Successfully Navigate ABA Insurance Laws

Los Angeles Healthcare Billing ProviderApplied Behavior Analysis (ABA), is recognized as the most effective therapy for autism-related deficits, leading to reform of autism insurance laws across the country. This was a victory for families affected by autism, and practitioners like you who specialize in ASD diagnosis and treatment.  It is the only evidence-based treatment method recognized by most major insurance carriers, for the treatment of autism.

As with any victory, there are associated tolls that can complicate the good news. In this case, it is that insurance laws are not consistent from state to state, which makes it very difficult for patients and practitioners alike to navigate.

With ML Medical Billing, however, navigating the choppy waters of insurance laws is much easier. Not only do we have 30+ years of experience serving practices like yours with top-notch medical billing services, but we also offer the expertise and knowledge that you need, particularly the specialized aspects inherent to ABA billing services. Where few billing companies have even the knowledge or certification to help your practice, we have an experienced ABA billing team to handle the billing and insurance services, while you focus on treatment and successful outcomes.

Medically Necessary and Mandatory

Autism insurance laws were reformed when ABA was classified as a “medically necessary” form of autism therapy, leading to state-specific insurance mandates requiring all fully-funded individual and group plans to cover Autism diagnosis and treatment as medically necessary, as well. Although each state law is different, the laws generally define required treatment as habilitative and/or rehabilitative services. These changes helped lessen the financial pressure on families across the country.

These changes also help practitioners like you, who have been championing ABA for years, and continue to advocate for the proper reform for access to medically necessary care. As providers, you are now able to focus on delivering appropriate and effective treatment under the auspices of various ASD coverage laws.

But, as you know, the reforms and improvements in the insurance laws are not without kinks.

Inconsistencies from State to State

Despite your tireless reform efforts, the laws and guidelines for determining coverage differ significantly from state to state, including variations in:

  • Age restrictions
  • Coverage and visitation limits
  • Qualifications of ABA practitioners

These are just a few of the aspects that can affect the protections for patients and families as well as the reimbursement to you, the practitioner.

Here’s a quick example comparing Alabama and California:

Alabama:

  • Coverage applies to any insurance plan with 51+ employees
  • $36K a year limit
  • No visitation limits
  • For children 9 years old or younger
  • Practitioner must be a board-certified behavior analyst (BCBA)

California:

  • Coverage applies to any disability insurance plan and all health care plans that include hospital, medical, or surgical coverage
  • No visitation limits
  • No age restriction
  • Practitioner must be licensed or certified by any national entity, such as Behavior Analysts Certification Board

As you can see, a simple comparison of states in two different areas of the country shows significant distinctions.

If you are focusing on providing the best treatment possible, how can you keep up with such distinctions, particularly when the number of cases is increasing and when reforms likely will continue evolving?

What ML Medical Billing Can Do for You

Florida Healthcare ABA BillingWhile your primary focus is obviously on caring for your patients, you’re still running a thriving practice, so getting paid is also a priority. This is our primary focus. That’s why our specialized ABA services are designed to let you do what you do best.

Our experience, practice management applications, and state-of-the-art technology are all designed to ensure that you can be confident in our specialized ABA services, which standard medical billing won’t cover. We know how ABA billing and authorization guidelines can vary widely across individual insurance policies, as well as treatment  – including assessment and reassessment, parent training, and supervision.

But that’s not all – here’s what else ML Medical Billing can do for you:  

  • Insurance case management support
  • Patient billing and collections to sustain revenue
  • Credentialing and HIPAA compliance
  • Understanding billing codes for ABA treatment (TCodes)
  • Established relationships with all major insurance carriers
  • Understanding how clinical documentation can impact billing and reimbursement

For ABA Medical Billing Expertise, Contact ML Medical Billing Today

When you outsource your billing and coding to ML Medical Billing, you’ll get the ASD-related insurance billing and claims expertise you deserve!  Contact ML Medical Billing for more information on navigating ASD-related regulations and increasing cash flow for your practice.

Next, read Preparing Your Practice for the New Medicare Beneficiary IDs