How Ensora Health helped Autism House increase their revenue and improve RCM 

This case study will demonstrate how Ensora Health’s RCM services have unraveled complex billing and revenue collection methods to create an efficient and seamless process for healthcare agencies. This is especially true amongst the growing Applied Behavior Analysis (ABA) community, as one ABA organization, Autism House, has experienced firsthand. 

Autism House provides behavior analytic services to children diagnosed with developmental and learning disabilities. Autism House was created with the mission to provide a fun and supportive environment for children to learn while participating in ABA therapy. An instrumental piece of providing any health care service, such as ABA therapy, is to ensure timely and accurate medical billing. These processes need to work seamlessly to avoid lapse in service or other serious financial losses. RCM services appear to be the most intuitive decision an ABA organization can make to safeguard their business. 

In-house billing challenges 

Prior to 2017, Autism House had managed their medical billing process in-house. In the beginning phase of a start-up ABA business, it seems to be the right move to keep the overhead cost down. However, it can quickly become a formidable task and actually wind up more costly, as Autism House has experienced. Autism House reached out to Ensora Health in April 2017 to learn about their Revenue Cycle Management (RCM) services after some billing challenges were encountered. Some of these challenges included things such as: 

• denied medical claims 

• inaccurate and delayed accounts receivable reports 

• incorrectly utilizing billing code modifiers 

• rates entered incorrectly into NPAWorks 

While one or two of these errors occurring occasionally wouldn’t hinder the financial stability of an agency, frequent errors for extended durations across all the abovementioned categories could potentially result in detrimental financial repercussions. 

Seeking solutions to seamless revenue management 

Autism House was proactive with their approach to tackle billing complexities head-on by deciding to locate a reputable Practice Management Software provider to support with vital billing processes. The leaders of Autism House knew taking this step would assist in increasing financial stability and the longevity of their ABA business for many years to come. Inevitably, this is what led the leaders of Autism House to Ensora Health. Eager to get started, both teams quickly connected and scheduled the exploratory meeting to discuss the benefits of using Ensora RCM. 

Transitioning to Ensora RCM 

Exploratory meeting 

There are multiple components involved with Revenue Cycle Management (RCM). For this reason, Ensora Health is focused on performing their due diligence when a new agency comes to them for support. This is achieved by setting up an exploratory meeting, or on-boarding meeting, where the ABA agency can share what challenges they are encountering and the outcomes they desire to achieve. Autism House was encouraged to ask questions during the exploratory meeting to make sure Ensora Health was going to be the right fit for what their practice needed. These questions included topics such as:  

• What is the insurance verification turnaround time? 

• How does the account receivable reports process work?  

• How to set up appointments using the insurance billing codes and convert them?  

• How to set up different fee schedules and link to proper billing codes (i.e., private pay, funder pay)? 

Dedicated account manager 

Being forward-thinking, Ensora Health sets up the on-boarding meeting and assigns a Dedicated Account Manager right from the start. A Dedicated Account Manager is someone who has extensive training and experience in managing ABA billing and is committed to getting every claim paid and maximizing revenue growth. The leaders at Autism House consider their Account Manager family and it is not hard to see why. Autism House shared how their Account Manager, who started with them in 2017, has remained the same to this day. It is no wonder they are called “Dedicated” Account Managers. 

Transition and implementation plan 

After all the necessary information is gathered, the next step of on boarding with Ensora Health consists of establishing general billing guidelines and procedures. The process encompasses the below RCM activities, or more depending on the individual service needs of the organization:  

• establish a billing cadence  

• schedule recurring meetings with the Account Manager  

• set up electronic data interchange (i.e., EDI, payer IDs) 

• thorough review and continued training of the software product  

• create plan and prepare for the first billing cycle to be completed by the Account Manager  

In terms of the timeline to transition Autism House to Ensora RCM, the account was live immediately after onboarding, and the Account Manager successfully completed the first billing cycle in about 4 weeks, respectively. 

