Medical authorizations for ABA therapy can bring about many challenges for an organization. Ineffective authorization management can result in decreased revenue, in addition to potentially negative outcomes for the clients. Establishing sound authorization management practices is vital for a healthy organization.
Underutilized authorizations
One of the primary authorization challenges ABA organizations face is underutilized authorizations. Authorizations may be underutilized due to various reasons such as scheduling conflicts or inefficient management of hours. An inability to fulfill authorized hours can create a significant financial strain on ABA organizations. Additionally, underutilized authorizations can result in delays in treatment progress, as clients may not be receiving the clinically recommended number of hours necessary to achieve their goals.
Closely monitoring authorizations is crucial to prioritize client care and improve revenue. With CentralReach’s Practice Management software, you can gain instant visibility into underutilized authorizations and immediately enact modifications to address them.
Another critical aspect of maximizing authorizations is enacting streamlined scheduling processes. With disintegrated scheduling systems, you may miss vital opportunities to ensure more efficient schedules, thus losing out on authorized hours. Optimize your schedules with CentralReach’s smart scheduling technology. Create complex schedules in a few clicks that automatically account for drive time, authorized hours, client and staff availability, and more.
Overutilized authorizations
On the flip side, overutilized authorizations can create challenges for an organization as well. Overutilizing a client’s authorized hours can strain an organization's resources, as they bear the costs of sessions that cannot be billed. If an overutilized authorization resulted in overbilling, the company may also be required to repay for hours beyond what was authorized. Furthermore, this could lead to insurance audits, resulting in additional loss of productivity and revenue.
It’s essential that organizations carefully monitor and manage their clients’ authorized sessions to prevent over utilization. With CentralReach’s integration of scheduling and authorizations, a notification will populate to warn the team if sessions are scheduled beyond a client’s authorized hours.
Reactive authorization management costs revenue
Agencies that enact reactive authorization management procedures rather than proactive management may cost their organization a great deal of revenue and productivity loss. Reactive authorization management involves responding to denials or other issues as they arise, whereas proactive authorization management involves anticipating and addressing potential issues before they can occur. Proactive authorization management ensures you maximize possible revenue and optimize your organization’s productivity. This approach can help to minimize service disruption and reduce stress for both providers and families.
Closely monitoring your authorizations and modifying schedules to address any issues can result in increased revenue, as opposed to winging it and waiting until you identify an issue during billing processes.
Lower unit approvals for re-authorization
At the time of re-authorizations, sometimes funders reduce the units of authorization. Despite the BCBA asking for continuity of the same hours previously authorized, they decrease to a less intensive level of care. Often this is done either because the client did not make sufficient progress or the client has made significant progress and the reviewer believes they no longer need a higher intensity of care. From a business standpoint, this poses a challenge of reduced revenue. However, arguably more important is the impact that this can have on the client. Fewer authorized hours may result in less positive outcomes.
Understanding what insurance reviewers are looking for and knowing relevant laws such as the Mental Health Parity and Addiction Equity Act (MHPAEA) can help prevent reductions in hours during re-authorizations. Additionally, improving clinical workflows so your clinicians can effectively communicate client progress can go a long way in advocating for continued hours. With CentralReach’s clinical solutions, you can efficiently show your client’s progress to funding sources for re-authorization. With digital assessments like WebABLLS® and AFLSonline™, you can demonstrate your client’s progress across multiple domains of functioning and clearly show areas of skill deficit. Additionally, with ABA data collection, you can seamlessly auto-generate graphs, thoroughly displaying your client’s progress across treatment goals.
Services provided on expired authorizations
Providing services on an expired authorization will result in insurance denials, thus affecting an organization’s revenue. This can occur when providers don’t keep track of authorization renewal dates and fail to submit for re-authorization. Organizations must be proactive in tracking authorization expiration dates. In addition, organizations must understand each funding source’s requirements for authorization renewals and follow procedures to obtain re-authorization before the expiration date.
Lack of visibility results in low supervision and parent training utilization
Most often, protocol modification and parent training services are the primary services that are underutilized due to low visibility. Case oversight, behavior technician supervision, and parent training are necessary for the best possible outcomes. Therefore, clinicians must effectively manage these authorized services.
With CentralReach’s instant visibility into authorized hours, your clinicians can easily manage each client’s authorization. Behavior analysts can identify the number of authorized protocol modification and parent training hours available throughout the authorization period and closely monitor to maximize utilization without going over.
Streamline authorization workflows with CentralReach
With the right software solution, you can improve your bottom line and maximize organizational productivity. Streamline your workflow with CentralReach’s all-in-one ABA practice management software. Eliminate authorization inefficiencies, increase visibility, and improve your revenue flow.
