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ABA Business Insurance Overview: How Insurance Carriers View ABA Businesses (Webinar)

One of the most important aspects of having a business is protecting yourself and the business from legal backlash.

Join us as we walk through some action items to help mitigate risk while also explaining how insurance companies view ABA businesses.

Here are a few items we will discuss:

  • What Worker’s Comp Covers
  • Claims and Safety Tips
  • General Liability/Property/Auto
  • Claim Prevention and Prevention Programs
  • Cyber Liability and Employment Practice Liability

and more!

Our presenter is Jacob Kiley, Vice President at The Liberty Company Insurance Brokers who currently oversees their ABA program. Jacob has been enjoying the insurance industry for over 8 years. The passion comes from working with business owners every day to partner with them on how to mitigate risk. Starting in the claims department gave him a foundation of coverage analysis and how to work through the insurance process.


Rethink Behavioral Health Announces Strategic Partnership with Tellus EVV System

Rethink BH is excited to announce an official partnership with Tellus, in an effort to help Rethink users comply with the Florida Agency for Health Care Administration's (AHCA) new electronic visit verification (EVV) requirements.

FLORIDA, Dec 21, 2020 -- The 21st Century Cures Act has stated that effective January 1, 2021, agencies providing personal care services (PCS) and home health services (HHCS) must have an Electronic Visit Verification (EVV) solution in place.

The legislation applies to behavior analysis service providers in AHCA Regions 9, 10 and 11, and they can no longer bill through the Florida Medicaid Management Information System (FMMIS). These changes are all in an effort to reduce the rate of Medicaid Fraud throughout the industry.

Rethink Behavioral Health has announced a strategic partnership with Tellus, an EVV Software System designed to help customers comply with the Florida Agency for Health Care Administration's (AHCA) new EVV requirements.

Rethink’s EVV capabilities through Tellus gives service providers the ability to capture visit start and end times, report their corresponding GPS location, and seamlessly submit these visits to the state Medicaid office and track their statuses.

Customers will be able to meet mandatory compliance requirements quicker, easier and more accurately than ever before.

About Rethink Behavioral Health

Rethink is a technology company built with decades of experience in behavioral health. We offer all-in-one behavioral health solutions for businesses that include video-based RBT training, ABA data collection tools and practice management solutions to meet market demands. They are each robust alone, but even better together.

To learn more about Rethink, please visit: www.rethinkbehavioralhealth.com/bh/

Press contact: jamie@rethinkbh.com

Related Links:


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What is Electronic Visit Verification (EVV) & Why is it Important?

If you have any questions regarding your business or individual state requirements, don’t hesitate to reach out to us. We have a dedicated team standing by to help! CLICK HERE

The 21st Century Cures Act is a federal mandate which states that effective January 1, 2021, agencies providing personal care services (PCS) and home health services (HHCS) must have an Electronic Visit Verification (EVV) solution in place.

If they do not adhere, they are at risk of having their Medicaid claims denied. But what is EVV and why is it so important for ABA practitioners, parents and patients?

Continue reading this article to find out more useful information.

What is Electronic Visit Verification (EVV)?

Electronic Visit Verification, or EVV, is a new method used to verify home healthcare visits.

The purpose behind wanting more visibility is to ensure that visits are actually taking place and that patients are truly getting the care they need. Also, that Medicaid is being billed properly.

EVV helps cut down on home visit fraud by practitioners, and ensures that individual patient care is not overlooked.

How Does EVV Work?

EVV is a technology that allows professionals to track the following data:

  • Time service begins and ends
  • Date of service
  • Location of service
  • Name of individual receiving service
  • Name of individual providing service
  • Type of service and billing code

It’s important to note that while location will be recorded at the time of clock in and clock out, it will not be tracked throughout the actual shift.

Most EVV systems use GPS technology to pinpoint when a caregiver arrives at and leaves a location, while others utilize telephone lines.

