Top Billing: The ABA Billing Process and Best Practices

Updated on April 12, 2023

As treatments go, Applied Behavior Analysis (ABA) is a relatively new one. When ABA was first acknowledged as a medically verifiable and necessary treatment, the health industry wasn’t set up to bill for it. As with any surprise addition to a sector, it took some time to figure out how to go about the process, and nail down the codes and which ethical practices should be adhered to. Though the framework for speedy and reliable billing now exists, professionals in the sector face the fact that this young practice has some moving goalposts that must be factored into the billing process.

Therapists and billers have to collaborate to ensure that ABA billing is carried out quickly and reliably, even when the industry has several moving parts and new practices may be added to the menu. We all want the same thing: for patients to get the best care they can and get the most value from their medical insurance when claiming against payments they have made or submitting treatments for consideration and payment. When the process was standardized in 2012 there was relief in the industry. The amendments that followed in 2019 further proved the validity and necessity of the treatments, and today the number of codes sits at 16. Though all this work has been done, the process is still complex, and we would like to do everything we can to help struggling professionals get to grips with it. This article examines how the process should flow and addresses some common concerns and challenges. Let’s begin.

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The ABA billing process

To begin the process, a company will deal with all the service codes related to the claim and bill whoever needs billing. Using these service codes creates authorizations that ensure all providers are billing as they should be for the right client, in line with the payor requirements. Next comes scheduling, where appointments are booked or canceled, and the completed appointments are made into timesheets. Every unique client authorization is attached to its timesheets so the system correctly records the information when entered. The timesheets go back into the billing module, where claims and payroll can be processed when necessary.

These tasks should always be noted and remembered as an important part of the process.

  • First comes claims management, which should be undertaken as soon as possible after receiving the claim to avoid delays that may cause problems for the patient or therapist. Execute this step in a timely manner and as accurately as possible. Use all the expertise at your disposal.
  • Second comes credentialing. Always review all documents before final submission and follow up on anything outstanding as needed.
  • Working with organizations is the next part of the process. Maintain contact with the relevant organizations to stay abreast of any changes coming to the process or to note any concerns that therapy providers or patients may have about the process.
  • Lastly comes consultation and any training necessary. This step should carry on outside the billing process and inform how you bill your clients. This is an industry in which things change often and quickly without warning. Your work ethic should dictate that you always know as much as possible.
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Common challenges

Incorrect information is captured

This is likely the most common issue in many businesses because human error is part of any process involving humans. Incorrectly capturing any information relating to a therapist or patient could result in a claim being denied, which could have unpleasant repercussions for the client or the therapist. Check your work and ensure you capture all information properly the first time.

Not confirming eligibility

Coverage for ABA therapy can vary from company to company. The average patient or the person paying their bill may need help understanding their coverage and all the official language that goes along with it. There might be times when they think a particular event or therapy is covered when, in fact, it is not. Rejection of an important claim might come as a nasty surprise if you don’t do the necessary legwork and check that everything they need is covered, and inform them promptly if it is not.

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Missing deadlines for claims

The time frames in this industry are tight, and adhering to them requires staying on top of your workload. Even if a claim is accurate in any way, a payor can deny it if it is not submitted within the required deadline. These deadlines vary from payor to payor, so double-check yourself or keep a chart of various payor requirements at your desk so you never miss one.

Wrap-up

Billing for ABA therapy can be tricky at the best of times. Stay up to date on all changes, and keep your eye out for new software or practices that might help you handle your work more efficiently. It’s up to you and your skills to ensure everything runs smoothly.

The Editorial Team at Healthcare Business Today is made up of skilled healthcare writers and experts, led by our managing editor, Daniel Casciato, who has over 25 years of experience in healthcare writing. Since 1998, we have produced compelling and informative content for numerous publications, establishing ourselves as a trusted resource for health and wellness information. We offer readers access to fresh health, medicine, science, and technology developments and the latest in patient news, emphasizing how these developments affect our lives.