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| When Bad Things Happen to Good Providers: Navigating Insurance Coverage for ABA Therapy |
| Thursday, May 26, 2022 |
| 4:00 PM–7:00 PM |
| Meeting Level 2; Room 258B |
| Area: AUT; Domain: Service Delivery |
| CE Instructor: Jerome T. Chiu, M.A. |
| AMY WEINSTOCK (Insurance Resource Center/UMass Medical School, EK Shriver Center), JEROME T. CHIU (UMass Chan Medical School
), LISA CROUSER (UMass Chan Medical School), TERRI FARRELL (UMass Chan Medical School) |
| Description: Insurance coverage for ABA therapy has expanded dramatically over the past decade. This has had a significant impact on the profession. Behavior analysts providing services reimbursed by insurance have to navigate a complex, confusing, and sometimes illogical system. Unfamiliarity and inexperience can result in negative consequences for both the Behavior Analysts and consumers. This can create signficant financial, regulatory, and legal repercussions for individuals, and damage the reputation of the profession. Are you a Behavior Analyst whose services are reimbursed by insurance? Are you thinking about taking insurance? Are you concerned about rejected claims, audits, recoupments, fraud accusations, and other issues? This workshop will give an overview of insurance systems (both public and private), insurance contracting, documentation and compliance requirements, common issues, and tips for successfully navigating insurance coverage. |
| Learning Objectives: At the conclusion of the presentation, participants will be able to: 1. Determine the insurance coverage in place for ABA treatment for an individual client. 2. Understand what documentation is expected by insurers. 3. Identify requirements for authorizations, and strategies to address denials. 4. Understand financial, licensing, ethical, and legal requirements. 5. Identify processes and resources to ensure clinical, operational, and regulatory compliance. |
| Activities: Workshop Objectives 1-4, will be met through a combination of lectures, document reviews, and case studies. Workshop Objective 5 will be targeted through facilitated breakout group discussions targeting clinical, operational and regulatory compliance strategies. |
| Audience: The target audience includes Behavior Analysts currently working in insurance-funded programs or considering working in insurance-funded programs. |
| Content Area: Practice |
| Instruction Level: Basic |
| Keyword(s): Compliance, Documentation, Insurance |