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.

The workshop was split 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 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 no longer are needed. A quick crosswalk for the more commonly used codes is listed below and more detailed descriptions can be found here.

Old Category 3 Code New Category 1 Code
0359T 97151
0360T – 0361T 97152
0364T – 0365T 97153
0368T – 0369T 97155
0370T 97156
0371T 97157

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 afterwards.

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 like 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 technician to perform the service.
  2. RBT: Attends trainings with BCBA. Reviews patient medical records. Creates materials for session.
Intra-Service Work
  1. RBT: Works with client based on protocol created by BCBA.

Post-Service

  1. RBT: Writes session note. Communicates with BCBA as needed about session.
  2. BCBA: Reviews/Approves session note. 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 be working 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 due to the fact that the responsibilities of each professional during the mutual session are different.

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 am hoping 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.

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!
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  • 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.

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Translating Medical Necessity Criteria (MNC) for ABA Providers Working with Health Plans – Part 2

This piece is based on our recent webinar presented by Dr. Diana Davis-Wilson, DBH, LBA, BCBA, who is a licensed behavior analyst, with several years of experience providing consultation and training to families, school districts, and organizational personnel nationwide. She holds a Doctorate of Behavior Health with an emphasis on integrated health care management and is currently the Chief Executive Advisor for Aspen Behavioral Consulting.

Part one can be found here.

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

As clinicians, Applied Behavior Analysis (ABA) providers seek to improve the lives of their patients by offering treatments that are both beneficial and medically necessary.Magnifying Glass with words

However, the needs of patients are just one of the many factors that need to be considered in health care. There are also the needs of health plans to consider. This is usually what ABA providers refer to as the preauthorization process where providers create treatment plans, follow standards, and send their treatment plans to health plans.

Throughout this process, health plans analyze these treatment plans to determine whether they satisfy medical necessity criteria. Health plans are also obligated to consider medical necessity as a legal concept that follows and adheres to specific guidelines and coverage policies. Some clinicians don’t factor this perspective into their treatment plans and as a result, struggle to comprehend what they should deliver to health plans.

In a recent Rethink Behavioral Health webinar, Dr. Diana Davis-Wilson, the Chief Executive Advisor for Aspen Behavioral Consulting in Arizona, outlined a few ways ABA providers can navigate the world of health care and “learn the language of health plans”.

The first step, she says, is to understand how medical necessity is viewed by clinicians, health plans, and legal entities.

“When it’s unclear as to what medical necessity is or when we don’t have the data to support the typical avenues for developing medical necessity, it becomes challenging for us to present our cases to health plans,” says Davis-Wilson

Health plans are usually responsible for large populations and must make their decisions based on the interests of the majority. This is often unique to ABA providers, who commonly look at priorities and patient care from an individual scope.

When an individual purchases a health plan, the policies are driven by many things; one of which is the population itself and the majority.

Therefore, a health plan’s job is to develop guidelines and coverage policies specific to a variety of different components outside of the individual lens. Considerations to coverage policies include an intensive review of available documentation pertaining to the following indicators:

  • Disease burden
  • Public or provider interest
  • Controversy
  • Variation in care
  • Cost
  • Quality
  • Effectiveness of research
  • Potential impact to entire population

To the untrained ABA provider’s eye, these factors may not have a significant impact. But from the perspective of a health plan, decreasing disease burden, reducing long-term costs and improving the quality of care and the effectiveness of research is a benefit to a majority of individuals with health plans, not just singular patients.

When ABA providers fail to realize this, medical necessity reviews can become problematic for them and health plans. ABA providers can also experience a breakdown in communication with health plans that must satisfy the needs for a majority within populations they serve. But at the very heart of the matter, health care will always have three main goals.

“This is better known as the triple aim”, says Davis-Wilson, and provides three objectives:

  • To improve patient care and the patient experience
  • To improve the health of populations by aiming for continued improvement to the quality of care
  • To reduce the future per capita cost of health care by allowing individuals to obtain preventive services and care prior to the presence or discovery of certain illnesses and diseases

So where does medical necessity come in, and how can we translate it into a language that we understand? According to Davis-Wilson, medical necessity means that the services an ABA provider carries out is for the purpose of evaluating, diagnosing or treating an illness, injury, disease or its symptoms.

