Keeping the lights on and your company’s doors open is no easy task. While the mission of your Applied Behavior Analysis (ABA) practice is first and foremost to serve individuals with autism, the reality is that bills need to be paid every month. A healthy practice needs to maintain a positive cash flow, and must collect revenue for the services provided as soon as possible, or at the very least in a timely manner, to maximize profits and continue to grow in order to meet ever-increasing demands for ABA therapy.
ABA billing is unique. To start, other types of medical practices often bill patients’ copays in-office before services are provided, which kicks off billing almost immediately. But ABA practices provide services in a variety of ways and locations: clinics, schools, homes, communities. From copays and deductibles to private insurances and Medicaid, the complexities are real, especially when processes are constantly changing and the practice has to keep up with everything manually.
Have you ever asked yourself whether there is a way to simplify and automate this process? Well, the answer is yes. CentralReach’s unique set of billing features, designed by experts in ABA billing, are here to help. Let’s go over some of the automations available in CentralReach to help you streamline the complexities surrounding ABA billing and take one step toward a positive cash flow:
1.Managing Bill and Agreed Rates: How much you charge your clients for services rendered depends on how much your funding sources have agreed to pay you for such services. These details are tracked in your payor contracts under the fee schedules, and agreed rates vary by payor. Poor management of your payor fee schedules may prevent you from covering your costs, as you may not be billing the correct amounts for the services provided. Additionally, the medical model of billing that ABA now participates in requires that you show no favoritism to any one payor, and that all rates for all services remain the same.
How does CentralReach automate the agreed and bill rate process?
With CentralReach’s service code configuration, which includes billed and agreed rates, you can have billed rates that are universal for all payors. You can customize and establish agreed rates for each individual payor plan based on your fee schedules, and CentralReach provides a clear view of the amounts owed pursuant to your contract. This sets a clear picture of what you are entitled to receive from payors in order to accurately complete the revenue cycle for every service you provide. Get an end-to-end billing configuration so you can create a sustainable framework for successful billing from the ground up.
2. Payor Workweek and Time Format: Payors have individual requirements pertaining to authorization frequencies and amounts approved per their own established workweek, and may also require that you submit a certain time format within claims to show when the services were rendered (e.g., TRICARE and some state-based funding sources). If you don’t keep up with these requirements, you could easily submit claims that will be immediately rejected or denied, which consequently affects payment time frames and cash flow.
How does CentralReach automate payor requirements?
CentralReach has a customizable configuration for accepted insurances. You can manage and determine, at the payor level, the workweek that authorizations and appointments validate against, for proper time tracking and claims processing. Additionally, you are able to configure the format of the appointment time so it is included in each claim (e.g., military time or SVCNOTE 0000-2400 formats). These minor yet very important details will ensure that claims are properly submitted from the get-go to prevent denials, rejections, and rework.
3. Claims Management: The more you grow to meet the increasing demand for autism services, the more payors you will need to accept so you can service more clients. Are you limiting your accepted payors and growth because you don’t have enough time to manage it all? Are you reworking all denied claims to ensure no money is left on the table? Are you submitting claims to secondary and tertiary insurance after the primary has paid? Processing claims manually and managing everything through payors’ portals without a centralized view of your overall accounts receivable is possible, but properly tracking all this information on an ongoing basis, without the right systems in place, can be extremely challenging.
How does CentralReach automate claim management?
By connecting to an electronic clearinghouse, CentralReach allows you to track and manage claims electronically. You can process rejected and denied claims from all payors in a centralized location, where you can rework and resubmit claims in a timely manner. Additionally, you are able to post payments to the billing entries once received, to complete the process and automate your revenue cycle management from start to finish.
4. Combining and Merging (Total Dollars/Day) Services in Claims: Payors in many instances require you to combine all service codes provided to a client on the same date in one single claim, and they may accept only the first iteration of the claim and assume other ones thereafter are duplicates. If processing multiple claims for services rendered on the same date, you may end up having to process replacement claims, which delays payment for weeks and doubles administrative work. If you don’t rework these claims, you simply won’t get paid.
How does CentralReach automate the claims merging process?
CentralReach’s electronic claim processing technology allows you to merge all the line items for services provided on the same date, so they are properly submitted to the payor. We also parse out similar services that were merged to a single line item on the claim when it comes back to posting. Additionally, multiple dates of service can be merged into a single claim to simplify accounts receivables and the claim rework process, in case any updates are necessary.
5. Billing Frequency: How regularly are you able to process billing? The faster you bill all funding sources, the faster you will be paid, which maintains a healthy cash flow. Additionally, insurance contracts have clauses that require you to submit claims within a certain time frame after services are rendered, and falling behind on filings can certainly put you at risk of not collecting payments. However, it can be a challenge to get up-to-date records of the services that have been rendered by clinicians and technicians, and that challenge can create a bottleneck for your billing operations.
How does CentralReach automate the billing process?
CentralReach creates orderly data flow between authorizations, appointments, and billing entries. This allows you to streamline the billing process by providing therapists a simple way to submit timesheets with all service details, as soon as the services are rendered. These timesheets, upon conversion, create billing entries to kick off invoicing and claims processing daily, weekly, biweekly, or however you like, based on your cash flow needs. All information is centralized in a single location, providing you with the visibility required to finally get ahold of all accounts receivables.
CentralReach’s billing automations are designed to address the specific needs of ABA practices and provide the flexibility required to process billing the way you want to. Whether you have a dedicated in-house billing team, need to temporarily outsource billing to help establish best-in-class workflows within CentralReach, or have outpaced your billing capacity and want to outsource it all, CentralReach is here to support you and your business, every step of the way.
Contact us today to learn more!