With autism treatment becoming more widely available , treatment centers are faced with some difficult decisions. One of the biggest decisions is to outsource their billing to a 3rd party. With autism claims, not all medical billing companies can effectively file for reimbursements. Applied Behavioral Analysis is relatively new reimbursable treatment, and a billing company needs real life experience. Through out this experience of do’s and dont’s it leads to a successful partnership with a center.
Billing In House Vs Outsourcing
If a center is wanting to take billing in house, there needs to be experienced employees in place. Most centers will try to cross train an employee in this area. This is where a problems can occur because ABA billing is extremely time consuming.
The days of submitting a claim and not following can lead to disaster. Can your employee find time to follow up on claims. Each phone call to an insurance company can be over 45 minutes. We at Artemis, follow up on claims because that is our commitment to our clients. This dedication leads to faster reimbursements. For a center to be successful, their needs to be a level of constant revenues. To obtain that, there has to be a large amount of time dedicated to claims.
ABA Claims Tracking Software
If you bill in house, will you have access to tracking software. Many centers track claims on a spreadsheet (sound familiar). This leads to more time spent on data collection, then pulling that data takes additional time. We developed claims tracking software specifically for autism centers. With a click, you have the data you need to review your claims in real time. Our system can even track the amount of therapies that are approved in real time.
Industry billing Knowledge (Leverage)
Most centers are extremely knowledgeable on clinical aspects of treatment. When it comes to ABA billing, centers are at a disadvantage. If there are billing issues, you may not know if it is specific to your center or industry wide. With Artemis, we are billing for multiple centers, so when we encounter a problem, and determine it is an insurance company issue, we are able to find a solution. A center may not find that solution because of possible mis-information. We are not saying carrier will intentionally provide wrong information but there are layers in each claims department.
Will your center be able to form human relationships with insurance companies claims departments? These relationships take years to develop but they yield claims information. We leverage these relationships to benefit out clients.
Will your center be able to file the correct claims? If you are moving from a 3rd party biller to in house, this is a serious issue. Then if there is a delay on finding out the claim has been denied, there could be months of lost revenue. A corrected claim, is even time consuming for a billing company to work.
Are you billing the appropriate claims? In some situations, a center can bill for multiple codes during treatment. The insurance companies are not going to tell you how to do this. The appropriate codes can lead to a significant increase in reimbursements.
In House Vs Third Party Cost
There are many methods and concepts for comparing in house costs against paying a 3rd party.
When you pay an employee to file claims, you are paying them even though you have not been reimbursed. Artemis is paid on reimbursed claims, so we work on performance.
Will you have multiple employees or will just one employee file claims? Who file if they are not there? How long will it take to train those employees? What kind of turnover will you expect.? How long can you budget with a loss of revenue?
Will you have time to manage a billing department? Will that time take away from your clinical goals?
What is your time worth?
Here is what the most important aspect of 3rd party biller. What value do you have for them? If you are an owner or executive director that finds known value in the billing services, then you will not be happy. If the 3rd party creates a more effective claims management process for your center, and you recognize and value that, then the fee will be acceptable.
A 3rd party billing company should help your center reach higher goals. This can only happen if the billing company believes in your vision and wants to be a part of it.