Applied Behavior Analysis (ABA) is the science of behavior and application of research-based methods to ameliorate socially significant behavior. As behavior analysts, our services of designing, implementing, evaluating, and modifying treatment programs of behavior change as well as providing consultation to individuals and organizations are covered under certain insurance claims. As clinicians working with insurance companies, we are held to the ethical and professional standards set by multiple agencies, including but not limit to the Behavior Analysis Certification Board (BACB), HIPAA privacy guidelines, state regulatory organizations and the United States Department of Health and Human Services (HHS). This course will provide you with the information needed to successfully and ethically navigate the realm of insurance billing. You will be equipped with the knowledge of which of the BACBs Guidelines for Responsible Conduct apply to billing, best practices in billing and ethical issues, information about billing codes, what constitutes fraudulent billing and how to avoid fraudulent billing. *Participant complaints regarding this or any other BACB CE event requirements violations must first be directed, in writing, to the Relias Learning ACE Coordinator, Rhonda Davin, PhD. Please contact Dr. Davin via email: [email protected] The ACE Coordinator will make every reasonable attempt to resolve participant complaints; however, should the ACE Coordinator be unable to resolve the complaint, the complainant may file a formal complaint directly with the BACB.
This course is designed to meet Ethics CE requirements as outlined by the BACB.
CEU Type: Learning
Section 1: Introduction A. About This Course B. Learning Objectives Section 2: Billing for Services: Guidelines for Responsible Conduct A. Scenario: Ethical Dilemmas in Billing B. 2.07 Maintaining Confidentiality C. 2.13 Fees, Financial Arrangements and Terms of Consultation D. 2.14 Accuracy in Reports to Those Who Pay for Services E. 2.15 Referrals and Fees F. 9.05 Avoiding False or Deceptive Statements G. Review H. Summary Section 3: Best Practices in Billing Clients and Ethical Issues A. Client Rights B. Neutrality C. Professional Integrity D. Honesty E. Confidentiality F. Review G. Summary Section 4: Billing Codes A. Billing Codes B. New Temporary AMA Billing Codes C. Review D. Summary Section 5: Identifying Fraudulent Billing A. Fraudulent Billing B. Common Medical Billing Fraud C. Fraud as a Felony and Consequences D. Who Monitors Fraudulent Billing? E. How to Avoid Fraud F. Case Examples of Fraudulent Billing G. Review H. Summary Section 6: Conclusion A. Summary B. Congratulations
Dr. Bryan Davey currently serves as President of Highland Behavioral and Chief Clinical Officer at Ensure Billing in Phoenix, Arizona. His professional experiences include being an administrator, certified special education teacher, consultant to schools, businesses, and behavior analytic agencies nationwide, and establishing multiple agencies in which ABA services are delivered to families and within school districts. He has expertise in training organizational personnel in the application of behavioral principles and procedures, functional behavioral assessments, intervention implementation, autism insurance laws, and effective teaching practices. Dr. Davey has developed a unique understanding of how insurance companies operate with regard to Autism coverage and ABA services. His experiences as a provider and agency administrator afford him a working knowledge of licensing, credentialing, insurance billing and claims adjudication. He assists organizations to implement policies and procedures for working with insurance companies in states that have and have not passed autism insurance laws. Dr. Davey actively supports the process of developing, implementing and monitoring ABA benefits for large self-insured companies. Dr. Davey consults for Fortune 500 Companies, insurance carriers, school districts, families and behavior analytic agencies across the United States. He has presented his research and conducted workshops at numerous regional and national conferences including ABAI, APBA, BAAM, and CalABA. Disclosure: Bryan Davey, PhD, BCBA-D has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.Expert Reviewer: Jessie Marshall, MAS, BCBA
Jessie Marshall currently serves as Research Coordinator of HOPE Group. Her educational background consists of psychology, business, early intervention, research and Applied Behavior Analysis. Her professional experience includes administration, teaching, serving as a research technician for a nation-wide autism prevalence study and as a state ambassador for the same autism study, as well as serving as a lead trainer for habilitation and respite providers. Her clinical expertise includes assessing infants and toddlers for early intervention services, observing and assessing familial relations, providing direct therapy as a habilitation provider and as a behavior technician as well as writing behavior program and treatment plans for clients with developmental disabilities. Disclosure: Jessie Marshall, MAS, BCBA has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
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