In these cases, caregivers must call the agency office from a landline that can be traced back.

Benefits of Electronic Visit Verification

While having a basic EVV solution will help meet state legal requirements, there are more benefits for agencies, businesses and behavior analysis services providers.

Those who follow the rules will enjoy streamlined scheduling and billing, and those currently taking advantage of the system will no longer be able to do so.

Time will be saved as processes will be automated and client care will improve.

The 21st Century Cures Act

As stated in the introduction, The 21st Century Cures Act is a federal mandate directing EVV implementation and oversight.

Although the act sets key data points that must be collected and verified, each state will be responsible for creating and enforcing their own systems.

State governments will decide how to gather and report data used by EVV vendors, and whether or not to create additional compliance rules.

The Impact of Medicaid Fraud

Medicaid fraud has been rising sharply over the past few years.

According to The Wall Street Journal, the U.S. government recovered $3.3 billion federal health program fraud tied to individuals and companies in fiscal 2014.

That’s why effective EVV implementation is so important in preventing fraud, but also providing more accurate reimbursement for those who are following the rules.

Rethink Behavioral Health & EVV

Rethink’s practice management suite currently offers Electronic Visit Verification (EVV). This technology gives us the ability to accurately capture visit start and end times, their corresponding GPS location and seamlessly send these visits to the state Medicaid office via the Authorized EVV Aggregator.

Our goal is to help inform, educate, and train behavior analysis service providers as we move forward together with EVV and state mandatory compliance.

If you have any questions on anything in this article or specifically regarding your business or individual state requirements, don’t hesitate to reach out to us.


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Best Practices: Navigating the Contracting & Credentialing Process (Video)

Rethink billing software and services can help save your ABA therapy practice, clinic or business time and money by increasing efficiency and automation by eliminating workarounds, excel spreadsheets and lost revenue potential.

From our scheduling and billing synchronization, to easy reporting, business transparency, advanced reporting and compliance capabilities, you’ll have all the tools you need at your disposal.

You can also fully outsource your billing efforts with Rethink if you’d like. That all sounds great, right? But wait, there’s more…

New Partnership & Webinar

In case you missed it, we recently announced that MRC Billing has become part of Rethink Behavioral Health.

This new partnership further expands our Revenue Cycle Management (RCM) services by enabling us to offer Enrollment Services for a seamless credentialing and contracting process.

To celebrate, we hosted a webinar with Monica M. Hammel, who is now the Enrollment Manager at Rethink Billing (formerly MRC Billing) to discuss the following.

  • What you need to do to become contracted
  • What is a CAQH and what exactly is credentialing?
  • What to expect from the insurance companies
  • Types of contracts
  • Following up on your requests for contracts and credentialing

About the Presenter

With over 8 years experience of working for an ABA billing company overseeing the Enrollment and Credentialing Services, it is Monica’s department’s responsibility to verify how an incoming client is contracted and credentialed, so that we are billing the insurance companies correctly, from the very beginning of our relationship with our clients.

Throughout the years, Monica has found that 9 out of 10 customers have experienced some type of credentialing or contracting issue that resulted in denied claims PRIOR to deciding to outsource.


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Returning to Work: A Conversation to Resume Regular Operations

Returning to work will bring new legal and practical challenges for employers in all industries and geographies.

For this reason, it is imperative to have a plan in place while being cognizant of laws/guidelines to avoid any legal repercussions on your company.

Vanessa Kelly, a Labor & Employment Attorney and Litigator with Clark Hill, PLC, and Melinda Lapan, Vice President of HR Advantage Advisory, recently hosted a webinar to help businesses and individuals prepare to resume regular operations.

They discussed the following topics in detail:

  • Preliminary considerations
  • Preparing the workplace for safe re-entry
    • OSHA/CDC guidelines
    • State Health Authorities
    • Executive Orders
  • Hiring/Rehiring
    • Dealing with Workers’ Anxiety
    • Refusals to work
    • Telework, accommodations & leaves
  • Dealing with workplace exposures or workers who get sick
  • Takeaways/Action steps
  • & more!