It is expected to be in accordance with the accepted standards of practice and should be clinically appropriate, efficient and cost-effective. Measuring progress is an essential component as to whether treatment is considered efficient and cost-effective. Most plans seek to reduce the duplication of services and prevent contradictions that may be costly. Health plans are also committed to monitoring client progress individually and as a whole for populations, thus moving them closer to their goal of reducing the future per capita cost of health care.

In essence, the more ABA providers learn to think of the whole as a sum of the individual parts, the better they will be equipped to create treatment plans and satisfy criteria in a way that health plans can understand. The legal aspect of what health plans require is also very rarely discussed but plays an essential role in how health plans view medical necessity.

Many health care contracts include agreements which state that a plan will provide coverage only for services that are deemed reasonable and necessary, which is up to the discretion of health plans. This also means that the progress an individual makes over the course of a treatment plan is more likely to be approved by health plans when it’s meaningful to overall outcomes for majorities within populations and supported by research.

When a treatment is supported by research, health plans can justify compensation for services provided and satisfy reductions and improvements to indicators such as disease burden, cost, quality, effectiveness of research and the potential impact to majorities within populations.

Yet, these are just some of the many ways ABA providers can become experts at decoding medical necessity criteria and documentation for health plans. Learning to speak the language requires careful attention to detail and a more holistic perspective of health care in general.

 

Rethink Behavioral Health provides an intuitive and comprehensive solution to scale your ABA business and ensure client success. Our one-stop-shop platform 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!

Documentation Requirements: The Who, What, When, Where, Why, and How of a Medical Record

This piece is based on our recent webinar presented by Sarah Schmitz, the Owner and President of Comprehensive Billing Consultants. Sarah has over 13 years of experience in medical coding and billing and is an expert in getting you credentialed, contracted, and paid for your services quickly and properly.

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

Understanding the many facets of medical documentation can be a challenge to both patients and providers in the health care world. On one hand, medical records are critical to the treatment of patients and on the other, they are essential to the overall organization of medical records divisions within practices across the country.

The divide between what’s expected and what’s delivered can even affect payment procedures. So, realizing that the most valuable documentation to payers are the types that satisfy their requirements is key.

According to Sarah Schmitz, the Owner and President of Comprehensive Billing Consultants, knowing what’s expected and who provides those expectations on daily session notes and medical records should be the goal for every provider. However, in order to master this key concept, you should first understand the basics of daily session notes.

session-notes
Say goodbye to filing cabinets and take session notes on the go with Rethink.

Why do we have daily session notes?
Daily session notes exist to document any and all services you provide. They give you the opportunity to go back and take a look at what was done and helps plan for with forward-looking care. Consistent documentation also provides evidence regarding the assessment, treatment, and progress of services for a client.

“This is important because you will need to see where a patient started and where they’re ending up,” says Schmitz.

Documentation expands the way that we communicate with other service providers and ensures practitioners and all those who receive documentation are aware of any provider, client or family involvement in the daily session. It can also serve as required evidence for insurance companies to ensure you are properly reimbursed for the services that have been rendered.

Here are a few benefits of daily session notes:

• It’s your legal protection for clients, the practice and practitioners
• It can be used for data and research
• It enables a facility to train and provide quality assessments and review of staff practices
• It helps you produce correct coding procedures
• It allows for optimal care of the client

Overall it is required that session notes be permanent, legible, accurate, timely, clear, concise, complete, encompassing and truthful. Medical records are also legally-binding and often need to be accessed or retrieved both inside and outside of a practice. Medical necessity also almost always refers back to symptoms. Therefore, documenting accurate diagnoses are equally important to billing policies and procedures for your practice.

Who will see these records?
Staff within and professionals outside your practice could potentially see client medical records. This can include administrative support staff, risk management professionals, coders and billers, insurance companies and others.

Family members could require access to session notes in order to facilitate the transfer of treatment documentation from one service provider to the next. While all session notes are not required to be sent to all coordinating providers, documentation of treatment plans must be forwarded to the referring physician at each review.

