Running a small or mid-sized medical practice often requires primary employees to involve themselves in multiple activities, and this can sometimes lead to inefficiencies and a reduction in the quality of services that patients and their families receive. Having to verify network and insurance statuses, billing processes, and other legal or financial aspects of your business can lead to poor efficiency, repetitive audits, revenue losses, and much more. Let’s learn how you can streamline business activities and improve your business’s legal and financial aspects.
The Importance of Effective Care
Independent medical practices are the backbone of care in most of our country. They are often the primary source of non-emergency care. Many dental services operate independently, and so do therapy services that focus on Autism Spectrum Disorder (ASD). A large chunk of independent care providers only employs a few people because they need to operate “lean” teams to ensure their practices achieve and maintain profitability. This sometimes results in a case where an ABA therapist must contact and confirm with insurance providers before being able to offer care. Larger operations can afford to employ people to focus on administrative, legal, and financial tasks, but this luxury is not always available.
In a perfect world, this wouldn’t be an issue; caregivers, insurers, and patients could work together smoothly. Every second spent doing something inefficiently is a second spent not offering care; it’s time for your practice to move to the easier side of life by outsourcing aspects of your business to specialized providers like billing, legal, booking, and the like. A single case agreement can be the key to unlocking the full potential of your business.
Single Case Agreements
Missing Piece ABA billing Single Case Agreements (SCAs) are essential within the medical space because they allow patients to access specific health procedures or treatments for specified periods. These agreements are often between an insurer and an out-of-network provider on behalf of clients. In the past, negotiating single-case care with out-of-network providers was tedious and time-consuming; this unpalatable experience led to the growth of SCAs within the ecosystem. The agreements often specify the type of care, duration, agreed-upon rates, and sometimes cover conditions for extension. SCAs have been crucial in medical compliance over the past few years.
What Happens When SCAs Are Not Implemented?
Lost Revenue
No business wants to lose money, especially with small and medium-sized practices that cannot afford to miss out on revenue. Revenue can be lost when care has to be denied, delayed, or deferred; losses can also arise when caregivers have to spend time working on administrative and other “non-medical” activities. Single-case agreements can help ensure that you tap into as many customer classes as possible, whether within the network or not.
Care Denial
Applied Behavioral Therapy (ABA) is helping kids with ASD live better and more productive lives. ABA therapy has achieved incredible results in the lives of current and ex-patients. Imagine how heartbreaking it must feel to deny, delay, or defer treatment due to insurance and billing-related issues. Nobody wants to experience this; one of the few ways to avoid this is through SCAs. ABA care might not be the easiest form to access in many parts of the Midwest. Your current provider changing insurance networks can suddenly put you and your family in limbo, as the next provider in your network might be hours away.
Constant Audits and Stunted Growth
Failure to outsource critical aspects of your growing practice means you or another critical employee might need to work on the books, engage with insurers, file claims, follow up on administrative procedures, and other important (and distracting) activities. Your practice is more likely to get things wrong, miss deadlines, or act in ways that require frequent auditing. It’s also harder to grow your practice when you’re too focused on “everything else.” Implementing SCAs can be the first step to preparing your practice for the future while offering excellent value today.
Much Ado about Single Case Agreements
Out-of-network providers may be required when in-network options cannot offer comparable quality of care. A patient already used to a service shouldn’t have to start over because said service goes out-of-network. Providers may also work with SCAs when they are in the process of joining your insurance network. When applying for an SCA, it’s essential to get all your paperwork in order and better understand what these types of agreements are about and the intricacies like billing, duration, conditions, and more. Unfortunately, SCAs may take more time to finalize due to insurer delays.
What’s Next?
You need a service that has your best interests at heart and is willing to go the extra mile to ensure that you and your family get the best ABA therapy care possible through single case agreements if necessary.
