Medical Necessity and Insurance Issues in ABA Practice
Hours: 1.00
Medical necessity is a condition required by payor sources for reimbursement for services. Understanding medical necessity as related to providing ABA services is critical for practitioners. However, it is not always easy to define and implement. Each third-party payor has their own definition of what constitutes medical necessity. In 2019, Current Procedural Technologies, or CPT®, codes for applied behavior analysis services approved by the American Medical Association, or AMA, clarified the notion of medical necessity somewhat. However, strategies for determining medically necessary services still vary across circumstances. This course will offer some broad definitions of medical necessity as it relates to ABA and some strategies for ensuring payment.
The goal of this course is to provide behavior analysts in clinical practice with information regarding medical necessity and treatment planning.
This training program is offered independent of the Behavior Analysis Certification Board® (BACB®).
Medical necessity is a condition required by payor sources for reimbursement for services. Understanding medical necessity as related to providing ABA services is critical for practitioners. However, it is not always easy to define and implement. Each third-party payor has their own definition of what constitutes medical necessity. In 2019, Current Procedural Technologies, or CPT®, codes for applied behavior analysis services approved by the American Medical Association, or AMA, clarified the notion of medical necessity somewhat. However, strategies for determining medically necessary services still vary across circumstances. This course will offer some broad definitions of medical necessity as it relates to ABA and some strategies for ensuring payment.
The goal of this course is to provide behavior analysts in clinical practice with information regarding medical necessity and treatment planning. This training program is offered independent of the Behavior Analysis Certification Board® (BACB®).
Behavior Analyst Certification Board
This course is designed to meet CE requirements as outlined by the BACB.
CEU Type: Learning
Identify behavioral symptoms that align with payor definitions of medical necessity.
Describe AMA CPT codes as they relate to medical necessity.
Describe treatment plan development strategies that support medical necessity.
State ways to ensure staff are providing medically necessary services that meet payor standards.
Outline:
Section 1: Introduction
About This Course
Learning Objectives
Section 2: Behavioral Symptoms and Medical Necessity
Health Insurance, Billing Codes, and Medical Necessity
Symptoms of Autism and Medical Necessity
Review
Summary
Section 3: The AMA Codes
Major Changes
Assessment Codes
Treatment Codes
Obtaining Authorizations
Review
Summary
Section 4: Treatment Planning Strategies
Assessment for Treatment Planning
Building a Payor-Friendly Treatment Plan
Updating the Plan
Review
Summary
Treatment Plan Implementation Issues
Policy and Procedures
Staff Training
Compliance Monitoring
Review
Summary
Section 6: Conclusion
Summary
Course Contributors
References
Congratulations
Dr. Rhonda Davin is a Board-Certified Behavior Analyst with over 25 years of experience in the fields of developmental disabilities and autism. She has served the field as a teacher, college professor, consultant, and expert witness. She started Behavior Consulting Services which provided direct behavior analytic services to children with autism and their families. She has supervised and mentored several behavior analysts and service providers currently practicing in the field today. Dr. Davin has also provided technical assistance for large-scale organizational change efforts in the area of Positive Behavior Supports. Disclosure: Rhonda Davin, Ph.D., BCBA-D has no Relevant Financial or Non-Financial Relationship with ineligible companies to disclose.Subject Matter Expert: Ashley Williams, BCBA-D
Dr. Ashley Williams is the Sr. Clinical Director for Behavioral Concept Inc.’s Eastern Massachusetts region, overseeing five BCI learning centers located in Wilmington, Woburn, Newton, Braintree and Brockton. Dr. Williams has overseen home- and center-based services for BCI (formerly ABACS) for 10 years. She serves as President of MassCAP, a Massachusetts trade organization, and is one of two behavior analysts on the state’s licensure board for Allied Health. In addition to her work at BCI and current board roles, Dr. Williams teaches at Northeastern University in their graduate and undergraduate ABA programs. Disclosure: Ashley Williams, BCBA-D has no Relevant Financial or Non-Financial Relationship with ineligible companies to disclose.
The target audience for this course is: Behavioral Analyst; in the following settings: Intellectual Developmental Disabilities.
Asynchronous/Online Distance Learning; please see certificate details for specifics on delivery format.
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All courses offered by Relias, LLC are developed from a foundation of diversity, inclusiveness, and a multicultural perspective. Knowledge, values and awareness related to cultural competency are infused throughout the course content.
Reference herein to any specific commercial product, process, or service by trade name, trademark, service mark, manufacturer or otherwise does not constitute or imply any endorsement, recommendation, or favoring of, or affiliation with, Relias, LLC.
All characteristics and organizations referenced in the following training are fictional. Any resemblance to any actual organizations or persons living or dead, is purely coincidental.
To earn continuing education credit for this course you must achieve a passing score of 80% on the post-test and complete the course evaluation.
If you require special accommodations to complete this module, please contact Relias Customer Support here.