When do notes need to be completed?
The best practice for daily session notes should be completed no later than seven days from the date of service. Discharge summaries should be completed and forwarded to the referring physician within 30 days of discharge. You should refer to state and federal requirements for any medical record storage and policies associated with your service area.

Where and how do the records need to be stored?
In order for medical records to be HIPAA compliant, a copy of all records must be backed up and stored outside the family’s home. This includes in-home services. Medical records must also be locked away in a safe storage environment, such as a locked closet or room in an office.

If your practice chooses to use digital or electronic records, they must be double password protected and backed up regularly to a server or the cloud.

In the event that corrections need to be made to medical documentation, be aware that you cannot delete or edit items or words. You can however make edits with a single line drawn through notes. Any and all changes must be initialed and dated. Corrections should only be made by the original author, with supervisors serving as an exception to this rule.

Ultimately Schmitz says that the golden rule for medical records is “If it’s not documented, it didn’t happen.” So remember to be smart about meeting requirements and creating documentation that works for your patients, staff, and payers.

Rethink’s practice management makes session documentation compliance a breeze. The customizable templates ensure that each note contains all the required information, and does the dirty work for you by pre-filling information such as the client’s name, staff name, session date/time/duration, and even inserts a summary of the clinical data collected. Our customizable workflows enable you to ensure that the staff member completes the note before the session gets marked as completed and billed. Finally, a PDF copy of every session note is automatically backed up to each client’s record, giving you piece of mind during an insurance audit. Schedule a demo today at your convenience!

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Navigating Insurance: Unlocking the Denials & Appeals Process

This piece is based on our recent webinar, Navigating Insurance: Unlocking the Denials & Appeals Process, presented by Emily Roche, Director of Services at ABA Therapy Billing and Insurance Services. Emily brings a range of experience in working with ABA providers and insurance companies and has navigated contracting, appeals, and negotiations across multiple payers and states.

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

nav-insurance

For Applied Behavior Analysis (ABA) providers, maintaining a healthy revenue stream is one of the most essential functions. Doing so helps ABA providers keep up with organizational costs, staffing and the resources necessary to run a successful practice.

However, it is not uncommon for some ABA providers to become fraught about the complexities that surround the billing and claims process. For some providers, a fear of denial can lead to avoidance of pushy insurance companies looking to negotiate. For others, fears can simply be rooted in an inability to navigate the appeals process when an insurance company issues a denial.

According to Emily Roche, “accurate billing can result in 90 percent of claims paid.” In order to collect the other 10 percent, ABA providers must learn to not only track issues, but resolve errors and overcome fears of appeals by developing a deeper understanding of how to navigate the claim denials and appeals process.

The first step for ABA providers is to understand two common types of appeals:

Clinical and Medical Necessity:  This type of appeal issue occurs at the time an ABA provider tries to request authorization when insurance companies may try to immediately deny authorization, reduce the number of hours requested or attempt to dictate service locations, goals, parent training or impose other restrictions.

Billing and Claims Processing: This type of denial or appeal issue occurs when a claim is sent in for processing or when an ABA provider reviews payments or Explanations of Benefits statements.

Roche says it is important to understand that insurance plans cannot dictate:

  • Service location
  • Parent training
  • Goals that relate to services
  • Timeline for reducing hours or phasing out services
  • Treatment bases on age threshold or years of ABA treatment

At the billing stage, it is equally important for ABA providers to be able to distinguish between different types of errors. In order to do this, providers should carefully review Explanation of Benefits statements and get to the root cause of anything that has been paid incorrectly or denied.

In order to help with both of these common issues, Emily offers a number of tips for ABA providers when working with insurance:

1. File claims in a timely fashion and pay attention to appeals deadlines. Be sure to also save all documentation if faxing or mailing claims.

2. Understand laws like the Medical Health Parity and Addiction Equity Act, which exists to protect patients, so you know when to file an appeal or push back on insurance companies.

3. Prevent the need for corrected claims or issues that grow into denials or appeals by addressing clinic-side errors.

4. Train others in how to handle peer reviews and calls with insurance companies.

5. Include the recommended number of hours at the start of services. If a request is made to reduce hours due to schedule conflicts, highlight the reason for the reduction and include the length of time hours will be reduced below the recommended number.

