Brandon Herscovitch, Ph.D., LABA, BCBA-D

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Costs associated with buying BCBAs time can quickly escalate, and it’s important to have a full picture of those costs.

Let’s look at what it can cost an ABA practice to reduce their BCBAs’ caseloads by 1 billable hour per week.

We need to start with some basic assumptions from which we can do our math.

Let’s use some generic numbers, which are not meant to be reflective of any particular market. We’ll say $120.00/hr for BCBAs and $60.00/hr for BTs.

Let’s assume BCBAs supervise 20% of BT services, of which three quarters of that (15%) is billable. This can vary.

Now for the math: 1 BCBA hr per week at 120 = approximately $500.00 per month (120 x 4.33). Based on 15% billable supervision, that’s approximately $1800.00 (30 hours x 60 per hour).

So, for each hour you reduce from your BCBA caseloads per week, that can amount to a reduction of approximately $27,600.00 worth of revenue per year. Then, multiply that by the number of BCBAs at your clinic. If you have 10 BCBAs, that’s over a quarter million per year of revenue this investment can cost, which can directly impact the company’s ability to invest in quality and compliance.

The purpose here is not to suggest against doing this. In fact, I recommend this as a good way to support your staff, to the degree that is feasible. However, it’s very important to understand the implications of ABA billable hours and clinician wellness, and even be transparent with your staff so they understand too!

Brandon Herscovitch, Ph.D., LABA, BCBA-D
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Understanding the relation between ABA billable hours and clinician wellness is an important part of being an ABA practice leader. Partners Behavioral Health can help with your clinical and business standards, compliance, and outcomes. We can help you scale an ethical ABA practice you’re proud about.

The post Billable hours and clinician “mental space” in context: costs and care appeared first on Partners Behavioral Health.

In ABA, however, it’s common for therapy companies to invoice clients for their co-pays after services and for multiple sessions, for example, monthly. Despite providers’ best intentions, this practice can lead to challenges for clients and providers alike which we’ll outline in this article.

Five reasons to collect co-pays at the point of service:

1. It helps customers avoid accruing unmanageable balances and occasions a transparent and upfront approach to planning for that.
2. Though there are exceptions, providers can discontinue serving clients who don’t pay their bills, despite common misconceptions.
3. Liabilities stem from providers waiving, discounting, or not collecting co-pays.
4. Helps address cash flow challenges in the ABA practice
5. It helps reduce avoidable or redundant administrative costs.

Collecting co-pays at the POS as part of your regular RCM process can help foster healthier customer relationships in the long run and improve operations, enhancing the overall customer experience. Of course, being an early adopter of changes like this may be received with varying levels of acceptance and support across different stakeholders, and understandably so, but it’s worth considering how it can improve the practice and patient experience.

Providers might look at various options for accomplishing this change in a way that is best received by clients and staff alike.

Take Action: Here’s How

Moving toward this change in our field requires revisions to provider policies and procedures, assignment of responsibilities, staff training, and use of technology and practice management systems.

Center-based programs might implement this in a standard fashion; clients check in, pay their copay, then go in for their appointment.

In practice, the process becomes more complex for home or community-based services, so let’s look at that.

Home-based ABA providers can look toward POS copay collection solutions that allow customers to log in and pay their copay for a session before that session, which then triggers a text to the administrator and therapist. The ABA practice might have a policy requiring payment at a specific time before a session (e.g., between 2 and 4 hours).

In addition to addressing the five essential points above, this signals the client is ready for a session and may otherwise yield improved opportunities to reschedule staff and avoid unnecessary travel.

With this approach, (1) providers can maximize the opportunity to serve otherwise understaffed cases, (2) they can meaningfully address costs associated with cancellations and utilization, and (3) this can even improve staff satisfaction and experience associated with client cancellations.

Inevitably, there will be some practices and client populations where this won’t work well. In that event, providers may seek additional options or solutions. For example, triggering on-the-spot push notifications using a HIPPA-compliant mobile device as a payment processing tool. Of course, solutions like this would need to be agreed upon and accepted by all parties beforehand and therapists would need adequate training.

