Single Case Agreements, also known as SCAs, are contracts between an insurance company and an out-of-network provider.
Month: April 2024
Relative Value Based Reimbursement
The Resource-Based Relative Value Scale (RBRVS) represents the foundational payment model utilized by the Centers for Medicare & Medicaid Services (CMS) and the majority of other payers. While still new to ABA therapy services, this system is rooted in the philosophy that reimbursement should align with the underlying costs of providing such services. The RBRVS […]
The Difference Between Rejected & Denied Claims
Submitting healthcare claims is a complex and ever-changing process as new technology and regulations bring changes that make understanding claims processing sometimes feel like a moving target. Understanding claims processing is an evolving skill, but learning the basic language is the first step to successfully navigating this landscape. One of the keys is knowing the […]
Writing ABA Treatment Plans for Medical Necessity
Applied behavioral analysis or ABA therapy is considered medically necessary by most, but certainly not all, insurance companies or plans. Payers require that services they approve and reimburse are medically necessary, and providers must have documentation to justify these services. Review these guidelines to help prepare treatment plans.
ABA Therapy Documentation Best Practices
Medical records are a critical service piece for both patients and providers. These records document the health, well-being, medical needs, plan of care, medical necessity and treatment(s) rendered for a patient during their time with a clinician or therapist. This information is frequently reviewed by internal and external medical professionals, patients, and third-party payers. Failure to document information correctly can not only be detrimental to a patient’s care, but it can greatly impact payment for services.
HIPAA and Confidentiality for ABA and Behavioral Health Providers
All healthcare providers must be very familiar with the basics of HIPAA and state confidentiality regulations, as well as the requirements of their certification or licensure regarding confidentiality. In addition, as a practice, a comprehensive HIPAA analysis should take place regularly to ensure all required safeguards have been put in place to minimize risks.