6. Prepare to highlight cases with significant need or effects that occurred in cases when an issue was left untreated or undertreated.

7. Avoid sounding “too academic” when explaining the reason why a patient needs a particular service.

8. If an insurance company tries to deny a full authorization or reduce hours at the authorization phase, ask for a peer or secondary review after the initial review or phone call. If you go through a secondary review and receive a denial, be sure that the reviewer issues a denial for the difference in hours.

9. If an insurance company authorizes payment for a percentage of recommended hours, the insurance company should issue an authorization for the designated hours they approve of and a denial for the hours not approved. If the insurance company issues a full denial, be sure a denial letter is issued to the provider and the parent.

10. When preparing to write an appeal, be sure to include demographic information, copies of treatment plans, notes and reports and any supporting documentation. Remember to use clear language and be concise. You should also refer to any sections of your contract that are being violated, if any.

If you encounter issues such as not receiving a denial letter at all or harsh restrictions from an insurance provider, you can file a grievance or complaint if you are a member of a network. Remember that you can also exercise your right to consult a healthcare attorney, who will have a deeper understanding of health care laws, or opt to leave or switch your network if issues continue.

Health insurance is of course very complex, but with the right information and resources ABA providers can ease fears of the billing and claims process.  For more information, you can also check out practice guidelines from the Association of Professional Behavior Analysts (APBA) and autism spectrum-specific guidelines from the Behavior Analyst Certification Board (BACB).

Rethink Behavioral Health provides an intuitive and comprehensive solution to scale your ABA business and ensure client success. Our one-stop-shop platform 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!

ABA The Mobile Workforce: Managing the Risk of Employee Drivers

This article is based upon a recent webinar presented by Daniel Law, of The Liberty Company Insurance Brokers. Over the past 14 years, Dan has focused on the design and implementation of insurance and risk management programs for clients on a global basis.

Applied Behavior Analysis (ABA) providers face very unique challenges with the clients they serve and the practice they run. These issues are often related to operations, clinical data collection and practice management. However, while ABA providers understand a variety of techniques that effect their clients, sometimes the hurdles that come with managing a business and its employees are difficult to navigate and they need to rely on experts.

One of these challenges is risk management. Far too often it is only understood as a reactive measure when ABA providers and their employees face issues that affect a business financially or in practice. However, there are strong benefits to including the right risk management approach in proactive initiatives, like establishing policies for employees who drive.

According to risk expert Daniel Law, of The Liberty Company Insurance Brokers, ABA providers across the country rarely think about the risks associated with employees who drive duringdriving company hours. In many cases, ABA providers have a very young workforce and employees may commute to and from work sites via a car or public transportation. For those who drive and work in a wide variety of environments, there are different levels of exposure. This can include everything from weather to traffic and by helping clients get from one destination to another.

“The general rule,” says Law, “is if you provide a mileage reimbursement, you have an employee driving on company and your business is at risk if the employee is involved in an accident.” But every case is unique. In fact, employees who have a specific location or work site that they travel to and from on a consistent basis may use a car for the commute, which wouldn’t be classified as company time.

In order to understand the risks, experts like Law say ABA providers should critically analyze guidelines for when an employee is considered to be driving on company time.

When are Employees Driving on Company Time?

  • Driving in between sessions or client homes during work hours
  • Going from a school-based session to a client’s home in the evening

These are just two examples of when an employee may be driving on company time and each practice will determine their own policies that correspond with how their business operates. In order to implement the risk management approach for employees who drive, each company should first know the fundamentals of the three-step process.

What is the Risk Management Approach?
The risk management approach is a three-step process that centers on identifying, analyzing and responding to risks. Each environment poses different hazards, so ABA providers must first identify, in their specific operations, where they have risks and analyze how they might impact the business and then formulate a response.

Identifying Areas of Risks
Some risks can be mitigated with appropriate policies, while others cannot. The risk management approach suggests that those areas of risks that can be avoided should be avoided, like when employees allow clients or children to enter their car. Exposure in a situation such as this can be tough to manage. So if ABA providers don’t know the maintenance of a car or are not providing a company car, Daniel recommends businesses prohibit employees to drive clients in their own vehicles.

