ABA Service Partnering—How To Choose Your Preferred Insurance Billing Partner

What therapists and providers need to consider when choosing the best insurance billing partner for your ABA Therapy agency.

I’ve had the opportunity to speak to quite a few BCBA’s and Directors of ABA agencies who are seeking a preferred billing partner for their ABA Therapy billing and collection needs. I also worked for a large national ABA agency and was in charge of payroll for 1,000 employees and revenue across multiple funding sources in multiple states. When it was time to venture into the managed care world as additional autism mandates were passing, I was involved in working with a billing partner outside of my internal department so I’ve seen both sides of the view. This outsourcing effort failed miserably so this blog is not a one-sided approach, saying that you should only use a billing partner for your insurance billing. Rather, this is a list of many factors to consider in this very important decision.

Keeping it in-house: In my previous blog, ABA Therapy—Billing and Collection Best Practices, I talk about some tips for your internal billing and collection efforts.

This blog is written based on my own personal experience as well as some of the experiences others have shared with me in their quest to find the best fit. When we decided to “outsource” insurance billing only, we learned very quickly that a medical billing company does not always equal the best ABA Therapy billing company. Through these failed efforts and my decision to start my own company a few years later, my eyes have been opened to the importance of not just working with an insurance billing company, but having a billing PARTNER.

Here are some questions for you to review when considering the best billing partner match for your ABA agency:

  • Does the billing company have experience specifically with ABA Therapy billing? Experience beyond submitting claims to insurance companies.
  • Have they worked with an ABA Therapy agency in the past, and is their experience deeper than just what billing codes are being used for ABA Therapy? Do they understand a treatment plan and how to match codes for each insurance company with the recommended treatment hours in the plan?
  • Are they familiar with the top software programs being used in the industry at this time?
  • If you are a multi-discipline agency, can they also bill your other services?

Let me mention a few red flags:

  • If your billing partner is telling you what rates to charge for your services, specifically if they are suggesting that you “mark-up” your services excessively, this is a red flag.
  • If your billing partner requires that you “pay” for your records should you choose to drop their services, this is a red flag.
  • Are they charging you set-up fees? Evaluate what you are paying for.

Investigate fee options—this is where my accounting background comes in (if you need help evaluating your current numbers, I’m happy to help):

Billing Chart: Percentage vs Flat Rate

  • Billing services typically charge either a % of collected funds or a flat rate fee. Both have pros and cons.
  • In order to evaluate the best fit, you will want to review your case load for frequency of care.
    • For example, in a state with a $36k mandate, for cases maxing out the benefit with % of collected fees ranging from 4–6% it will cost you $120–$180 per month per child for billing and collections.(note: all rates are for illustration purposes only)
    • If your cases are 50–75% annual max dollars, your % of collected fees will range $60–$90 (50%) or $90–$135 (75%).
    • Some billing companies will charge you flat rate fees based on a tier of number of clients. Example: $500 for 1–5 clients or $750 for 6–10. Be aware that flat rate tiers can be lopsided when you only have 6 or 7 clients and are paying for 10 (for example).
    • Comparison using the mid % of collected from the sample above at 5% (you can substitute another number) vs the flat rate tier above (you can substitute another number)

The costs are comparable. Review the numbers and make the decision based on YOUR agency needs and your preferred budgeting. Do you like a fixed fee that you can budget monthly, is it more economical for a flat rate fee (per client preferably), or do you prefer the motivation for the billing partner to get paid when you get paid? This is your decision.

Other Benefits of a great billing PARTNER:

  • A partner understands the timekeeping behind the billable and non-billable hours.
  • Software—a partner can work with your existing software and even work within it if you prefer.
  • A partner is willing to go the extra mile to help you “scrub” the timekeeping to get it ready for billing.
  • A partner can also call on eligibilities and obtain authorizations.
  • Transparency—a partner is willing to share information regarding their processes, status updates, and regular reports as well as on demand reports.
  • A partner can bill with any frequency you choose (daily, weekly, semi-monthly, monthly).

In the end, if you decide that a billing partner is not the best choice for your company, you can also seek a company that offers training for your internal staff. That partnership can be one time training, long term training, and even supervision of your internal staff.

ABA Therapy Billing and Insurance Services offers customized billing and training plans to fit your needs. If you are in search of a full-service billing partner or training for internal processing, contact us or call (520) 800-4740 and we can help. We can also refer you to other partners to review the services they have to offer in order to determine what the best fit is for you.

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