Quick Summary TLDR:

POS copay collection may not be the right solution for all ABA practices, but it could be a good solution for many people. We must be in a progressive field and learn from other healthcare professions and professionals who have already worked through many challenges we’re encountering as an emerging field.

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Brandon Herscovitch, Ph.D., LABA, BCBA-D

Our Partners Behavioral Health team comprises industry leaders in ABA and other more established healthcare sectors. We help our customers look at creative, transformative, and strategic approaches for their specific use case to build their competitive edge as they scale ethical ABA practices.

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Brandon Herscovitch, Ph.D., LABA, BCBA-D

Partners Behavioral Health can help with your clinical and business standards, compliance, and outcomes. We can help you scale an ethical ABA practice you’re proud about.

The post Ethical Billing: A Cornerstone of Trustworthy ABA Practices appeared first on Partners Behavioral Health.

Approaching contract negotiations in an informed manner is integral in this process. It should be tackled at the outset and not retrospectively or as an afterthought. When contracts are signed with commercial payers it can be very difficult to renegotiate better rates. If you are not intimately familiar with this process, this may be one of the worst places to forgo professional expertise. Just do the math. Changing your blended rates by even a few dollars can have a meaningful impact on your financial position and therefore your ability to reinvest in quality and compliance. This impact magnifies as you scale.

Here are 5 misconceptions that some ABA providers have about the process.

MYTH #1: COMMERCIAL HEALTHCARE FUNDERS CAN’T OR WON’T NEGOTIATE. 

False.

Commercial healthcare funders can negotiate. Any internal policies discouraging this activity can be modified or waived at the funder’s discretion. It’s generally a matter of bargaining power more so than anything else, so network adequacy is an important factor.

MYTH #2: CONTRACTING WITH ALL FUNDERS IN A GIVEN REGION IS A SIGN OF SUCCESS OR BETTER BUSINESS ACUMEN. 

False.

The reimbursement schedule commercial funders offer as their initial rates are largely market dependent. Knowing and negotiating to your budget is key.

MYTH #3: ACCEPTING RATES BELOW MEDICAID IS A REASONABLE OR STANDARD PRACTICE IN HEALTHCARE.

False.

In healthcare in general commercial reimbursement is often well in excess of public funders – Medicaid or Medicare. These public funders have processes for determining their rates and although this is not the only factor by any means, this is a relevant indicator and relevant to provider budgets and projections. 

MYTH 4: A FUNDER PROMISED ME THEY WOULD RE-EVALUATE MY RATES AFTER A YEAR IN NETWORK; THAT SEEMS LEGIT.

Unless you have that in writing, I would definitely say false.

If they’re serious about that they’d be willing to put it in writing, whatever the specifics of the arrangement may be. 

MYTH 5: FUNDERS WILL PROACTIVELY INCREASE REIMBURSEMENT RATES PROPORTIONAL TO INCREASES IN PROVIDER OPERATING COSTS

False.

SOME FINAL THOUGHTS: 

If any of your payer rates on their own can sink you, you might want to give that thought, since it’s possible your “better” payer lowers their rate. It’s not a regular thing, but it has happened multiple times across several markets. 

The “I’ll figure it out later approach” is not only unlikely to pan out, but it’s entirely irresponsible. You have people whose jobs depend on you, and clients who probably don’t want to get back on a waitlist at another provider.

ABA is an emerging market and whether it’s lack of knowledge on the part of providers, or market share, the reality is funders won’t make it a practice to pay more than they need. If providers keep taking the rates they’re offering, then why would it make sense to pay more, right? Providers operate independently and as part of a competitive market, and it’s up to the provider to determine whether the rates allow for sustainable operations that meet pertinent standards.

Brandon Herscovitch, Ph.D., LABA, BCBA-D

Partners Behavioral Health can help with your clinical and business standards, compliance, and outcomes. We can help you scale an ethical ABA practice you’re proud about.

The post Five myths about contracting with commercial healthcare payers appeared first on Partners Behavioral Health.