The Do’s & Don’ts of ABA Claim Submission

Applied Behavioral Analysis is a form of therapy that can be provided to patients who are thought to benefit from it. As a provider of this type of therapy, you must submit ABA claims so that the patient’s health insurance can pay for the sessions. Doing this properly can be quite difficult as you have to use the correct codes otherwise, you run the risk of the claim not going through, causing you to miss out on the money you are due. Below we will go through some of the do’s and don’ts of ABA claim submission so that you aren’t left out of pocket.

What are CPT codes?

ABA billing is a complicated topic; therefore, it is important to have a good understanding of crucial aspects of it. Current Procedural Terminology codes, or CPT codes, are extremely important when it comes to ABA billing, as different codes correspond to different types of therapy that can be given. There are 3 main categories when it comes to CPT codes. These are CPT I, CPT II, and CPT codes which are used for ABA billing.

In short, CPT I codes are used for specific services and procedures, whereas CPT II codes are used to measure performance and function as a way to track progress. CPT III codes are temporary and used for any new services, technologies, and procedures for which CPT may not yet cover CPT I code. These codes are just one of the reasons which make ABA billing difficult, but below, we will go into some of the other reasons why it can become so complicated.

Why is ABA billing so complicated?

There are a number of reasons why ABA Billing can become very complicated, from understanding the different CPT codes to making mistakes with patient details and even issues with systems that detect fraudulent activity.

Issues with CPT codes

As previously mentioned, CPT codes often cause a lot of issues when it comes to submitting claims for ABA billing. One of the main problems that people often run into with codes is that they are constantly updating, so it can be hard to keep track of all the changes to ensure you are using the right codes. Additionally, it is common to see codes used for the wrong services and certain codes not being included when they should be.

Incorrect patient details

Although this is something that should be easy to avoid, it is more common than you think. Even the smallest mistake in the patient details whilst submitting a claim can cause major issues with ABA billing and slow down the entire process. It can sometimes even lead to a claim not being processed altogether. This is why it is extremely important to double-check that the patient’s details are correct before you submit anything. This means looking over the claim to make sure things like the patient’s name, sex, policy number, and date of birth are all correct.

Fraudulent claim prevention

Several systems are in place to detect fraudulent claims, which can cause headaches in billing for your services. This is why it is extremely important to know which CPT codes you should be using for your services so that your claims are not flagged.

How to avoid issues with ABA claims

It is true that there are several hurdles to jump over to submit accurate ABA claims however, it is possible, and there are a number of things you can do to optimize your accuracy when it comes to your billing.

Don’t miss submission deadlines

You must submit your claims before deadlines are reached. The deadlines will vary depending on which health insurance provider you are dealing with, so it is important to check this beforehand to ensure you don’t miss it. To prevent this from happening, submitting your claims as quickly as possible is a great idea.

Use the latest codes and processes

As mentioned previously, CPT codes can create many problems with submitting claims, so it is a good idea to be updated on what codes should be used for each service. This way, you reduce the chance of using the wrong codes and having your claims denied.

Conclusion

ABA billing is a complicated process that requires in-depth knowledge of how the whole process works. If you are able to grasp what CPT codes you should be using whilst making claims and don’t make simple mistakes, then you should find that you won’t run into as many problems that will slow the whole process down.