About the Presenters

Vanessa Kelly is a Labor & Employment Attorney and Litigator with Clark Hill, PLC, a full-service, global law firm. Vanessa’s clients seek her experienced, confident counsel in addressing their employee management needs. She provides legal services including risk assessment and risk avoidance in employee terminations, accommodating disabilities, addressing workplace misconduct, protecting key personnel and proprietary information, performing reductions in force, and implementation of workplace policies designed to avoid disputes and comply with state and federal law, to name a few. Vanessa also defends employers before federal and state courts and civil rights agencies. Vanessa earned her J.D. at George Washington University Law School, and is licensed in both NJ and NY.

Melinda Lapan is Vice President of HR Advantage Advisory, a subsidiary of Clark Hill. HR Advantage Advisory provides HR outsourcing and consulting services. Melinda has over 20 years of Generalist experience in Human Resources, having worked in various HR leadership roles across multiple industries prior to joining HR-AA. She has a Master of Business Administration (MBA) degree and she holds two HR certifications: the PHR and the SHRM-CP.


Complete Guide & Resources for Telehealth in ABA Therapy

Introduction & Our Goal

Updated: 4/13/2020

No one was expecting the COVID-19 to force practitioners to provide from their homes. At Rethink, we have telehealth solutions integrated into our ABA practice management solution. For Rethink users, we have prepared guides and instructions on how to use our telehealth solution to conduct your remote sessions. We understand that not all of you are users of our platform, so we will be releasing content that can help support your operations.

Interested in learning how our solutions can help you? Click Here To Schedule Your Free Demo  

We are working hard to distribute the most up-to-date content that will help you transition your practice from in-person to remote sessions.  Our team will keep adding resources and sharing our knowledge as quickly as possible.

Please bookmark this page and check periodically for updates.


How To Guide Video

To Download Our Bundle, Please Fill Out Your Information Below:

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1. Rethink Parent Portal Task Analysis for Clinicians

This document is designed for clinicians to assist parents in the utilization of the Rethink Behavioral Health parent portal.

2. Rethink Behavioral Health Clinical Prep for Telehealth Services

This document provides resources for clinicians for setting up Rethink client profiles to provide telehealth consulting services.

Tips for Conducting Telehealth Consultation

This document provides general tips and suggestions in conducting telehealth consultations such as pre-service considerations, session format considerations, initial sessions, subsequent sessions, additional tips.

Parent Resources

This pack includes a Parent ABC Data Log and a Guidelines to Developing Behavior Management Strategies document.

Supervision Sample Templates

This pack includes an RBT Supervision Checklist (both PDF and an editable Word document), Performance Feedback – Supervision Consultation Form for telehealth (editable Word document) and BCBA RBT Supervision Session Note document.

Within Session Templates

This pack includes a Session Notes Template for Telehealth Consultation (both PDF and an editable Word document), Preference Assessment Checklist, Parent Strategies for Managing Challenging Behaviors, Initial Intake Notes Template for Telehealth (both PDF and an editable Word document), and various PDF and editable data sheets.

Guidelines for Practicing Applied Behavior Analysis During the COVID-19 Pandemic

These guidelines represent an expansion of some information that was first presented on March 25, 2020 in a live webinar hosted by the Association of Professional Behavior Analysts (APBA), titled “Telepractice of ABA During the Pandemic: Working with Health Plans.” (To access a recording of that webinar, click here). They are meant to provide general answers to some of the most common questions that have been posed to APBA since the outset of the COVID-19 outbreak in North America, and a framework to assist ABA practitioners in making certain decisions about whether and how to provide services to clients in the context of the pandemic.

