ABA Billing Denials: Change Your Mindset to Change Your Results!
Prevent Denials by Changing Your Mindset
Denials are painful, but they don’t have to be. We get it, we really do. When you are busy and buried in tasks, it’s easy to say, “we’ll fix it later”. But is it really easier? Most ABA billing and coding denials are preventable if you shift your mindset from reactive to proactive. But when you’re already drowning in work, how do you know where to start? Here’s some tips that have transformed our ABA AR management process over the years.
Verify client benefits prior to starting services
Verifying benefits at the start of services is critical for several reasons. Not only do you want to ensure that your clients’ insurance coverage is active and that services are covered, but you also want to confirm clients’ coordination of benefits to ensure all parties are working with the most accurate information. Additionally, verifying if prior authorization is required before services begin helps prevent denials for not having an authorization on file.
Understand payer requirements
Each insurance payer and funding source has their own billing, coverage, and coding rules and requirements, and it’s critical to know these before billing. Some key pieces of information that are essential to the ABA billing process include: knowing requirements for authorizations (for both primary and secondary payers), referrals, concurrent billing, unit caps, timely filing limits, modifiers, and even which places of service are allowed.
Communicate, Communicate, Communicate
Payers’ rules and requirements for billing ABA services are constantly changing. This critical information should be consistently communicated to both providers and your entire billing and support team. When the communication breaks down, you will likely see the repercussions later in denials, resulting in revenue delays. The same payer information that we discussed above, can be critical information for the clinical team, authorizations department, and even the schedulers. Building protocols and workflows that acknowledge payer compliance and billing guidelines allows your organization to be proactive with reimbursement from every angle.
Monitor, analyze, communicate, revise
At Keystone Medical, we place a high value on learning from our mistakes. Having a consistent denial review and feedback loop has been essential to our success in resolving and preventing denials for our ABA billing clients. We suggest implementing the following processes to help establish a denial review loop in your own organization.
Monitor your denials and analyze the root cause.
This first step is imperative. Although this can be a time consuming endeavor initially, ignoring the problem means you will keep making the same mistakes and will end up wasting more time and money. Push back on the vague payer denials you receive and dig deeper into the workflows that influenced the denial. Invest time with the payers to understand how the denial can be corrected, and any additional policy guidelines that may impact clients’ coverage going forward.
Once you know the root of the issue, communicate the information to all key stakeholders.
Information is power! As team members start to be aware of ABA payer requirements, they will better understand how their role impacts reimbursement. We’ve seen great ideas and processes come from individuals in many different roles! Communication and collaboration activate the ingenuity and wisdom of the whole team.Revise and Repeat.
Once you understand why a claim is denied, review protocols and workflows to ensure the root issue is addressed going forward. Resubmit denials and repeat the tracking and feedback loop. Over time, this loop will help improve reimbursement, refine internal documentation and workflows, and reduce the operational overhead required to complete the ABA claims cycle.
TLDR? Time invested on the front end will decrease time spent chasing down claims. ABA Denials can be a goldmine of information that can be leveraged across your ABA organization to increase revenue and optimize ABA billing workflows.
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