ABA Therapy Billing can be challenging, especially for medical companies with limited resources. Aside from staying familiar with ABA billing codes and coding categorization, they need to collaborate with certified therapists and verify insurance coverage, among other essential practices. This helps avoid claim rejections and time-consuming audits that can distract from the patient experience.
Insurance coverage for ABA therapy can be complicated, ranging from Medicaid programs to private insurance plans. The latter may require that a client pay a copayment or meet a deductible before coverage kicks in, depending on their policy. Families can also find help through grants from the government or their community, which offset some of the cost of treatment.
The ABA billing process starts when a client makes an appointment and is evaluated for the recommended treatment plan. Afterward, the clinic will submit documentation to verify the client’s insurance coverage and receive authorization for the specific number of ABA sessions. This typically lasts for six months and requires a review by the insurance company to be renewed.
This is just the start of a long process, which can include submitting and filing claims, paying deductibles, negotiating with the insurance company, and getting a detailed explanation of benefits (EOB). It’s critical to stay informed of changes in CPT ABA billing codes/code modifiers and how they affect reimbursement rates. Having access to a system that provides comprehensive knowledge of these updates empowers providers to optimize their ABA billing procedures.