Information and recommendations are offered in these areas:

  1. Determining if ABA services are deemed “essential” under emergency governmental
    orders or regulations
  2. Identifying and complying with applicable behavior analyst licensure laws and rules, in
    particular those pertaining to telepractice (i.e., remote delivery of ABA services via
    telephonic, audio, and/or video technologies)
  3. Using professional standards to guide decision-making about delivering services to
    clients
  4. Working with health plans and other third-party payers on the delivery of ABA services
    via telepractice

Source: https://www.apbahome.net/

Coming Soon!


ABA Therapy Claims Billing

ABA Therapy Billing Services From Rethink

ABA therapy billing services are now available to all Rethink Behavioral Health customers!

Prior to our billing services, Rethink customers only had the option of self-billing solutions. We have listened to our customers to fill a gap when it comes to billing for your ABA therapy services. 

Big or small, our ABA therapy billing services are built to scale

We believe that ABA practitioners should focus on providing care, not spending time reviewing payor contracts or following up on payments. While our ABA data collection tools, RBT training modules, scheduling and billing software improve your operations, billing departments may lag behind. A common reason billing becomes a burden due to external forces is when payor requirements are updated, and you get notified when you receive denials.  

You may have lots of questions, so we’ve listed some of the common concerns and thoughts our clients have below. Review them for help determining whether or not our services are right for your clinic.

Do you currently have an internal biller? 

If you answered yes, the next question you should ask yourself is “Does your current biller have the capacity to handle more work?” If you answered no to either one of these questions, then our solutions are a great fit for your organization.

Do you struggle in keeping up with payor requirements?

If you answered yes, then our billing solutions are definitely a great fit for you. Furthermore, if you are looking to diversify your payor mix in order to increase your clientele base, our team will help onboard your company with the new payors. Please keep in mind, we cannot negotiate contracts on your behalf as we are an extension of your team not a representative of your organization.

Are you looking to improve your cash flow?

While this is a silly question as most people will say, “Yes!”, one of the biggest benefits our customers see when they use our billing services is that we may help improve cash flow.  

Here's how...

We bill on a weekly basis and post payments once a week. In addition, our team reviews all denials and rejections. During our review, we analyze the reason behind the denials and we will address them with you to create improvements to reduce them. 

Is your billing department holding you back from scaling your business?

Customers that use our practice management solutions are able to scale their business without the worry of technology failing them. The benefit of technology is that it can scale as fast as you can hire and train new talent. Billing departments are vulnerable to scaling issues as it takes time to find the right resource. When you leverage our billing services, you can virtually scale your business as fast as you'd like without the worry of being backlogged with billing responsibilities (how awesome!? 🙌).

Do you want to ask somebody questions about billing or how to improve your process?

As an ABA therapy business owner, trying to keep up with client demands, insurance requirements, staffing efforts and other administrative burdens are not easy. Let alone, trying to create strategies around billing improvements. When you use Rethink’s billing services, you will have your own billing specialist will provide you transparent billing reports. Your billing specialist is your dedicated resource, they are there to help you grow and answer any questions you may have. 

For example, if our billing specialist notices is an increase in denials, they will start at the review of the data that is being collected by your team. If they notice inconsistencies in the data that are being collected they will notify you and provide you with guidance on how to improve. 

How much does this cost?

Our cost structure is aligned to the size of your organization and the volume of insurance claims. We would be happy to schedule a call to discuss options with you! To schedule a call with us click this link.


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Liability Insurance Basics & Current Claim Trends in ABA Therapy

This piece is based on our recent webinar presented by Daniel Law, ARM, CRIS and President of Liberty San Jose of The Liberty Company Insurance Brokers.

You can sign up for the monthly webinar series, Entrepreneurship in ABA, mailing list here.

One of the most important business principles is to have an effective liability insurance policy in place to not only protect your business, but also yourself.