Analyzing Risks
Like all other business, providers should always analyze risks prior to events. This is a great way to mitigate risk for a business and establish a precedent that is flexible to implement when employees enter or leave the company. For example, ABA providers can look at Human Resource policies to determine if they already have a structure in place to require employees to have higher personal auto insurance limits. If it is a requirement for employees to drive on company time, ABA providers can also require employees to provide regular information on the condition of their vehicles and allow for random or scheduled inspections.

Responding to Risks or Accidents
Some accidents or events are unforeseen and can’t be avoided or overlooked once they occur. So if an employee does drive on company time and is involved in an accident, one of the first things that will be looked at is who is at fault. The term “at fault” is generally used to define a point in time when injury or damage occurs to someone or something else, better known as third-party exposure. It is rarely cut and dry. A simply allegation of fault can force a business to step in and defend the company, even though the allegations may not have a basis in reality.

The key to handling these situations is staying calm and controlling the situation by formulating an appropriate response at the right time. Injury to occupants and employees are often an integral part of the response process. So understanding the limitations of auto insurance policies and following the rules and procedures associated with the Workers’ Compensation process is essential. Obtaining a great business auto insurance plan can be a big help.

Each month, Rethink Behavioral Health hosts a webinar with ABA  specific business experts that offer support and guidance for providers. So be sure to check out the next webinar and arm your practice with the right information to succeed!

Rethink Behavioral Health provides an intuitive and comprehensive solution to scale your ABA business and ensure client success. Our one-stop-shop platform 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!

Translating Medically Necessity Criteria (MNC) for ABA Providers Working with Health Plans

This piece was based upon a recent webinar presented by Tim Crilly, BCBA. Tim spent 3 years as Director of Autism Services for a major national health plan and an additional 10 years for a provider group in California.

Conceived more than 50 years ago out of the idea that positive gains can be made in an individual’s behavior by applying principles of learning and techniques, the scientific practice of Applied Behavior Analysis (ABA) is a relatively new concept in the healthcare industry.

Although the process has many different elements, health insurance managers and teams often receive only a snapshot of the type of care being offered to individuals in need of treatment. Health insurance organizations use this snapshot and medical necessity criteria (MNC) to define the benefits they cover for their members. However, not all snapshots or MNC are created equal.

Medical necessity criteria can vary greatly from organization to organization. The guidelines help to determine levels and types of care that are considered medically necessary for an individual’s behavioral health. Many health insurance companies also opt to create their own MNC or LOC guidelines, although there are commonalities.

How Managed Care Teams Use Medical Necessity Criteria
Below are three common phases of interpretation for MNCs:

  • Initialization of care: Set of criteria that determines if care is needed and at what level treatment should be authorized for.
  • Maintenance of ongoing care: Set of criteria that determines if care should continue at current level.
  • Change or termination of care: Set of criteria that determines if care should change.

While the criteria most organizations use was originally meant to simplify the interpretation process, ABA is still widely misunderstood. The challenge that insurance management teams face when reviewing care is that MNC and LOC guidelines don’t offer interpretations for appropriate levels of care. Additionally, the lack of consistency in care within the ABA community only makes this challenge greater for insurance management teams, as they review a wide range of care requests that carry different recommended programming levels.

Challenges for Applied Behavior Analysis Providers
ABA providers also face challenges in providing care. They include:

  • Struggling to align programming approaches and goals with requirements for MNCs
  • Requesting hours for ongoing services that are not instep with MNC/LOC guidelines
  • Pairing reduction behaviors with replacement behaviors
  • Creating caregiver involvement and goals and following through

To help solve the challenges for both insurance management teams and providers, it is important to start with one common element: The MNC. In order to get through the metaphorical “front door” or past the initiation of care phase, providers should look at medical necessity criteria for every funding source they have to gain a better understanding of what’s expected at the initial intake phase. Proceeding with the right level of care in the beginning of the process can also result in a decrease in denials later down the line.

If the original treatment is determined to be an appropriate type of ongoing care for an individual, it should then be clearly justified. As health care definitions continue to expand, clear and concise justifications for ABA care are more necessary now than ever before. Insurance care teams often look for the most cost-effective solutions for their business and their members. Once ABA services become an ongoing offering, health insurance organizations calculate them as new lines of costs that they will attempt to reduce if possible.

