Supporting Your Practice: ABA Billing and Credentialing

Revenue Cycle Management is the financial process that healthcare facilities use to track patient care episodes from registration and appointment scheduling to the final payment of a balance. RCM involves managing claims processing, payment, and revenue generation, ensuring that healthcare providers are paid for the services they provide in a timely manner. 

Medical Billing Services involve the process of submitting and following up on claims with health insurance companies to receive payment for services rendered by a healthcare provider. This includes coding diagnoses and procedures, preparing and submitting claims, and handling any related correspondence with insurance companies to ensure that healthcare providers are reimbursed accurately and efficiently. 

Credentialing is the process of verifying the qualifications and background of healthcare providers, such as physicians, nurses, and therapists, to ensure they meet the necessary standards and regulations to provide care. Contracting involves negotiating and establishing agreements between healthcare providers and insurance companies, ensuring that providers are part of the insurance networks and can receive reimbursement for their services. 

 Denial Management involves analyzing and resolving claims that have been denied by insurance companies. It includes identifying the reasons for denial, correcting any errors, appealing the denials, and resubmitting the claims to ensure that providers receive payment. Effective denial management helps minimize revenue loss and improve cash flow. 

Insurance Benefits & Verification is the process of confirming a patient's insurance coverage and benefits before the service is provided. This ensures that the healthcare provider knows what services are covered, what the patient's financial responsibility will be, and can avoid surprises in payment delays or denials later on.

Authorizations Management refers to the process of obtaining approval from insurance companies before providing certain medical services or procedures. This is typically required for more expensive or specialized treatments. Managing authorizations ensures that the provider will be reimbursed for services, reducing the risk of claim denials and ensuring compliance with insurance requirements.