As an ABA provider, you are overlooking a key element of the ABA billing process that needs attention. And that key element is secondary insurance!
You already know that ABA billing can be very expensive for patients, and the insurance part of ABA billing is confusing. Utilizing primary insurance properly and understanding secondary insurance adds to the complexity of ABA billing.
If you want to ensure that revenue flows seamlessly in your healthcare practice, then you have to simplify primary insurance and master secondary insurance. This may sound like a daunting process, but don’t worry.
This blog is your guide to grasping secondary insurance claims better and learning how you can boost your operational flow to maximize revenue.
Let’s start by diving straight into discovering why secondary insurance matters more in ABA billing!
Importance of Secondary Insurance in the ABA Billing Process
ABA therapy is very detailed, and sometimes kids need 20 to 40 hours of therapy in a single week. Some kids may also need extra time for supervision, assessment, and parental training.
Because the process is so intensive, it generally leads to longer treatment durations, more CPT codes, and a more complex medical billing process.
Due to this, the treatment costs increase and extend beyond the primary insurance cover. When primary insurance underpays the treatment cost, the remaining cost becomes the patient’s responsibility (out-of-pocket costs).
However, a lot of patients have secondary insurance that could cover the remaining costs.
Now! Even if you are aware that you can recover your revenue through secondary insurance, you still need to file claims accurately.
The real problem starts when you know what’s holding your healthcare practice back, but you don’t know how to achieve it.
Understanding Secondary Insurance - What Is It?
Many families have additional insurance known as secondary insurance. Some may have it as a second parent’s employer plan, others as a state supplemental plan, COBRA, a retiree plan, or Medicaid as secondary.
The most important part is that secondary insurance only comes into the picture when primary insurance underpays. So, the primary insurance always pays first, and then if there is some amount left, it is paid by secondary insurance.
The Process of Secondary Insurance Claims in ABA Billing
Here’s the step-by-step process of billing your claims through secondary insurance:
Step 1
Bill your claims through primary insurance first. This remains the first step for all insurance claims.
Step 2
After processing your claims, your primary insurance provider will send you an Explanation of Benefits (EOB). This will tell you the amount paid by the insurance provider and the out-of-pocket cost for patients, if any.
Step 3
You have to submit your secondary claim along with the EOB file attached. The EOB will specify the already paid amount to the secondary insurance provider.
Step 4
And then the secondary insurance provider will review your claim and pay the remaining amount of your revenue.
If these steps are done properly, they will lead you to earn complete reimbursement and also prevent the patient’s family from paying out-of-pocket. However, if these steps are not followed accurately, you will lose your compensation.
What Happens If the Secondary Claim Doesn’t Go as Planned?
The first scenario is where you don’t actually file a secondary claim. This happens due to lack of awareness or lack of secondary insurance. In the latter case, the family is liable to pay, but in the case of lack of awareness, you lose revenue.
Additionally, if you bill your secondary claim incorrectly, even then you lose revenue. For example, there is a balance of $70 after the primary insurance claims have been paid. This is just for a single session. Now think you offer multiple sessions to that patient throughout the week. You lose thousands of dollars per month.
However, this will not happen if you do the secondary insurance claims right. Even if you don’t recover 100% of your revenue, you will still recover more than 90% of your revenue.
What Makes ABA Billing Process Challenging – Exploring Other Complexities
We discussed how secondary insurance claims are causing revenue loss. But there are other factors that cause revenue leakage, and it is crucial to address them as well. Because you need an overall corrective approach to boost the bottom line.
Here’s a list of other challenges in the billing process:
ABA Therapy Is Vast: It Includes Various Services
ABA therapy includes various services such as parent training, supervision, and more. The billing process needs documentation, coding, and claim filing for all these, which makes the process complex.
The Process of Attaining Authorization Is Tricky
Pre-authorization is a must for an efficient ABA billing process, and the rules to attain it are quite strict. But if you are unable to acquire pre-authorization, your claims will result in denials.
You Need to Meet Medical Necessity Standards
You also have to establish a medical necessity for rendering services to patients. This is also extremely important due to the seriousness of ABA therapy. But failing to meet these standards will lead to claim denials.
Insurance Providers Have Different Rules
You must deal with two different insurance providers to recover revenue for every other patient. However, every insurance provider has different rules. Some may allow reimbursement of all treatment hours, while others may reimburse only for half. These rules act as roadblocks for healthcare providers.
Documentation Process Is Challenging
The documentation process of primary and secondary insurance claims must be in order and accurate. Even minor mistakes can give insurance providers a reason to deny your reimbursement.
All these reasons not only increase complexity but also spike your stress. That’s why you need a one-time solution that manages both common complexities and secondary insurance.
Choose Medical Billing Services to Do It All for Your ABA Practice
You just need a medical billing partner who could simplify all the mentioned issues and kickstart your revenue cycle management once again.
Here’s how a medical billing partner will help you:
Eligibility Check
Your billing partner will simplify the process for you by ensuring eligibility checks for both primary insurance and secondary insurance. Being proactive will save time and help prevent complexities later in the process.
Timely Claim Submission
Medical billing services will streamline the entire billing process, ensuring accuracy and efficiency in all billing steps. Then, they will make sure claims are submitted on time to avoid denials caused by late submission.
Accurate EOB Documentation
EOBs must be correctly attached so that the secondary insurance provider understands them. Your billing partner will take care of the documentation process and ensure accuracy in EOBs.
Tracking Unpaid Claims
Another thing that a medical billing company does is track your insurance claims. This helps in knowing the status of your claims, including unpaid claims and where they are in the reimbursement process.
Denial Resolution
Medical billing companies are experts at identifying the cause of denials, refiling them, and recovering the lost revenue. They successfully appeal unnecessary denials and reclaim the lost revenue. It also includes improving the administrative process as a whole to avoid denials in the first place.
Payer Rules Compliance
Your medical billing partner will stay up-to-date with all regulatory rules and stay compliant with them. This will make the medical billing process more efficient.
Effective Administrative Handling
Last but not least, your medical billing partner will elevate your overall administrative process. Allowing you to de-stress and focus on treating patients and not billing complexities.
Final Thoughts – Secondary Insurance Will Help You Prevent Revenue Leakage
Mastering secondary insurance claims is your road to maximizing revenue. But that’s not all! You need equal attention towards other ABA billing steps. And you don’t have to do all this alone. You can simply hire a medical billing partner and let the experts handle complexities.
Your first step towards preventing revenue leakage and ensuring consistent revenue starts with Eminence RCM.
We at Eminence RCM are well-versed at handling secondary insurance claims. Our team is ready to take your administrative responsibility and prevent you from financial uncertainty. We are experts at managing the entire medical billing process without breaking a sweat. So, it’s time to stop struggling and start recovering complete revenue from ABA services with Eminence RCM. Explore our website to know more about our services!
.webp)