How Care Management Team and Providers Measure Success
To ensure clinically appropriate levels of care, providers must do a better job in gathering information and providing evidence for types and levels of care. Doing so will help redefine the limitations for care and reduce instances when ongoing care is inappropriately changed or terminated at the expense of those who need it most.

Being smart about goal alignment also makes a difference when insurance management teams review reports. Providers should ask themselves if they are sending in goals that are representative of what is outlined in an MNC while considering whether their goals are appropriate for funding through an insurance process.

Any behavior plans should be closely aligned with what is determined in an MNC. Caregiver programming is perhaps one of the areas with the most inconsistency when it comes to who is being placed in an environment and how much caregiver support is being provided. This is a big factor for health plans, as an insurance management team evaluates care and wants to see it in programming. Although goals should align with the MNC as much as possible, providers should also at times focus on additional services that are not outlined in the MNC if doing so will meet the overall needs of their clients.

With the vast majority of providers using digital data systems today, technology should help to make challenges easier to overcome. Every ABA provider should analyze whether their technology platforms work hand in hand with health plans to ensure they are taking clinically, socially significant and ethical actions in programming and care that align with health plan values. The technology platform a provider uses should also offer the right tools and benefits for providers to share with individuals and families as care continues.

Ultimately, the success of health care plans should be measured by titration of care over time; transitions to less intensive care when appropriate; caregiver empowerment and consumer protections for member groups.

However, the measures of provider success are still being defined. Over the next few years, it will be imperative for providers in the healthcare industry to come together in a cohesive manner to avoid regulations imposed by insurance management teams that miss the mark.

Providers should be upfront and coherent in their communication with each other, so everyone can appear on the same page to insurance management teams. Clinically integrated networks, which can negotiate collectively with health insurance organizations, may be an opportunity for providers work together to protect the quality and consistency of care in the future.

Rethink Behavioral Health provides an intuitive and comprehensive solution to scale your ABA business and ensure client success. Our one-stop-shop platform 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!

Thinking “Big Picture”: Promoting Quality in ABA Services

This piece was authored by Kathleen Bailey Stengel, Sr. Vice President ABA at Aveanna Healthcare.Think-Big

The “gold standard” for effective treatment for individuals with autism has always been Applied Behavior Analysis (ABA). However, as ABA services are increasingly sought after and provided to large groups of individuals, new clinicians are being trained and certified at a rapid pace. Because of this, a true “standard” for these ABA programs is difficult to define in the marketplace.

Where the Difficulty Lies
A quick scroll through social media sites can highlight complaints from both consumers and clinicians regarding poor programming, lack of evidence based treatment plans, and ineffective data collection. Part of this difficulty lies in the individualization of programs as ABA programs are typically designed for each individual, which results in certified and credentialed providers not developing standards of care across the board rather than the individual client. While many individual practitioners are experiencing success at their practice, providers and funders often run into issues when scaling practices toward large populations and across many practitioners to obtain (effective) outcomes expected by stakeholders and clinicians. Ongoing supervision and training of staff, standard documentation practices, and consistency of clinical interventions and outcomes are enormous challenges faced by clinical organizations as they grow and move into community-based integrated service models. Though challenging, there are methods to smooth this transition.

Setting up for Success
As a behavioral health provider across many states, we maintain large waiting lists for clients and are constantly hiring new clinicians at a rapid pace in order to keep up. One of the most difficult tasks we’ve experienced is maintaining appropriate clinical and operational checks and balances while providing services to families who are in dire need of them. This need for effective monitoring and supervision of clinical programs is essential in assuring the ABA programs we provide remain the “gold standard”. Therefore, it is a priority to hold all our clinical programs to the high standards that ABA has demonstrated and knows so well.

At Aveanna, creating and maintaining organizational quality indicators has been a priority over the last 3 years. As part of this initiative (and given the larger size of our programs), it has been imperative to have a partner electronic platform that allows us to continue providing excellent ABA case management services, while reducing time costs related to supervision and training, information storage and data collection, and management at the individual and aggregate levels. Rethink Behavioral Health, a division of Rethink First, has been this partner for Aveanna. The Rethink platform has provided us with tools to standardize our clinical documentation and data management, while allowing an efficient way to access and review all of the clients’ records.

