Over utilizing client authorizations can severely affect an organization's financial health and, more importantly, client care. Billing beyond the authorized hours can lead to financial strain, payor audits, and potential repayments. Moreover, it can adversely impact client outcomes, as learners may miss out on other crucial services or activities.
This blog will focus on the risks associated with overutilized authorizations and proactive strategies to manage them effectively. We will discuss the importance of streamlined communication systems and proactive scheduling practices. By understanding the challenges and implementing proactive strategies, ABA practices can navigate the complexities of authorization management, ensuring financial well-being and optimal outcomes for their clients.
Risks of Over Utilized Authorizations
Over utilizing client authorizations can have tremendous consequences on an organization’s revenue and impact client care.
Risks associated with over utilized authorizations include:
- Financial strain – When an organization bills for more hours than authorized, the company is responsible for bearing the costs associated with those sessions without reimbursement. If they over-billed the payor as a result, the payor may require recoupment of funds. Additionally, overbilling comes with additional risks, including the financial strain from administrative time spent on payor audits.
- Impact on client care and outcomes – Overutilizing an authorization typically means the learner received more hours than clinically recommended. While some may argue that access to more therapy hours results in the best possible outcomes, this is not always true. If a learner receives extra ABA therapy hours, they are likely missing out on other beneficial services or activities, such as school, extracurriculars, other therapy services, or quality family time. This can impact their progress and overall quality of life.
Proactive Strategies for Reducing Over Utilization
Now, let’s delve into solutions to improve an organization’s authorization management. Proactive strategies are the best way to prevent the headache that comes with over utilizing hours.
Improve Lines of Communication
Establishing an efficient communication system is pivotal for the effective management of authorizations. Eliminating communication barriers among clinical, administrative, and financial team members is crucial to ensure optimal authorization utilization.
Organizations should employ a unified platform to foster collaboration and enhance authorization visibility. This platform would allow behavior analysts, clinic directors, billers, and other employees to access information related to authorization workflows, utilization, and unit availability. Opting for technology solutions that provide real-time updates ensures that information about each client's current utilization is readily available.
Enhance Scheduling Procedures
Companies implementing proactive scheduling practices can improve authorization management and prevent unexpected financial setbacks. Scheduling ahead across the full authorization period helps schedulers and supervisors more readily identify over-scheduling, thus avoiding overutilization and excessive billing.
Using practice management software with real-time access to authorization utilization enhances visibility and allows supervisors to better manage their client’s authorized time. When authorizations are tied into scheduling, overutilization can be avoided with a notification that alerts the scheduler that no authorized units are available to cover that session.
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Using practice management software with real-time access to authorization utilization enhances visibility and allows supervisors to better manage their client’s authorized time. When authorizations are tied into scheduling, overutilization can be avoided with a notification that alerts the scheduler that no authorized units are available to cover that session.
Managing Services on Expired Authorizations
When authorizations are mismanaged, there is substantial risk to the organization and clients. Failing to obtain a new authorization before the current one expires may result in placing the client on an unexpected service hold, impacting continuity of care and client progress. If the expired authorization is not identified in a timely manner, services may continue to be billed, leading to claim denials, delayed payments, and considerable financial strain on the organization. Operating with expired authorizations may also expose organizations to legal implications. Non-compliance with authorization requirements could result in contractual breaches with insurance providers and potential payor audits.
To ensure ethical and legal adherence, it’s critical ABA organizations establish robust mechanisms for managing authorization workflows. A proactive auth tracking system will help to avoid any unwelcome surprises.
Organizations can empower their clinical teams to enhance workflows by:
- Immediately inputting authorization expiration dates into their practice management software.
- Implementing automated reminders for all upcoming expiration dates. Set up advanced notifications for due dates that take into account payor processing time and potential returns or peer reviews to ensure there are no gaps from one auth to the next.
- Establish clear communication channels for re-authorizations to ensure workflows are clear. Ensure each staff understands the requirements and procedures to follow to obtain re-authorization.
Optimize Authorization Management for Improved Outcomes
Efficient authorization management is necessary to achieve client success and safeguard organizational financial well-being. The risks associated with overutilizing authorizations carry significant implications, impacting the company's financial standing and the outcomes for the clients they serve. Collaboration, enhanced visibility, and improved proactive scheduling practices allow organizations to optimize authorization management to achieve the best possible outcomes.
As a therapy provider, if you found this to be helpful, you should check out The Impact of Under Utilized Authorizations on ABA Practices to learn more about the common causes of under utilized authorizations and explore strategies to address these challenges.
Posted in ABA Records, Authorizations, Billing, Practice Management
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