Included benefits of RCM 

After learning of the billing challenges brought forth by Autism House, Ensora Health’s dedicated Account Manager went straight to work. To start, the Account Manager identified errors with billing codes and specific modifiers and quickly had those errors remediated. Account receivable (AR) reports were previously inaccurate due to billing errors with reimbursement rates and fee schedules, which resulted in more costly tax returns as proper deductions were not accounted for. The Account Manager quickly recognized these errors and personally worked with Autism House’s accountant to rectify claims and resubmit their taxes to which reportedly resulted in a sizable return. Other principal aspects of RCM services and benefits offered by Ensora Health, and their Dedicated  

Account managers include: 

• quick turnaround of insurance verifications 

• accurate and efficient claims submissions, including missed and/or corrected claims 

• adhering to individual funder’s billing policies and guidelines to avoid denied claims 

• proper use of clinical codes and modifiers 

• accurate clinical notes and documentation of services rendered 

• available to provide live support as needed 

• once per month account receivable (AR) report provided 

• frequent and consistent communication regarding any updates related to funder billing policies and guidelines 

Statistical overview 

The chart below depicts the average revenue increase from the baseline in 2017 when Autism House began their partnership with Ensora Health. 

The results depicted in the chart demonstrate the success Autism House has experienced over the past 4, almost 5 years, since beginning their journey with Ensora RCM and their personal Account Manager. Something even more commendable is the fact Autism House not only weathered the COVID-19 storm, but also managed to keep their revenue growth increase up by 50% of their initial baseline levels averaged in 2017. During a time when many ABA companies and other small businesses around the nation had to close their doors, Autism House was fortunate to have access to their Dedicated Account Manager. 

The Account Manager was able to provide support immediately and help channel essential information regarding insurance changes related to Telehealth billing guidelines. This allowed Autism House to continue to provide some familiarity of their client’s routines and meaningful ABA services during a time when the world was full of uncertainty. 

Analysis of overall benefits  

Autism House has experienced great success and reaped many financial benefits over the past few years since joining forces with Ensora Health and implementing Revenue Cycle Management services. The number of denied claims has reduced to near zero and has consistently remained at this level. This directly translates into dependable and accurate AR reports, so the leaders always know where they stand financially. The Administrative Manager from Autism House (2021) has kindly shared her experience working with Ensora Health stating:  

“It’s been great; lots of communication [and we] always have a good turnaround time. [We] are not left waiting and wondering what happened to this or that. [There is] less anxiety and worry if you know you have a dependable person you can contact about your billing (recorded interview, 2021).”  

The Dedicated Account Manager (2021) was interviewed to share his personal experience with providing RCM support. He shared how, “when people take on our RCM services, we are not just billing out for them; we are helping them with the software. We are a point of contact for them” (recorded interview, 2021). With a Dedicated Account Manager available to provide insurance updates as the information is released, claims are no longer submitted with errors which previously resulted in a lengthy correction process and delays with paid claims.  

Summary  

Ensora RCM services are detail oriented and unique in that the services provided consistently meet their consumers’ needs by having live support, training, and consistent communication readily available. These components were a game changer for Autism House and have helped their business continue to thrive. Despite the ongoing global pandemic that has rocked so many small and mid-sized businesses across the nation, Autism House is standing strong and dedicated to continuing to be a pillar of support for their team members and clients. Ensora RCM services has allowed the leaders of Autism House to reallocate their resources and time where it is needed the most, providing quality and meaningful ABA services, while greatly improving the consistency and accuracy of the revenue growth for their business in the process. 

The Autism House family  

Jessica Cordova founded Autism House in 2011 with the objective to provide a supportive and enriched learning environment for children on the spectrum and their families. The therapy sessions provided by the Autism House team are uniquely different from the majority of ABA clinic providers. That is, Autism House provides client services in a large two-story home which sits on 3.5 acres of beautiful Texas terrain. Autism House prides themselves on providing quality services on a personalized level for all of their families and have scaled their business strategically over the years to ensure the maintenance of this vital company value. Autism House has fortified a company culture with values centered around nurturing a child’s curiosity, promoting family-centered services, and most of all, making learning fun and stimulating for everyone. These values are encouraged amongst the 25 clients and families, 17 Registered Behavior Technicians (RBT), 2-3 Case Managers, 2 Board Certified Behavior Analysts (BCBA), 1 Billing Administrator and 1 On-site Manager. Autism House has a maximum number of 25 clients they provide therapy to at one time, which allows for quality services and personalized care for the entire team, as well as preserving the family-like culture they strive to uphold.