Operant Billing for ABA is one of the most challenging aspects of ABA therapy. Medical professionals must have a deep understanding of the industry’s ever-changing policies, regulations, and coding requirements to ensure on-time reimbursement and sustainable operations. However, this can be extremely difficult for ABA therapists working in private practice or small facilities where the majority of administrative tasks are handled by the individual therapist.

The Importance of Professionalism in ABA Billing Services

Having a comprehensive record of client data is the first step in successful billing. This includes progress notes, session summaries, and treatment goals. These records will help support claim submissions and demonstrate the medical necessity of ABA services. In addition, it is imperative for ABA providers to keep up with the latest CPT codes and stay aware of insurance company filing deadlines.

When claims are submitted to a payer, the ABA pre-billing team will verify that the claim meets the insurer’s requirements. This includes ensuring that the correct CPT code is used for each service rendered, and the correct PPRU code is associated with the session being reported. Incorrectly coded sessions and missing or delayed submissions are common reasons for denials, which can result in a loss of revenue for the practice.

ABA RCM specialists can reduce the risk of errors, improve efficiency, speed up reimbursements, and provide detailed reporting. They can also help with credentialing, negotiating rates with insurance companies, and optimizing billing processes. They can even identify and address problems with a payer’s ABA billing practices to prevent costly denials.