life can be exciting. It can also feel challenging when you take into account how much information needs to be gathered and organized as part of the in-take onboarding process.
The truth is onboarding can be a potentially cumbersome and time-consuming process for both you the ABA therapist and the patient. This starts with gathering some of the critical information, such as documenting the “Medical Necessity” that is required by many insurance providers as well as public health institutions. While it’s important to check off these boxes for all the potential payers, it is just the tip of a much larger iceberg. Especially in complex cases, or one where the patient has considerable needs.
Any errors or missing information in the onboarding process can ultimately show up later in the coding and medical billing process. Errors and this level can lead to claim rejections, claim denials, and other issues that can both cause delays in your revenue stream as well as prevent the patient from making the most out of the ABA therapeutic services you offer.
Key Information In The Intake Process
When you stop to think about it, there are a lot of key pieces of information that need to be gathered in the onboarding process for a new patient. Some are initiated during the scheduling process, and others are collected during the earliest stages of the assessment. While some are critical and delineate the salient need for a “Medical Necessity” others factor into the ABA treatment plan you develop to meet your patient’s needs.
This includes collecting the following information or data
- The patient’s key demographics
- The patient funding information
- A copy of all insurance cards
- Signed consent for services form
- A signed financial agreement or consent form
- A HIPAA Policy Consent form
Organizational forms that might be required by a payer or public health institution
- A signed Attendance Contract
- A clearly worded “Letter of Engagement”
- A consent for Handbook or provider policies, when applicable
- In-Home therapy Survey, if necessary
- A signed Observation or Video Release form
- A signed consent to release information to a third party
- Consent forms to release information to physician, school, or another institution
- Prior authorization information and approval is necessary
Key Information For Prior Authorizations
It’s also worth bearing in mind that you might also want to obtain the following information before the initial evaluation. The following documents are often required by insurance providers as part of the prior authorization process.
- An updated diagnostic report
- Individualized Education Plan or IEP
- Any relevant reports from other providers previously or currently in services
- A referral or script from primary care or diagnosing physician
Information For Payers & Public Health Institutions
Every organization needs to create its intake and consent paperwork tailored to its in-house onboarding process. Though you always need to be mindful to refer to state and federal guidelines to meet requirements as part of their own payer infrastructure regulations. Many public health institutions and government-sponsored agencies tend to prefer paper documentation that is mailed or emailed. Any electronic documents will need to be printed, or information can be submitted through the EMR systems or located in an online website portal.
Many of these institutions require additional components which you may need to include when seeking prior authorization or as part of the claim submission process. This includes things like:
- The Patient’s Demographics
- A thorough history of diagnosis including the diagnostic provider, date, and location
- Any applicable Parent/Guardian(s) contact information
- The Primary Care Physician’s contact information
- The Patient’s Medical History
- A listing of past and current prescription medications the patient is taking
- Any related history of seizures
- Any recent surgeries or major medical history
- Any and all known allergies
- All other services currently receiving or previously received
- Any past or current counseling or psychiatry
- Any need for speech therapy, occupational therapy, or physical therapy
- Early Intervention services rendered for the patient
- Other relevant services
- The Patient’s Developmental History
- All Relevant Family Medical History
- Any Behavioral Health History
- Academic and other Educational History
- Noted Problematic behaviors
- Key nutritional concerns that might affect symptoms or treatment
- An updated self-care history
- All verbal of language concerns in the patient’s history
- The patient’s social skills background
- The current family living arrangement background
- Past home environment concerns
- The current parent/guardian status
- Any siblings or notable extended family members
- The patient’s cultural or religious background
- Any noted parental concerns or preferred goals for their child
Personal Patient Information To Collect
With some patients, especially those who are receiving ABA therapy and other treatments at home additional personal preference information might need to be collected during the intake process, or early in the initial evaluation and assessment. This includes things such as:
- The patient’s daily routines and schedules
- Other in-home therapeutic services and schedule
- The patient’s preferred items or comfort items
- The presence of an emotional support or therapy animal
- The patient’s preferred activities
- The patient’s nutritional needs and preferences
- Any prioritized personal items or toys
- The patient or caregiver’s access to technology
The Benefits Of Third Party Coding & Medical Billing In The Intake Process
The amount of information that an ABA therapist needs to collect during the onboarding process can feel understandably staggering. Especially when it comes to information needed to meet the requirements of insurance payers and public health institutions. Compounding this concern is the fact that any missing or incorrectly entered information can interrupt the early stages of the therapeutic process, which are so critical toward a patient meeting their ABA therapy goals.
That’s why so many ABA therapists recruit third-party medical billing and coding specialists like Operant Billing Solutions. Our specialists have years of experience working with payers and ABA providers throughout the industry. Their trained eye can spot any missing or incomplete information to make sure the updated information or data is included for things like prior authorizations or claim submissions. This lets you focus on treating the patient and creating a customized treatment plan, while we handle the nuts and bolts details of the intake process.