Insurance may be required for certain transactions and are usually a pre-requisite for the following:

  • During the process of obtaining funds
  • When applying in a school district/Regional center
  • From Easter Seals/BHPN
  • When trying to lease an apartment, a landlord may ask insurance from you

On the other hand, in order to be eligible for insurance, one must know the following:

  • Limits and type of coverage is within the range $1m-$3m
  • Indemnification
  • Additional insurance
  • Waiver of subrogation

ABA providers face unique risks such as:

  • Inherent Risks with Autism
  • Professional Exposure
  • Dangers to Employees
  • In-Home, School-Based, Clinic
  • Hiring and Retention
  • Regulation (Licensing, Funding Source, Authorizer)

For ABA therapy, the liability coverages are as follows:

Professional Liability

This is covered by a wide range of aspects such as in professional services fees incurred, a wrongful act by an employee or even for some circumstances the government mandates that or from regulatory standards.

They may be liable as well to those who are additionally insured, who are already insured or those who have a waiver of subrogation.

General Liability

This covers bodily injury, property damage, personal injury and even advertising injury.

The coverage may be divided into 3rd party coverage, the number of occurrences, limits and deductibles.

The liability will also differ when there is additional insurance, has waiver of subrogation and to those with common exclusion.

Abuse/Molestation

This item covers the vicarious liability, exclusions, and limits with the first item being the most concentrated one.

Vicarious liability will be in effect if the person being insured is known, there is an innocent party defense, and what items will be/should be covered.

Automobile Liability

This item covers the hired automotive, non-owned automotive liability, and physical damage liability.

Physical damage is determined by which a person involved is insured/not insured, the application/coverage of the liability, and the determining of who can be able to drive and who cannot.

Cyber Liability

This is a liability policy that covers a data breach or compromised personal information of a client.

It can be covered by the consideration of HIPAA concerns, how much the coverage is and other options.

In this manner, the regulatory trends are appropriate to be considered.

The WCIRB – NCCI should be taken into account regarding Workers' Compensation changes while for funding sources, the increased requirements and increased scrutiny should be considered as well.

Lastly, for regulatory trends, it is important that accreditation, state licensing, and inspections are to be considered as well.

In the aspect of claim trends, the following should have attention:

Independent contractors

RBT cannot be an IC or else it would be Mis-classification.

In the event the IC wants to have the medical bills paid, the action over claims must be understood. In terms of work comp issues, one must consider looking into those who are not paying a premium.

Cyber/Data Breach

In this type of claim, several items should be assumed to be claimed:

  • HIPAA Allegations/Violations
  • The costs involved incurred by the breach
  • If the attacker claims for ransom
  • The liability on who owns the records

These are some of the items that may be claimed in the event of a Cyber/Data Breach.

According to Bloomberg, health data breaches can cost more than $400 per patient and have an average claim trend of ~3m per year.

This is due to the fact that Phishing and social engineering have been the major drivers of cyber events.

Employment Practices Liability

Possible claim items include misclassification, wrongful termination of an employee and failure to pay appropriate wages and incidentals such as overtime, drive-time, and breaks.

Workers’ Compensation

This claim item includes worker vs. contractor claim disputes, classification systems, and even the origins/causes of the injuries.

Injury to Children

This is one of the most sensitive items mainly due to the fact that children are involved in this situation.

Claims could come from the clinical setting, community outings (i.e. injuries from accidents on the event), and even child abuse/molestation.

Indemnity and Defense

This claim item includes the item about contracts (i.e. a school was being sued by its employee after being injured), how the claim works and what are the items seen in certain situations.

Rethink Behavioral Health provides an intuitive and comprehensive solution to scale your ABA business and ensure client success.

Our one-stop-shop platform is HIPAA compliant and offers both Clinical and Practice Management tools along with RBT Training, VB-MAPP licenses, and more than 1500 resources/materials as curriculum pieces.

Schedule a demo today at your convenience!


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New Category 1 CPT Codes for Applied Behavior Analysis (ABA) Services

rethink-vbmapp-promo Category 1 CPT Codes

Anthony Porcelli, Manager of Billing Services for Rethink Behavioral Health, had the pleasure of attending Dr. Wayne Fisher’s workshop on the new Category 1 CPT Codes for ABA Services, which will be effective January 1, 2019.

