Does any of this sound familiar?
- You feel overwhelmed, stressed or frustrated dealing with insurance companies.
- You love caring for children with special needs, but insurance claim problems are piling up and distracting you from growing your clinic.
- Insurance companies are unwilling to pay for services rendered due to errors (ABA credentialing issues, pre-authorization issues, insurance company processing errors, and numerous other potential errors), costing you valuable revenue.
That's where we come in...
Our RCM Process for ABA Clinics
At Advocate Insurance Billing, our Revenue Cycle Management (RCM) process is the backbone of our services, offering a comprehensive solution to manage the financial health of ABA clinics.
We streamline the entire lifecycle of patient accounts, from patient registration and insurance verification to billing, claims processing, and payment collection. Our approach integrates technology with expert knowledge to ensure accuracy, compliance, and efficiency at every step.
We focus on maximizing revenue and reducing delays by addressing potential issues proactively. Multiple team members work tirelessly to keep the revenue cycle running smoothly, enabling behavioral health providers to focus on delivering quality care to children without the administrative burden of insurance operations. With our robust RCM process, we ensure financial stability and growth for our ABA clinics.
See our separate page for ABA Credentialing and Contracting Services for more information on this service.
We understand the critical importance of accurate insurance verification in the insurance billing process. Our comprehensive Eligibility and Benefits service ensures that before patients step into the clinic for care, their insurance coverage is thoroughly verified and confirmed. We diligently verify patients' insurance eligibility, benefit details, co-payments, deductibles, patient policy status, effective dates, and more, using our efficient system and our experienced team.
Pre-Authorization is a pivotal step designed to secure necessary approvals from the insurance company for procedures and behavioral health treatments before they are carried out. We work closely with healthcare providers and insurance companies to provide the clinics with the information they need to know so that all required documentation is accurately submitted and approvals are obtained promptly.
This process not only facilitates a smoother billing cycle but also significantly reduces the risk of claim rejections or delays.
Our expertise in ABA insurance billing and claims processing stands as a cornerstone of our services. We specialize in navigating the complexities of behavioral healthcare billing, ensuring that every claim is accurately processed and submitted in a timely manner.
We diligently track each claim through its lifecycle, from submission to final payment, actively managing denials and appeals when necessary. This thorough approach maximizes reimbursement rates and minimizes delays, allowing behavioral health providers to focus on patient care without the burden of insurance intricacies.
With Advocate, you can expect a partnership that enhances revenue cycle efficiency and supports the financial health of your practice.
This is a crucial stage in the RCM process and is essential for maintaining the financial accuracy of your healthcare practice. We handle the posting of payments and adjustments from EOBs (Explanation of Benefits) and ERAs (Electronic Remittance Advice), ensuring that every transaction reflects the correct amounts.
We meticulously reconcile deposits with the insurer's remittances, guaranteeing accuracy in patient accounts and financial records. Our detailed approach identifies discrepancies, underpayments, and denials, enabling prompt corrective actions.
You (and your patients) will know where your accounts are at, and this clarity will bring peace of mind.
Effective management of rebilling and appeals is critical in the pursuit of fair compensation for healthcare services, and we focus on each one until it is resolved. Our appeals management process is designed to confront and correct claim denials and underpayments.
When claims encounter resistance, our seasoned billing advocates step in to analyze and construct compelling appeals based on an understanding of payer policies and healthcare regulations. We assemble the necessary documentation, articulate the rationale for services rendered, and re-engage with insurance companies to ensure that your claims are reconsidered and rightfully settled.
This approach not only recovers revenue that might otherwise be lost but also upholds the integrity of the billing process, ensuring that each claim is given its due diligence.
Our process involves issuing clear and detailed statements to patients for any remaining balances due after insurance processing. We understand the importance of transparency and simplicity in patient communications, ensuring that each bill accurately reflects the services rendered.
Our team can handle inquiries with sensitivity, providing patients with the necessary support to understand their financial responsibilities.
New Clinic Set Up for Billing
We offer a setup service for new clinics. It involves obtaining NPI numbers, billing software set up, clearinghouse setup, various online account setup, etc. We have experience in setting up new clinics, and provide you with valuable advice to guide you through the process.
We offer a review/audit process to discover if a clinic’s patient accounts are in good order, if clinic procedures are accurate and efficient regarding diagnosis codes, charge codes, etc. This service is normally done for a non-billing client as the first step to them utilizing our services.
Insurance Audit Assistance
Periodically, insurance companies will audit a clinic. Understanding the complexity and stress associated with these audits, we provide expert guidance and assistance every step of the way. We come alongside of a clinic and help them through this nerve-racking process.
We will work closely with your clinic to thoroughly prepare for the audit, ensuring all documentation is in order and compliance standards are met. We help interpret the audit requirements and assist in gathering and organizing necessary records.
Many times we are the front person/contact person for this process, keeping the practitioners and clinic staff out of this process as much as possible!
Let's to serve the greater good.
Don't try to navigate the complexities of ever-changing insurance policies and regulations by yourself. We’re here to advocate on your behalf.