Is your applied behavior analysis (ABA) practice suffering from
claim denials and delays? Lapses in ABA therapy billing—such as using outdated
codebooks, upcoding, unbundling, undercoding, failing to obtain prior
authorizations or referrals, or inputting the wrong patient identifier—can negatively
affect the financial viability of your practice. Billing errors may not seem
like a big deal, but over time, they can get in the way of your ability to
deliver reliable care to your clients. Thus it's crucial to
learn how to optimize collections.
Understanding billing for ABA therapy
ABA therapy billing services can help you navigate the process, especially in areas like CPT
(current procedural terminology) codes, the primary guidelines for charging
therapy services. You also need to know split codes for when a patient sees
multiple qualified healthcare professionals during their session.
Here are some of the most important things to note when
navigating ABA therapy billing:
CPT codes
There are 16 CPT codes, and they are divided into two main
categories. The first category of codes mirrors assessment, the initial stage
of creating an ABA therapy plan. Code 0359T (initial behavior identification
assessment) has two follow-up categories: (1) observational and (2) exposure
behavioral assessments.
These two steps can be further divided into two distinct codes,
depending on the length of the treatment session. The observational component
can be billed using code 0360T for sessions lasting less than 30 minutes and
under 0361T for longer sessions. The same applies to the exposure behavioral
assessment stage and codes 0362T and 0363T.
Codes 0364T to 0374T cover various treatment services, while
0370T to 0372T cover non-timed treatments. The final codes (0373T and 0374T)
are related to a single stage of treatment billed differently, depending on the
duration of every visit.
Different CPT
codes for professionals and paraprofessionals
Only a
qualified healthcare provider can submit ABA
therapy billing, but in some cases,
paraprofessionals/support staff are involved in the treatment. Treatment codes
relating to technicians may apply in these cases. Codes 0364T to 0367T, 0374T,
and 0373T indicate that technicians worked directly with the patient. The
remaining codes (0368T to 0372T) cover treatment provided by the qualified healthcare provider in charge of the team involved
in the treatment.
Split coding
for team therapy
If multiple
therapists work with a patient, they cannot all claim the total time covered. There
are two options: The therapist who took the leading role in the treatment can
bill for the entire session, or all the therapists can split the time into
separate billing codes.
Eliminate the
guesswork
Prevent errors and increase efficiency by outsourcing ABA therapy billing to a
reputable medical billing company that can handle your entire revenue cycle
management process. Doing this can also boost your revenue while allowing you
to focus on providing excellent care.
About
the Author:
Thomas John leads a global team of 500 employees in 3
locations as the President & CEO of Plutus Health providing, RPA powered
revenue cycle management services to healthcare organizations across 22 states.
Plutus Health Inc. is a 15-year-old full-cycle RCM firm specializing in medical
coding & billing, denial management, credentialing, prior authorizations,
AR follow-up for both medical and behavioral health specialties. As the
industry experts in revenue cycle management solutions, they've created a
unique process that combines machine learning and robotic process automation to
address the clients' most frustrating problems.