I split the workshop into 3 sections:

  1. Interpreting the new Category 1 CPT Codes
  2. Suggestions to help valuate the codes when negotiating rates with payers
  3. The work was undertaken to get the new Category 1 CPT Codes accepted by the American Medical Association (AMA)

The two great advantages I see with the new codes are that they are broken up into 15-minute units to allow for more efficient billing and the ongoing codes are no longer needed.

A quick crosswalk for the more commonly used codes is listed below and more detailed descriptions can be found here.

Old Category 3 CodeNew Category 1 Code
0359T97151
0360T – 0361T97152
0364T – 0365T97153
0368T – 0369T97155
0370T97156
0371T97157

A key talking point of the workshop involved valuating the codes when negotiating rates with payers.

When negotiating rates it is important to demonstrate to payers the amount of work that goes into each service.

For instance, when negotiating rates for a technician appointment (0364T – 0365T) providers should mention the training that is involved between the BCBA and the tech before the appointment, the work that goes on during the actual appointment, and the interpretation of data and session notes created afterward.

To do this, Dr. Fisher suggested that providers consider each CPT Code in 3 parts:

  • Pre-Service
  • Intra-Service
  • Post-Service

Pre-Service includes everything that goes on before the appointment takes place such as training staff and writing protocols.

Intra-Service consists of the work that goes on during the actual appointment itself while Post-Service is the work that happens after a session is completed such as writing progress notes and reviewing data.

By doing this, the provider can adequately describe the full scope of work that goes into each appointment.

A further example is provided below for what goes into a Support/Technician Appointment:

0364T – 0365T

Pre-Service Work

  1. BCBA: Trains a technician to perform the service.
  2. RBT: Attends trainings with BCBA. Reviews patient medical records. Creates materials for sessions.

Intra-Service Work

  1. RBT: Works with client based on protocols created by BCBA.

Post-Service

  1. RBT: Writes session notes. Communicates with BCBA as needed about sessions.
  2. BCBA: Reviews/Approves session notes. Interprets data. Updates treatment plan.

Next Steps

The last piece of the workshop involved discussion on the next steps that Dr. Fisher and his group would be working on involving the new Category 1 CPT Codes.

The first order of business for the group is releasing a “Tool Kit” for providers to help valuate their services when getting ready to negotiate with payers.

Dr. Fisher and his team will also work with the AMA to address the issue of billing for both the RBT and BCBA during overlapping service times.

He believes providers should be able to bill for both services concurrently because the responsibilities of each professional during the mutual session are different.

In Summary

In summation, I believe the new codes will positively affect the ABA world and simplify the billing process.

Since the ongoing codes have been eliminated, there will be less line errors during billing, leading to faster payments and less back-and-forth interaction with the insurance companies so that providers can spend more time with their clients.

Also, since the new codes have been assigned category 1 status, I hope that payers will be more uniform with their interpretations of their use which will also make for improved efficiency in billing.

rethink-promo- Category 1 CPT Codes

From scheduling the appointment to providing resources for treatment and tracking progress to getting paid - Rethink Behavioral Health will completely support you.

No more juggling systems.

Full Features

Our complete platform features:

  • Billing & Full Revenue Cycle Management (RCM) features electronic claims submission & remittances, eligibility verification, patient statements and payments portal, financial reporting, and more!
  • Staff Training & Resources on-demand, self-paced RBT Training and access to thousands of printable resources.
  • Clinical Programming & Data Collection spend less time on administrative tasks with robust tools for assessment, treatment planning, data collection and progress reporting.
  • Advanced Scheduling Tool Easy appointment set up, view multiple staff & client schedules at once, seamless controls prevent coding and scheduling errors, capture session notes and parent signatures.

Schedule a demo today at your convenience!