Single Case Agreements, also known as SCAs, are contracts between an insurance company and an out-of-network provider.
Author: Jessica Barnett
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.
Understanding CMS, NCCI, and MUEs, And How they Pertain to ABA Billing
MUEs can impact daily billing for ABA therapy. ABA providers should be familiar with the rules and regulations of CMS and NCCI.
What should be included in the ABA intake paperwork?
Initiating ABA services can be a cumbersome and time-consuming process for both the patient and the provider. Documenting medical necessity and the need for services andthe proper consents, are a critical part of a patient’s medical record. Most of this information is gathered during the intake process, which starts before the patient’s first appointment.
Why is Payment Posting in Medical Billing Important?
Many steps are involved in the revenue cycle management process. Posting payments and reconciling accounts is necessary to ensure that a provider is receiving all payments to which they are entitled.
Need Health Insurance?
Have you or your patients struggled with finding or maintaining health insurance? Many new options are available currently for coverage between COBRA, marketplace and Medicaid.
What is Coordination of Benefits and Why is it Important?
Coordination of Benefits for ABA therapy. One more step in understanding how to get paid.