The evolution from pen-and-paper to electronic software.
Before electronic management record (EMR) and practice management (PM) systems were born, pen-and-paper processes were the norm at most healthcare organizations. A patient or client was handed a clipboard containing paper intake forms upon arrival, their visit was documented by a provider on a paper record to be filed away later, and any instructions or notes were printed out and sent home with the individual.
Today, EMR/PM software has almost entirely replaced paper in the medical field and, while not as widespread, are becoming the norm for behavioral health – including applied behavior analysis (ABA). Given that ABA involves 1) such a large number of documents, and 2) varying documentation requirements and claims processes per insurance payor, billing is undoubtedly one of the toughest parts of both running an ABA practice as well as switching from pen-and-paper to an electronic system.
While the transition certainly is not easy, selecting a technology partner that specializes in ABA; is able to manage the robust needs of your business (and even help you scale); deliver exceptional training and support; and more, will yield long-term successes that offset the short-term struggle.
Alternatives to fully integrated billing software… and the repercussions.
It is common for ABA organizations that are either uncomfortable with billing, lack the time to manage it themselves, or simply don’t have enough staff, to utilize billing processes that end up doing more harm than good. For example: using a pen-and-paper and standalone system hybrid. This involves tedious manual efforts. Duplicate data entry, copy and pasting of information, referencing spreadsheets, and submitting claims into numerous insurance portals takes time -- time that can be better spent elsewhere. Also, the more systems you’re using for submission, the higher the likelihood of errors, timely filing issues, and denied or rejected claims.
Some practices turn to third-party billing companies. It may seem like a quick fix to hand billing processes off entirely, but for ABA practices, it is not so simple. While third-party billers might be well-versed in general healthcare billing, it’s rare to find one that understands the intricacies and layers involved in ABA billing. Authorization specifications, clearinghouse and payor requirements, and heavy documentation make ABA claims submission unlike any other industry.
Finally, while using an internal biller to manage the process might seem like a good solution, remember that the process is then dependent on one individual alone. What will happen when that person gets sick, goes on vacation, or resigns? Will claims submission come to a standstill?
Ultimately, all of these alternatives to billing from an integrated EMR/PM software will lead down the same path. Errors, claim rejections and denials, and leaving money on the table.
Billing through CentralReach.
CentralReach’s integrated platform was built specifically to manage the complexities of ABA. This means billing is completed correctly from start to finish. Along with billing, organizations are empowered with advanced reporting and metrics that enable complete, accurate oversight over each area of their financials.
Rather than toggling between systems or using other time-consuming methods, CentralReach takes users from A to Z within their billing process without ever leaving the platform. All the data you need is in one centralized location.
It all begins within the billing module, an area within CentralReach that arms clients with everything needed to establish best-in-class billing at their organization.
Here are 3 CentralReach modules that solve common -- and critical -- pain points during the ABA billing process.
The clinical module. This is where providers go to collect, graph, and analyze data, complete evaluations, and so forth. Along with optimizing data collection, users are able to use one system that both delivers therapy and kicks off billing – seamlessly tying together operations and enabling a faster revenue cycle management process.
The scheduling module. ABA scheduling is notoriously complex, and if mismanaged, can trigger major issues – like failing to meet authorized hours, setbacks in client progress, and client dissatisfaction. With CentralReach, schedulers and providers can book, cancel, or reschedule client appointments from one place – and even while on the go. Easily match provider and client availability, reschedule appointments, and provide visibility to those who need it.
The claims module. Here, companies process, send out, and receive payments for services rendered. Submitting cleaner claims faster, without having to reference different systems, spreadsheets, and binders means far fewer denials and errors -- facilitating faster reimbursements, decreased likelihood of leaving money on the table, and increased revenue.
A quick glimpse into the process.
It’s common for ABA companies to spend an exorbitant amount of time on meticulous, time-consuming billing processes. For example: downloading and exporting data to be sent to third party companies for processing… completing the process manually using internal staff and billable hours…, or utilizing a standalone system that requires data entry and/or copy pasting that leads to errors.
CentralReach has been fine-tuned and automated to provide the best and easiest possible experience for companies to get reimbursed for services rendered, and also get their providers reimbursed for the outstanding services they provide to their clients in need.
- One of the first things an organization will do is create and utilize service codes that have provider and client fees attached to them, along with the appropriate party being billed for services. Then, authorizations are created from these service codes to ensure providers are billing correctly, for the correct client, per the respective payor requirements, and so forth.
- From there, providers will move onto the scheduling module, where they’ll both book (or cancel, or reschedule) appointments as well as convert completed appointments into timesheets once services have been delivered. Each client’s authorization is attached to their appointment, so the system knows which provider is billing for which client. The appointments are then converted into timesheets once sessions are complete.
- Once appointments have been converted, they turn into time sheets, which end up back in the billing module. Once there, claims and payroll can be processed immediately, or at the time of the practice’s choosing. CentralReach enables billers to process payroll, as well as submit claims to insurance companies and/or private parties. Since rates and fees are already attached to service codes, the biller does not have to manually input any information. With a few clicks, claims are sent off, payroll is processed, and providers are on their way to receiving reimbursement for services provided.
CentralReach billing: a final note.
Billing is only one of the areas CentralReach simplifies and optimizes for users, and we recognize the struggles many ABA practices face. Because of that, our team works tirelessly to enable users to understand the ins-and-outs of billing, ultimately completing processes with ease, checking every box, and feeling confident in knowing the information being sent out is accurate, up-to-date, and matches requirements per payor.
CentralReach Customer Success Lead
Jordan Soutner has worked in behavioral health throughout the entirety of his career. Now a Customer Success Lead at CentralReach, he continues to work toward his professional goals in continuing to advance his knowledge and experience in educational and behavioral assistance for children. Jordan is proud to work with a wide variety of clients, helping users optimize workflows, solve problems, and ultimately achieve the best value out of their system. Jordan enjoys sports and exercise, family and friends, good food, and traveling.