In majority cases, ABA (Applied Behavior Analysis) therapy providers successfully maintain a focus on billing primary insurance. However, confusions occur when the client has 2 insurance policies.
Correctly billing the secondary insurer is equally important, but it is frequently done incorrectly. This confusion of two insurance plans results in missed payments, lost revenue, and more administrative work.
Here we will guide you best about;
- When the secondary insurance should be billed
- How to properly bill secondary insurance for ABA services
- How to steer clear of pitfalls that result in clawbacks or denials
- Workflows and best practices to maximize your revenue cycle management (RCM) for secondary claims
This useful manual is specifically for billing teams, RCM managers, and ABA providers. Any practitioner who wishes to minimize billing waste and collect all reimbursable dollars can benefit.
Why Billing Secondary Insurance in ABA Therapy is Important?
Billing secondary insurance is essential to obtain full reimbursement.
- If your practice is properly managed, a client with dual coverage may result in additional payment through the secondary plan. (for example, the mother’s employer plan plus the father’s plan)
- Insurer clawbacks, delays, or claim rejections may result from improperly overlapping secondary billing. Billing in the incorrect order could also be a reason.
- Every missed payment can add up to a substantial amount for ABA services, where every session, progress note, and therapy hour has value.
When Secondary Insurance Should Be Billed
- Verify Coordination of Benefits and Dual Coverage (COB)
- Check to see if the client has multiple insurance plans during intake. What is the primary plan? Which is the secondary one?
- Using COB rules, such as the birthday rule, parent policy, and employer policy, ascertain the order of payment (which payer pays first).
- Know that you must bill the primary payer before the secondary, even if you are not in the primary payer’s network.
- Await the primary decision.
- An Explanation of Benefits (EOB), which is necessary for secondary billing, is obtained after the claim is submitted to the primary insurer and processed (payment, adjustment, or denial).
- Most payers need the primary’s payment/adjustment information on the secondary claim.
- Don’t send the same claim to the secondary insurer before the primary has finished adjudication.
- Verify ABA Services’ Secondary Coverage
- A secondary policy does not always cover ABA services just because it exists. Check for any caps or exclusions, benefits, and modifiers.
- Find out if the secondary plan has different requirements, uses the same CPT codes (such as 97153 and 97155), or comply with the same rates.
- Send in by the deadline
- Check each insurer’s timely filing limits. Missing minor deadlines can lead to claim rejection.
- Ideally, maintain a workflow where once the primary claim is finalized, you initiate the secondary claim quickly.
Step-by-Step Guide to Billing Secondary Insurance for ABA Services
Step 1: Get the required paperwork ready
- Get the EOB/RA (Remittance Advice) from the primary payer, which details what was paid, what was adjusted, and what was the patient’s responsibility.
- Make sure the secondary policy is active, the client’s insurance information is accurate, and the COB is recorded.
- Make sure your primary and secondary insurers have your provider credentialing up to date (especially in ABA therapy contexts where credentials matter).
Step 2: Examine the Results of the Primary Claim
- Look at the coverage provided by the primary payer. Did they make a partial payment? Did they reject some units?
- Make a note of the units, CPT codes, and any modifiers for ABA services (e.g., 97155 – supervision, 97153 – direct therapy).
- Find out which portion, such as the unpaid portion, patient responsibility, or additional covered units, may be billed to secondary.
Step 3: Get the secondary claim ready and submit it.
- Make use of the appropriate form or electronic format (usually CMS-1500 for professional services).
- Add the EOB details and the paid or adjusted amounts for the primary payer.
- Make sure to include the secondary payer and make it obvious that the claim is a secondary submission by using COB indicators.
- Use the same CPT codes, units, modifiers, service date, and place of service, but modify to comply with the regulations of the secondary payer.
- If the secondary insurer requests it, attach the primary EOB or make reference to it.
Step 4: Track and Monitor the Secondary Claim
- Monitor the claim’s progress. Did it get approved? Rejected or Changed?
- If denied, quickly note the reason (e.g., duplicate claim, COB not recorded, modifier missing, timely filing) and, if necessary, file an appeal.
- Keep track of the following metrics: the percentage of clean claims, days to payment, and secondary claim denials.
Also Read: How to Educate Your Staff on Accurate Medical Documentation for Billing
Why Using Specialized ABA Billing Services or Outsourcing Is Beneficial
Secondary insurance billing adds a substantial administrative burden. Particularly in ABA therapy where payer regulations are complex. There are various benefits to working with a specialized ABA billing company:
- Professionals with knowledge of the specifics of payer-by-payer ABA services
- Workflows that are automated and smoothly move primary claims to secondary
- Denial prevention systems and analytics to track performance
- Reduced burden on your internal staff, allowing more focus on patient care
Our Two Cents
It is important to bill secondary insurance for ABA services in order to maximize collections and improve the financial stability of your practice. You can make sure that money isn’t lost by confirming dual coverage.
Just follow a methodical process, file claims in the right order, and stay clear of common mistakes.
If you want to increase your primary and secondary payer reimbursement, decrease denials, and streamline your ABA billing. Contact our team to schedule a free consultation on your current secondary billing workflow.
Learn from our experts on how to optimize your revenue cycle for ABA services. In majority cases, ABA (Applied Behavior Analysis) therapy providers successfully maintain a focus on billing primary insurance. However, confusions occur when the client has 2 insurance policies.
Correctly billing the secondary insurer is equally important, but it is frequently done incorrectly. This confusion of two insurance plans results in missed payments, lost revenue, and more administrative work.
Here we will guide you best about;
- When the secondary insurance should be billed
- How to properly bill secondary insurance for ABA services
- How to steer clear of pitfalls that result in clawbacks or denials
- Workflows and best practices to maximize your revenue cycle management (RCM) for secondary claims
This useful manual is specifically for billing teams, RCM managers, and ABA providers. Any practitioner who wishes to minimize billing waste and collect all reimbursable dollars can benefit.