LET YOUR CLAIM NEVER BE DENIED!

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Any Provider’s worst nightmare is a backlog on claims, hours spent on recording, filing, and submitting claims just for it to be denied at the end. We understand and don’t want ABA billing codes to put a strain on your therapy practice. For many providers, keeping up with ABA billing codes, changes in regulation/coverage, and chasing down payments have become a constant burden.

Therefore we AMROMED LLC, a 13 years experienced company plays a key role in providing the best back-end medical billing support to end the provider’s worry with an astounding track record of 98% return on the claim.

We provide innovative healthcare solutions to the physician technician and QHP pertaining to ABA therapy billing and Medical Billing Services dealing with their billing needs such as Payer consultation / AR follow up / Verification of Benefits / Credentialing / Payment posting / Coding / Charge entry. Experts in the ABA fields have found our billing solution ideal and covering all the prospects required by the ABA therapists across the country.

Basic Steps to submission with CPT Code & WHAT WE DO?

Initially, we manage practitioner requests and get approval from each of the practitioner’s funding sources to utilize any CPT code. To get approval, we contact your payors/insurance to make any necessary adjustments and execute your contract amendment including the updates to fee schedules, and any other pertinent information or specific requirements that must be followed for your successful bill and get reimbursed for sessions in which you are using this code. Going over these details to enable you to determine whether or not you will be able to successfully bill and get paid is a stressful process. When managed by us AMROMED LLC it prevents you from delaying your entire revenue cycle management process due to the improper use of the wrong code, while ensuring you don’t face recoupments during a payor-initiated audit.

If we get approval from payors, we confirm whether that your clients have the necessary coverage under their individual insurance policies. To do so, we will need to re-verify the client’s benefits, review their authorizations, and configure any limits that may be required. In summary; even if the payor has granted approval for your CPT code, it does not mean clients are necessarily covered. Re-verification of benefits and authorization updates are imperative and will set you up for successful billing and reimbursement down the line which is handled by the AMROMED team in a smooth hassle-free manner. 

However, each claim must be submitted with ICD-10-CM codes that reflect the condition of the patient, and indicate the reason(s) for which the service was performed.

Claims submitted without ICD-10-CM codes will be returned. 

How can AMROMED help here?

With 13 years of experience and a team working from various time zones. We are able to be a one stop solution to all your medical billing issues. From handling submission to making sure the patient and provider are linked to payer without delay or hassle. 

The Amromed software has many built-in features that will enable a quick and effective transition to start billing with any code, including the ability to:

  • Set up the new service codes and fee schedules based on your payor contracts.
  • Limit the usage of codes in accordance with AMA guidelines and payor restrictions.
  • Edit and update client appointments quickly to start taking advantage of the reimbursement of these costly expenses as your payor and client authorization updates occur.
  • Quickly identify and track clients and appointments using the new billing code for effective reporting and analysis — including the use of custom labeling functionality across the system.
  • Remain compliant with payor requirements and develop session notes for providers to complete upon each session. This will facilitate effective tracking and recording of all necessary information related to any new CPT code, per the payor requirement, and keep all documentation linked to client records.
  • Continue billing processes by submitting all claims electronically (and billing more frequently) to improve cash flow.

However below are codes and requirements for a basic submission:-

Assessment Code 97151:

The medical record must reflect that 

(a) the required elements of the code are met; 

(b) a QHP completed the face-to-face direct and indirect assessments, interpreted the results, and wrote a report and treatment plan; and 

(c) the assessment was medically necessary.

Assessment Code 97152:

The medical record must reflect that 

(a) the required elements of the code are met;

 (b) the technician conducted the follow-up assessment in accordance with one or more protocols developed by the QHP; and

 (c) the assessment was medically necessary.

Assessment Code 0362T:

The medical record must reflect that 

(a) all four of the required elements of the code are met;

 (b) a QHP with expertise in the assessment of destructive behavior provided onsite direction to the technicians who completed the assessment; and 

(c) the assessment was medically necessary.

Treatment Code 97153:

The medical record must reflect that 

(a) the required elements of the code are met; 

(b) the technician delivered the treatment in accordance with one or more protocols developed by the QHP; 

(c) the QHP provided face-to-face direction and modification of the treatment protocol, as needed, via the 97155 code; and 

(d) the treatment was medically necessary.

Treatment Code 97154:

The medical record must reflect that 

(a) the required elements of the code are met; 

(b) the technician delivered the group treatment in accordance with a protocol developed by the QHP; 

(c) the QHP provided face-to-face direction and modification of the group treatment, as needed, via the 97155 code;

 (d) between 2 and 8 patients participated in the group; and

 (e) the treatment was medically necessary.

Treatment Code 97155:

The medical record must reflect that 

(a) the required elements of the code are met; 

(b) the QHP observed a technician implement the treatment protocol and made refinements as indicated, or implemented and systematically varied the treatment in order to refine the protocol;

 (c) the treatment was medically necessary.

Treatment Code 97156:

The medical record must reflect that

 (a) the required elements of the code are met; 

(b) the QHP provided training to one or more caregivers for a single patient with or without the patient present; and 

(c) the treatment was medically necessary.

Treatment Code 97157:

The medical record must reflect that 

(a) the required elements of the code are met; 

(b) the QHP provided training to multiple caregivers for multiple patients with no patients present; and 

(c) the treatment was medically necessary.

Treatment Code 97158:

The medical record must reflect that 

(a) the required elements of the code are met;

 (b) the QHP provided face-to-face treatment to a group of patients and adjusted the treatment as needed during the session; 

(c) between two and eight patients participated in the group, and (d) the treatment was medically necessary.

Treatment Code 0373T:

The medical record must reflect that 

(a) all four of the required elements of the code are met; 

(b) a QHP with expertise in the treatment of destructive behavior provided onsite direction to the technicians who delivered the services; and 

(c) the treatment was medically necessary.

Understanding each code & following its given protocol is mandatory. With the right partner like AMROMED LLC with its properly managed ABA billing software and backend support, your practice can tackle this burden of ABA billing codes and claims, generating better RCM cycles. Let us help you take your practice, quality of care, and payment satisfaction to the next level. Schedule a demo to learn more.

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