Case Study: Optimizing Collections for an ABA Therapy Practice
An Applied Behavior Analysis (ABA) therapy practice achieved a 41.6% increase in collections by redesigning its billing and revenue cycle workflows. Through targeted interventions — resolving duplicate denials and aligning with Tricare billing requirements — monthly collections rose from $150,000 to $200,000, and average monthly collections improved from $120,000 to $170,000.
These process enhancements created a stable, compliant, and scalable financial structure.
2. Client Background
The client provides ABA therapy services to children and families, employing Registered Behavior Technicians (RBTs) under Board Certified Behavior Analysts (BCBAs). Claims are submitted using provider-level modifiers (HO, HN, HM) based on qualification. The payer mix includes Tricare, Medicaid, and commercial insurers, each with unique billing requirements.
3. The Challenges
Despite consistent service volume, revenue stagnated due to billing inefficiencies and noncompliance.
Key Issues Identified
Duplicate Denials: Multiple charge entries were submitted for the same patient and date of service, leading insurers to deny subsequent claims as duplicates.
Tricare Noncompliance: Claims lacked rendering provider details and service times, triggering repeated documentation requests and delayed payments.
These issues resulted in a high denial rate, A/R backlog, and unpredictable cash flow.
4. Solutions
4.1 Root Cause Analysis
Fragmented ABA Billing Workflow: Individual therapist submissions created redundant claims for the same patient/date.
Payer-Specific Noncompliance: Tricare-required data (rendering provider and service timing) was missing, causing denials and audits.
4.2 Strategic Interventions
4.2.1 Eliminating Duplicate Denials
Conducted denial trend analysis to identify recurring issues.
Consolidated claims by patient and date, resubmitting as single, combined claims.
Introduced a “Hold and Consolidate” billing workflow, ensuring all therapist notes were collected before submission.
Result:
Duplicate denials were nearly eliminated, and first-pass claim acceptance significantly improved.
4.2.2 Achieving Tricare Compliance
Completed a payer-specific audit to identify documentation gaps.
Modified billing setup to include individual rendering provider, session times, and supervising BCBA.
Created Tricare-specific templates and trained billing staff on compliance rules.
Result:
First-pass acceptance rates for Tricare claims increased substantially, and reimbursement delays decreased.
5. Results
| Metric | Before | After | Improvement |
|---|---|---|---|
| Monthly Collections | $150,000 | $200,000 | +33% |
| Average Collection | $120,000 | $170,000 | +41.6% |
| ABA Denial Rate | High (due to duplicates) | Significantly reduced | — |
Additional Benefits
Reduced A/R days by over 20%.
Streamlined collaboration between billing and therapy staff.
Improved payment predictability and cash flow.
5.1 Key Takeaways
Consolidating daily claims prevents duplicate denials and improves billing accuracy.
Therapist-level billing detail ensures payer compliance and faster payments.
Regular denial audits help identify process gaps early.
Collaboration between clinical and billing teams sustains RCM performance.
Conclusion:
By restructuring charge entry and enforcing payer-specific compliance, the ABA therapy practice turned systemic revenue leakage into measurable financial gains.
The result: a 41.6% increase in collections, improved cash flow, and a sustainable model for continued growth.
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