ABA Billing Codes and Challenges for Providers in 2021

ABA Insurance Billing Codes

ABA Billing Codes and Challenges for Providers in 2021

ABA billing codes do not have to put a strain on your therapy practice. For many providers, keeping up with ABA billing codes, changes in regulation/coverage, and chasing down payments has become a burden. It sometimes feels as though there are so many details to keep track of that it would be impossible for you to keep up.  

 

 

The issue is that the role billing plays within your practice is paramount to your ability to work with the clients. What is causing strain on your practice is the fact that you have yet to perfect the billing process. The use of ineffective billing solutions is what is holding your practice back from a streamlined, effective, and flourishing billing process. 

 

 

The good news that with the right technology or partnerships, your practice can finally tackle the ABA billing codes and challenges that have held you back for so long. 

ABA Billing Code Challenges

ABA Billing Challenges

Claims Management 

One of the most integral components of your claims process is coding each claim accurately with the correct ABA billing code. Doing so will offer you your best chance at an approved claim. This is one of the biggest challenges for providers offering ABA therapy. ABA billing codes are complex, specific, and require great understanding. With clients to focus on, it can be difficult to be an expert on billing as well. 

 

Denial Management 

Even when ABA billing codes are accurate, denials still happen. One of the biggest challenges that ABA therapy providers face is their denial management process. When a denial is not caught, corrected, and submitted within the required time-frame, revenue is lost. 

ABA Billing Codes

The most-used ABA billing codes include: 

 

97151 – Behavior Identification Assessment 

 

0362T – Exposure Behavioral Follow-Up Assessment 

 

97155 – Adaptive Behavior Treatment w/ Protocol Modification 

 

97156 – Family Adaptive Behavior Treatment Guidance

 

97157 – Multiple Family Group Adaptive Behavior Treatment Guidance 

 

0373T – Exposure Adaptive Behavior Treatment with Protocol Modification 

 

97152 – Observational Behavioral Follow-Up Assessment 

 

97153 – Adaptive Behavior Treatment by Protocol 

 

97154 – Group Adaptive Behavior by Protocol 

 

97158 – Adaptive Behavior Treatment Social Skills Group 

Improving Your Claims Process

ABA Insurance Claims

In order to improve your claim and denial management process, providers should access the following tools and services. 


Built-in End-to-End Billing Software
 with Revenue Cycle Management Options

What many providers do not realize is that they do not have to try and become ABA billing experts on their own. In fact, providers with the highest-functioning billing processes outsource claim and denial management to a qualified practice management or revenue cycle management billing partner.  

 

The right tool will simplify your billing process and save time by generating reliable electronic claims, easily posting payments/adjustments, tracking the status of claims, and much more. 

 

Billing software, such as NPAWorks by CodeMetro, can take over your claim/denial management to ensure you optimize your revenue cycle and fortify your bottom line. They will scrub each claim for errors such as incorrect ABA billing codes and track the claim to make sure you are receiving a high number of timely payments. On average, ABA practices collect on 80% of their insurance claims. NPAWorks has an average claim clearance rate of 95%…just think what your practice can do with the extra revenue!

 

With the right partner of either managed billing or ABA billing software, your practice can tackle the burden of ABA billing codes and claims while building confidence in its bottom line. To schedule a consult with an NPA Works billing expert that is ready to help you, click here.   

This post is for informational purposes only and is not meant to be used in lieu of practitioners own due diligence, state and federal regulations, and funders’ policies. 

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