With these features in place, we have been able to identify and monitor clinical quality indicators that will give us the opportunity to standardize and shape the clinical skills of our staff to reach the services and outcomes that we expect for all of the individuals we serve. As an example and a baseline point, we identified the following essential quality indicators that will be at the core of each and all programs offered. These quality indicators are the backbone of our standard performance expectations and will continue to pave the road for further development of all our clinical staff and the achievement of consistently valuable treatment outcomes.

Key Quality Indicators:

  1. Individual goals clearly match the assessments
  2. Goals are measurable
  3. Data collection systems selected match the stated goals
  4. Lesson plans for each goal are completed
  5. Positive Behavior Support plan is written and in place
  6. Graphs for each and all goals are up to date and complete
  7. Graphs reflect changes in interventions as needed
  8. Intervention protocols are evidence-based
  9. Follows up with supervision round recommendations

Thanks to Rethink Behavioral Health, we are able to audit the program integrity remotely to assure compliance with basic clinical standards. Our goal with standardizing and reverse engineering clinical outcomes at the clinician level is twofold: to create a basic standard of care while allowing the clinician to individualize treatment as well as to work toward creating a baseline for measuring large population aggregate results in the future.

When we can finalize and control the variables for treatment implementation across our national program, we will then move toward aggregating the data from Rethink on the children’s plans and measure full programmatic integrity. This data will then drive decisions from the child level all the way up through executive decisions. With Rethink as a partner in data collection and treatment integrity, the collected data will allow us in the future to make changes to our clinical and organizational structure that have direct and meaningful impacts on client outcomes across locations.

Rethink Behavioral Health provides an intuitive and comprehensive solution to scale your ABA business and ensure client success. Our one-stop-shop platform 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!

Terminating Employees: Best Practices and Red Flags To Consider

Did you know it’s best practice to prepare for your next termination during the hiring process?

Take a look at our latest installment published on Behavioral Science in the 21st Century discussing best practices & red flags to consider when terminating employees!filice

Terminating an employee is an interesting time for the entire office and can affect productivity and culture. Read the full article to discover how to avoid termination problems at the point of hire and understand stipulations such as “employment at will”!

Rethink Behavioral Health and bSci21 publish a new article every month, stay tuned for the next installment!

[Webinar] Translating Medical Necessity Criteria (MNC) for ABA Providers Working with Health Plans

Rethink Behavioral Health invites you to participate in our upcoming webinar, Translating Medical Necessity Criteria (MNC) for ABA Providers Working with Health Plans!

With a lack of consistency in the industry and guidelines that don’t offer interpretation of what an appropriate level of care is, this is an important topic to understand.

Expect to discuss:

  • MNC/LOC guidelines
  • Socially Significant Programming and MNC
  • Defining success and limitations

This live webinar will be held on Thursday, November 9th at 1pm EDT/10am PDT, register now!

Our guest presenter will be Tim Crilly, BCBA, Senior Director at Rethink Behavioral Health. Before Rethink, Tim spent 3 years at Magellan as the National Director of Clinical Services Autism and also 10 years for a provider group in California.


Rethink Behavioral Health holds a monthly webinar series entitled Entrepreneurship in ABA. This targeted set of presentations will focus on the business aspects of running an ABA provider group. Whether you are just getting started, or in high growth mode, this series will offer insights and best practices for helping your business succeed.

Eligibility and Benefits: Understanding Eligibility For ABA Coverage Through Insurance

Check out our latest installment published on bSci21.org, Eligibility and Benefits: Understanding Eligibility For ABA Coverage Through Insurance!

aba-billingDo you know the difference between self funded and fully funded insurance policies? What about the relationship between these policies and state laws mandating ABA coverage? Find out!

Recently, Rethink Behavioral Health hosted a webinar with guest speaker Emily Roche, Director of Services for ABA Therapy Billing and Insurance Services. Emily provided insight on two critical topics dealing with insurance laws which can help ensure a successful business.

Read the full article!

Rethink Behavioral Health and bSci21 publish a new article every month, stay tuned for the next installment!