In-House vs. Outsourcing: Choosing the Best ABA Billing Service for Your Practice

In the realm of ABA therapy, your commitment to positively impact your clients' lives is paramount. While clinical care is the heart of your practice, billing for services is the lifeblood that sustains it. This blog explores three common options – self-billing, in-house billing, and managed ABA billing services – to help you find the best fit for your practice's unique needs. Choosing the ideal billing solution is crucial for ensuring your practice's financial health and sustainability, ultimately enabling you to continue delivering life-changing care to those in need.

"while clinical care is the heart of your practice, billing for services is the lifeblood that allows it to beat"

This blog explores three common options – self-billing, in-house billers, and managed ABA billing services – to help you find the best fit for your practice's unique needs. We'll delve into factors like practice size, experience level, and payment complexity, guiding you towards an informed decision that empowers you to focus on what matters most – your clients.

‍Self-Billing Approach

Self-billing is a practice where the business owner personally manages all aspects of the billing process without outsourcing or delegating the task to external entities. In a self-billing arrangement, the owner takes on the responsibilities of invoicing, claims submission, payment processing, and overseeing the entire revenue cycle. This is typically ideal for new or small practices.

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Benefits

• Keep costs low: Self-billing eliminates the need for additional staff or outsourced services, making it a budget-friendly option as you're getting started.
• Maintain direct control: You have complete oversight of the billing process, making adjustments and ensuring accuracy as needed.
• Gain valuable knowledge: By managing your own billing, you gain a deeper understanding of insurance regulations and coding requirements.
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Considerations

• Time Commitment: Mastering billing codes, regulations, and navigating different insurance systems requires dedication and ongoing learning.
• Potential for Errors: Mistakes in billing can lead to delays in reimbursement and require extra time to rectify.
• Limited Scalability: As your practice grows, self-billing may become increasingly time-consuming and complex to manage effectively.

Hiring an In-House ABA Biller

In-house billing is a method where organizations handle billing processes internally instead of outsourcing them. A general rule of thumb for hiring is to expect one dedicated staff member for every $100k of monthly billing. This approach provides a certain level of control and visibility over financial workflows, allowing for potential adjustments and tailored procedures. Some benefits may include increased efficiency, the potential for immediate issue resolution, and having a dedicated team familiar with the company's unique billing requirements.

A general rule of thumb for hiring is to expect one dedicated staff member for every $100k of monthly billing.

Benefits

• Control and Visibility: If you want to be very hands on in the billing process, then having an internal team will give you more visibility into this aspect of the practice.
• Staff Familiarity: Teams can become more familiar with the company's operations, clients, and specific billing intricacies, potentially leading to a smoother and more efficient billing process.

Considerations

• Time: Do you have the time and experience needed to bring on and manage your internal team? This includes time and experience to onboard, train, manage and audit performance and collection rates?
• Variable Return: In-house billers will typically be paid hourly/salary instead of a percentage of what is collected. This could be a cost benefit, or an increased expense depending on the pay for the position, and the collection rate they are able to achieve.
• Phantom Costs: Consider the "Phantom Costs" of hiring internally beyond salary. These include taxes, benefits, equipment, licenses, etc

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‍What to look for in an ideal in-house ABA biller candidate:

• Experience in ABA billing: They should have a strong understanding of ABA-specific codes and regulations, as well as experience navigating different insurance requirements.
• Attention to detail: Billing accuracy is essential, so ensure the candidate possesses excellent attention to detail and a meticulous work ethic.
• Excellent communication skills: They should be able to communicate effectively with insurance companies, patients, and other healthcare providers.
• Strong organizational skills: Managing a large volume of claims and documentation requires strong organizational skills and the ability to prioritize tasks effectively.
• Ability to learn quickly: The healthcare billing landscape is constantly evolving, so the ideal candidate should be adaptable and eager to learn new information.

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ABA Managed Billing Services

Benefits

• Controlled Costs: Most vendors will bill for a fee of the revenue they collect. This means that your costs will remain relative to the revenue coming in compared to an in-house billing team with a fixed salary regardless of what was collected.
• Collection Rates: Vendors often collect 93% and above, so depending on your current collection rate, an experienced ABA billing company may be able to increase your cash flow by collecting more of what you billed. If your current collection rate is less than 85%, managed billing services might be a worth considering.
• Scalability: Your billing needs may change as your practice grows. A vendor will offer more flexibility for scaling on demand to meet your evolving needs.
• Experience: Trying to find an in-house biller with experience in a wide range of commercial, Medicaid and Tri-Care plans might not be realistic. So, if your practice has a complex range of plans you are in network with, you might benefit from a vendor with a team that matches your exact needs.
• Consistency: Turnover will eventually happen, even at the best companies. Having a vendor with a team of billers will ensure that your cash flow is not disrupted by inevitable employee turnover.

If your current collection rate is less than 85%, managed billing services might be a worth considering.

‍Considerations

• Experience and expertise: Choose a vendor with a proven track record in ABA billing and a deep understanding of the specific challenges faced by ABA practices.
• Technology and infrastructure: Ensure the vendor utilizes advanced technology and secure infrastructure to handle your sensitive patient data and financial information.
• Scalability: Your billing needs may change as your practice grows, so choose a vendor that can scale their services to meet your evolving needs.
• Transparency and communication: Look for a vendor that provides clear communication and detailed reporting, allowing you to track your billing performance and stay informed.
• Security and compliance: Partnering with a vendor committed to data security and adhering to HIPAA regulations is crucial.

The Perfect Fit for Your ABA Therapy Practice

As your ABA practice thrives, your billing needs will evolve. Remember, you have options! Self-billing offers control and cost-effectiveness for smaller practices. In-house billing provides greater oversight and customization for mid-sized practices with the resources to support a dedicated staff. And for larger practices or those facing complex billing challenges, managed billing services deliver expert guidance, efficiency, and peace of mind.

Ultimately, the best choice depends on your unique circumstances. Carefully consider your practice size, experience level, budget, and billing complexity. Here are a few ideas to get you started:

• Is your in-house team currently collecting at or above 85%?
• What is the cost of in-house salaries and "phantom costs" compared to collection fee of a vendor. (Industry average is typically 5% or less of what is collected.)
• Do I want to be closely connected to billing operations for oversight into hiring, onboarding, and collection oversight? Or would I prefer to focus more on clinical aspects of my business?
• Do I expect my practice will grow dramatically over the next few years?
• Do I have a complex billing network (commercial, Medicaid, TriCare, etc) that might benefit from an experienced billing vendor?

By weighing the pros and cons of each option, you can make an informed decision that empowers you to focus on what matters most – delivering exceptional ABA therapy to your clients.