The Survival Guide to ABA Insurance Mandates

Wednesday, November 4, 2015

Legislation that mandates ABA insurance coverage is a great opportunity for so many families needing support. It can also be a great opportunity for clinical entrepreneurs looking to start or grow their practice.

The Growing Pains of Growth
As wonderful as this is, it’s understandable if you feel anxious about accepting insurance. After all, most people do not become therapists or open a practice just to make money. Chances are, your passion for helping others is your biggest motivator, and growing administrative duties can quickly diminish this:

  • Tedious claim preparations
  • Mysterious denials and rejections
  • Chasing late payments
  • Insurance applications
  • Cryptic authorizations
  • Very complicated billing
  • Authorizations management
  • More complex schedule management
  • Growing staff management

Embrace the Change, or Brace Yourself?
The good news is if you adequately prepare yourself, accepting insurance isn’t so overwhelming. The sooner you start proactively planning for it, the better off you’ll be. In fact, preparation really boils down to three main things:

  1. Get an NPI: https://nppes.cms.hhs.gov/NPPES/Welcome.do
  2. Start the insurance application and credentialing process as soon possible. First, set up your CAQH file and check to see if your new mandate includes licensure. If so, make sure to sign up early to get “grandfathered” in, as mandates can change the landscape.
  3. Get HIPAA-compliant EHR billing software to manage the granularity of your practice. Make sure it includes document management (authorizations, claims, invoices), billing functionality, and ideally integrated scheduling. It is never is too early to start with software. Just make sure it has the scalability to handle your business today and years down the road.


A Great Investment
A practice management solution may be the best investment you’ll ever make in your growing therapy practice. When you start accepting insurance, the volume of business you handle will increase exponentially. It won’t be long before you realize that pen and paper won’t suffice. And that’s when CentralReach enters the picture. We’re here to help!

For other great pointers for new clinical entrepreneurs, check out our previous blog post: Five Things to Avoid When Opening a New ABA Practice.