One of the most complicated aspects of running an Applied Behavioral Analysis (ABA) therapy practice is billing.
It can be a tricky process to get right and errors can lead to payment delays or claim denials. As an ABA therapy provider, your focus is caring for your patients, but you can’t run a practice without income.
You have to manage your revenue cycle effectively and preventing common ABA therapy insurance claim denials will ensure that your cash flow is optimized.
Common Reasons for ABA Therapy Insurance Claim Denials
You can’t completely eliminate insurance claim denials in ABA practices, but it’s possible to reduce their numbers, especially if you can avoid human errors. And since ABA treatment is mainly therapy-based, which is more subjective than other forms of medicine, the likelihood of claim denials is higher. Here are the top eight reasons for insurance claim denial.
Medical Necessity
Many insurance companies question whether the patient actually needS applied behavioral therapy as a treatment for an Autism Spectrum Disorder. To avoid a denial in this case, you should include more than enough documentation about the treatment in the claim. Document the diagnosis and all clinical notes to make denial more difficult.
Precertification Authorization
Most insurance providers require patients who want ABA services to get precertification authorization before starting therapy. If you provide therapy without precertification, the insurance company will immediately deny the claim. So, if you’re unsure about a particular company’s policy, it’s always best to check with them before your first session.
Out of Network Providers
It’s not uncommon for Insurance companies to change their provider networks, and patients might not realize it until after they’ve seen a doctor. Patients and their guardians might be too busy to check the insurance provider networks, eventually ending up with the wrong practitioner and having to pay out of pocket for appointments. Unless you’re 100% sure that your practice is in the insurance company’s network, check before providing treatment.
Incorrect Codes
One of the most common reasons ABA insurance claims are denied is using the wrong coding on the billing form. ICD-10 coding is a system that translates medical conditions and procedures into codes. So the code is used in claims processing, instead of writing out the medical procedure. If the ABA practice submits a claim with the wrong code, they can expect a denial. Keep in mind that the codes are updated regularly, so a practice needs to stay up to date to avoid improper coding.
Issues With Patient’s Plan
Every insurance plan is structured differently, including and excluding certain medical treatments, which allows people to sign up for the plan that suits their needs best. If ABA therapy is implicitly or explicitly excluded, the claim will be denied. This is usually the case for patients whose plans are not under the Affordable Care Act or patients with short-term health insurance plans and fixed indemnity plans. Also, some patients might not be eligible to enroll for ABA therapy treatments, causing the claim to be denied.
Inaccurate Client Information
Seemingly minor mistakes like not spelling the patient’s first and/or last name correctly will result in a denial. With missing or inaccurate client information, a patient’s claim can be denied. At least, claims that are rejected due to inaccurate information can be refiled, but this will cost the practice more money.
Duplicate Claims
One of the most common causes of denied claims is duplicate claims. An ABA practice might bill duplicate claims when the first claim shows signs of an error but eventually goes through. When the insurance company gets the second claim, they cancel both. Working with ABA billing experts and using appropriate software can prevent duplicate claims.
Expired Time Limit
Most insurers require the practice to submit the claim within a certain period after the services have been rendered. ABA claims submitted after the time limit will be denied. So, ensure that all insurance claims are filed promptly.
How to Prevent Claim Denials in ABA Therapy Insurance
If you are struggling with rejected and denied claims, here are a few things to keep in mind when submitting claims to insurance companies:
- Before providing ABA therapy, confirm that the patient’s insurance covers this treatment and does not require precertification authorization.
- Submit all information correctly and cross-check all details, including the patient’s name, date of birth, and age.
- Check the submission deadline for each patient’s insurance provider and submit the ABA claim on time. The deadline is usually between 60 and 90 days after treatment.
- Use accurate codes to avoid billing errors.
- Always check for common billing errors like poor documentation, wrong codes, bad handwriting in doctor’s notes, and more.
- Analyze previous claim rejections and create a document of best practices to prevent these mistakes in the future.
- Use billing software to identify errors, make recommendations, and stay updated with the latest coding practices.
Avoid ABA Therapy Insurance Claim Denials With Best Practices
Not only do ABA therapy insurance claim denials jeopardize revenue, but they can damage the relationship between a practice and its patients. If your practice has an in-house billing department, it’s important that all members of this team use the latest recommended software and that they stay up-to-date on all ABA billing best practices. If you do your own billing and find that many of your insurance claims are returned or denied, consider outsourcing this task to ABA billing experts. Either way, you should see a rapid decline in the number of denied claims and can focus your energy on providing world-class treatment to your patients.
