Payor Delays Are Hurting ABA Practices. A Medical Billing Specialist Shares What to Do

In the wake of Florida’s recent transition to Statewide Medicaid Managed Care (SMMC) for behavioral health services, providers are reporting significant ABA billing delays, with long wait times for treatment approvals and claim reimbursements. These delays are threatening the well-being of the children and the financial stability of ABA practices.  

To help providers navigate these troubled waters, we spoke with Damaris Rodriguez, a Medical Consultant and Multi-Specialty Medical Billing Specialist, Certified in Health Information Technology with over 20 years of experience. As the founder of Abundantly Blessed Medical Billing Services, Rodriguez has guided dozens of practices through complex reimbursement changes and offers valuable insights for surviving the current crisis.

The move from traditional Medicaid to Managed Care Organizations (MCOs) has created what can only be described as a perfect storm of payment delays. “I personally feel MCOs were not prepared to handle the volume of claims during this transition period,” Rodriguez says.

Here are the most common causes of payor delays that Rodriguez says she is seeing with ABA providers right now:

“The influx of claims during the transition overwhelmed the MCO’s systems, leading to longer processing times and delays in payments to providers and patients,” she notes. “The pressure to quickly process claims may have resulted in errors, leading to incorrect denials of legitimate claims.”

She also points out that “the MCOs’ inability to keep up with the volume of claims may have also impacted their ability to efficiently contract with new providers.”

She highlights a critical challenge in the new system: “The shift to billing through Managed Care Plans introduces complexities and delays due to varying rules and processes for each payer. Each payer has different requirements and standards for claims processing, including timelines for payment and electronic claims submission.”

The specialist further explains that “these differences are outlined in contracts between the Agency for Health Care Administration (AHCA) and the MCOs,” and adds that “the ABA software development team has been required to create special insurance configurations for specific payers’ requirements for claims processing that were not required by Medicaid, in order for claims to process correctly for payment, this has caused delays in payments, and agencies have been required to resubmit corrected claims with claim modifications.”

“During the COC transition period, it has been challenging for agencies to stay updated with claims updates due to the fact that payers have not been allowing access to provider portals unless the credentialing process is finalized,” Rodriguez explains.

This information blackout makes it nearly impossible for providers to identify and address claim issues proactively, creating a frustrating catch-22 situation. 

With ABA billing delays in Florida mounting, many providers are seeking immediate ways to protect their revenue cycles and avoid operational setbacks.

While system-wide improvements are needed, your practice can’t afford to wait. We asked Rodriguez what providers can do right now to protect their revenue cycle during this challenging transition. She shared seven actionable strategies:

“Ensure accurate and timely documentation,” Rodriguez advises. 

The margin for error in documentation has never been smaller. Ensure your clinical team understands that incomplete or inaccurate documentation isn’t just a compliance issue—it’s now a direct threat to your practice’s financial stability.

Damaris Rodriguez stresses the need to “track authorizations conscientiously and submit re-authorization requests early.” With MCOs applying varying authorization requirements:

• Submit re-authorization requests well before current authorizations expire
• Implement tracking systems to flag approaching authorization deadlines
• Maintain detailed records of all authorization communications

“Insurance verification for new clients and monthly to make sure insurance is active, and that the client has not changed or been assigned to a different MCO plan,” Rodriguez recommends. She specifically warns providers to “make sure there is not any alert under TPL (Third Party Liability) for other health coverage, which will cause a denial due to COB (Coordination of Benefits).”

The specialist advises providers to “collect client financial info upfront.” She recommends:

• Implement financial responsibility form at intake.
• Communicate patient responsibility before services are rendered.
• Collect any deductibles, coinsurance, or patient copays upfront when benefits are verified with the payer.

“Conduct internal QA (Quality Assurance) before claims are submitted,” says Rodriguez. Her specific recommendation is to “designate someone internally (or with your billing service) to review claims before submission to avoid denials for billing errors.”

Rodriguez emphasizes the importance of “Denial Management.” Her advice is to “monitor denials, rejections, and aging, track the reason codes and denials trends. Fix problems at the source, educating providers and administrative teams to avoid these denials in the future, and fix and resubmit claims for payment. Follow up on outstanding claims in a timely manner.”

“Keep credentialing up to date to avoid any payment delays,” she advises. This simple but crucial step can prevent your entire revenue stream from freezing unexpectedly.

While no technology can completely eliminate these challenges, selecting the right practice management system can make a significant difference. We asked Rodriguez about technology solutions, specifically about ABA Matrix.

“ABA Matrix is a wonderful solution for ABA therapy providers,” she explains. “One of the many benefits of using this practice management system is their billing integration feature (ABA Matrix integrates with Claim MD) and their white glove service customer support.”

Rodriguez highlights several key advantages of ABA Matrix when it comes to ABA billing: 

• Faster Claims Submission and Reimbursement: Billing Integration automates tasks like claim creation, submission, and tracking. This reduces the time staff spend on manual data entry, allowing therapists and admins to focus on what matters most: client care.
• Fewer Errors and Rejections: Manually entering billing information increases the risk of mistakes, which can lead to claim denials or payment delays. Integration helps reduce human error by pulling data directly from therapy notes, scheduling, and documentation.
• Improved Compliance and Audit Readiness: Clearinghouse integration ensures documentation aligns with billing codes and requirements, lowering the risk of audits and penalties.
• Real Time Financial Visibility: Practices can easily generate financial reports, monitor revenue cycles, and identify issues like claim rejections or late payments, all in one place.
• Improved Client Experience: Fewer billing errors and delays mean fewer disputes or confusion for families, helping maintain trust and satisfaction.

The transition to Medicaid Managed Care represents a fundamental shift in how ABA services are billed and reimbursed. By implementing robust internal processes and leveraging appropriate technological solutions, your practice can minimize the impact of ABA billing delays in Florida and continue delivering essential care.