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Association for Behavior Analysis International

The Association for Behavior Analysis International® (ABAI) is a nonprofit membership organization with the mission to contribute to the well-being of society by developing, enhancing, and supporting the growth and vitality of the science of behavior analysis through research, education, and practice.

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44th Annual Convention; San Diego, CA; 2018

Workshop Details

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Workshop #W60
CE Offered: PSY/BACB
Unraveling the Complexities of Documenting Applied Behavior Analysis as a Medically Necessary Service
Friday, May 25, 2018
8:00 AM–3:00 PM
Room to be Announced
Area: PRA/AUT; Domain: Service Delivery
CE Instructor: Brian Lopez, Ph.D.
BRIAN LOPEZ (JumpStart Autism Center), ALLISON BARTSCH (JumpStart Autism Center- Colorado), KARA BATSON (JumpStart Autism Center- Colorado), SARAH BANKS (Jumpstart Autism Center- Colorado), CASSIE L MOHR (JumpStart Autism Center- Colorado)
Description: The ACA has increased the accessibility of ABA services; however, providers continue to receive denials because of insufficient documentation of a client's medical needs for ABA services. This workshop is aimed at reducing denial rates during the prior authorization process and increasing the success rate of appeals. Discerning components of medically necessary services can be a complex process, and the process can be an enigma for most BCBAs and psychologists. Denials are on the rise because insurance companies view a diagnosis of ASD as insufficient documentation for the medical necessity of ABA. The workshop is targeted at psychologists, BCBAs and other autism treatment providers. Participants can expect to learn the following: 1) identify components that make ABA services medically necessary, 2) how to collaborate with medical/behavioral health professionals to document comorbid diagnoses, 3) document level of care, 4) develop treatment goals that address medical necessity, and 5) develop a report template that fully documents medical necessity of ABA services. The content of this presentation is derived from scientific summaries of standard practices in the medical/behavioral health fields in order to establish standards of practice for psychologists and BCBAs to document medical necessity and levels of care for patients receiving ABA services.
Learning Objectives: At the conclusion of the workshop, participants will be able to: (1) gather and report behavioral and medical data to effectively document medical necessity; (2) gather, interpret and report data that is needed to demonstrate a client's medically necessary level of care; (3) interpret and report findings from standardized questionnaires that support a client's level of care for ABA services being requested; (4) collaborate with community medical/behavioral health providers to document various diagnoses that support medical necessity of ABA services, the recommended level of care (intensity of ABA services), and ABA treatment goals; (5) have the necessary information needed to write a prior authorization report that documents all facets needed to support the medical necessity of ABA and the level of care that is requested.
Activities: Workshop objectives will be met through a balanced presentation of lecture, guided practice, video observation, and group discussion.
Audience: The targeted audience of this workshop are psychologists, BCBAs, BCBA-Ds, behavioral health providers, and medical providers who support individuals with ASD
Content Area: Practice
Instruction Level: Intermediate
Keyword(s): Care Levels, Insurance, Medical Necessary, Treatment Goals

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