Retroactive Reimbursement Requirements For Credentialing
In many states, the law requires carriers to pay for covered services provided to the member during the credentialing process at the in-network benefit level and under the terms of the contract. To apply, the credentialing application must ultimately be approved by the carrier. Credentialing Requirements All health plans are legally required to use a database that is created and maintained by OneHealthPort/Provider Source for credentialing purposes. This includes non-delegated credentialing, where the medical staff services department of a [...]
What is CPT Code 97151 for ABA Therapy?
After August 1st, 2021 all authorizations requested on or CPT code 97151, for assessment and treatment plan development, need to be authorized for up to 32 units. This translates into a total of 8 hours for an initial assessment, which is broken down into 24 units, comprising up to 6 hours for all subsequent authorization periods. Though it’s also worth noting that CPT code 97151 still needs to be conducted over 14 calendar days or less. This means that [...]
Federal No Surprises Act Explained. Consumer Protection Against Surprise Medical Bills
The federal “No Surprises Act” took effect on January 1st, 2022, which enforces a new set of balance billing requirements for providers as well as private insurance companies and health plans. Though there are several facets of this act that need to be understood. In some states like Washington, additional regulations might also apply. Though this starts with first asking and answering some important questions. What Is Considered A Surprise Medical Bill? Before the No Surprises Act was passed, [...]
How To Start An ABA Therapy Practice: The Ultimate Guide
If you have a deep passion or calling for providing your community with specialized Applied Behavioral Analysis therapy services, and you have reached the point where you want to break out to start your own ABA practice, then this ultimate guide to starting an ABA Therapy practice is the perfect place to start. If you are a BCBA then you have likely had the chance to supervise behavior analysis as well as mentor other ABA therapy providers. Though when [...]
What Is Fee For Service vs Value Based in Healthcare?
Fee For Service or FFS is one of the most common payment methods in the healthcare industry. With this model, a healthcare provider, physician, therapist, or solo practitioner is reimbursed based on the number of services they provide. This includes therapy sessions and the application of specific treatments. Though it’s important to note that in an FFS model payments are not specifically bundled, which essentially means that the insurance provider, health institution, or the government payer agency needs to [...]
99211 CPT Code Use Case Scenarios For ABA Therapy
CPT codes play a critical role in medical billing. Using the wrong code in the wrong place or for an incorrect type of diagnostic or treatment process can lead to potential claim rejections and denials. Not to mention a very serious risk of delays in your practice’s revenue stream. One of the CPT codes that come under scrutiny by some insurance providers and public health institutions is the 99211 CPT code. Though knowing precisely when to use this 99211 [...]
How To Prevent Burnout With Your BCBA / RBT Practice
Whether you are a Board Certified Behavior Analyst (BCBA), a Registered Behavior Technician (RBT) with years of experience, or you are new to the ABA field, chances are good you’ve heard people talking about feeling “Burned Out”. Of course, people working in Applied Behavior Analysis Therapy are well-known for experiencing this phenomenon. What Does It Mean To Be Burned Out? The Merriam-Webster dictionary defines “Burn Out” as “Exhaustion of physical or emotional strength or motivation usually as a result [...]
When To Use Place Of Service Codes In Behavioral Health?
It seems like medical billing codes are constantly being tweaked, changed, or redirected in how they can be used. For a small practice or solo practitioner it can feel very much like a hassle to keep up with them and all the changes in minutia codes like the place of service codes. The truth is, providers everywhere frequently struggle to memorize billing codes that always seem to change. Yet it remains true that the proper use of all these [...]
REBT vs CBT for Behavior Therapy
There are many different therapy approaches, theories, and techniques used by mental health providers to engage with their patients to help them navigate their circumstances as well as develop healthy emotional skills. The particular modality that a provider employs can vary depending on a variety of factors, including preference. Though it ultimately boils down to the needs of a particular client. Many of the popular lines of thinking apply better to certain situations or help to engage with patients [...]
How to Reduce BCBA / RBT Turnover
Applied Behavior Analysis Therapy practices have always been challenged by issues with employee turnover, and the fact that it transfers an enormous cost to the business side of maintaining a thriving ABA practice. Though the grounded reality of this problem has only increased interest in possible ways to reduce turnover with Board Certified Behavior Analyst (BCBA)/Registered Behavior Technician (RBT) and improve long-term retention rates. If your ABA practice has been struggling to address BCBA and RBT turnover, some strategies [...]
