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| Navigating the 10th Circle of Hell (Or Getting Funded for Health Insurance Coverage of ABA) |
| Friday, May 22, 2015 |
| 8:00 AM–3:00 PM |
| 209 (CC) |
| Area: AUT/PRA; Domain: Service Delivery |
| CE Instructor: William Tim Courtney, M.S. |
| WILLIAM TIM COURTNEY (Little Star Center), VINCENT LAMARCA (Little Star Center), MARY ROSSWURM (Little Star Center), Michele Trivedi (Insurance Project ARC of Indiana) |
| Description: In the Middle Ages, Italian writer Dante wrote about the nine circles of hell in his epic poem, "Dante's Inferno." Perhaps, though, if Dante were alive today, his work would have included a 10th circle--health insurance. This workshop will help clinicians learn how to write successful treatment plans that support medical necessity for health-insurance funded individuals with autism. As more states adopt insurance mandates for autism, behavior analysts are supporting more clients whose services are being paid for by health insurance. To be successful with this new stream of funding, behavior analysts have to learn about how to navigate the medical insurance system. Topics covered in this workshop include credentialing, in-network vs. out-of-network plans, self-funded vs fully funded plans, how to write a treatment plan that supports medical necessity and an introduction to the appeal process. Once mastered, clinicians can focus on the more enjoyable circles of hell, such as treachery, heresy, and wrath. |
| Learning Objectives: At the conclusion of the workshop, participants should be able to: (1) state the necessary components of a comprehensive and focused treatment plan; (2) identify the information required for credentialing; compare in network and out-of-network plans; (4) distinguish between self-funded and fully funded plans; (5) analyze determination letters and construct appeal letters/reports; (6) organize all of the steps from preauthorization through reauthorization; (7) assess sample treatment plans to determine if they meet medical necessity; and (8) interpret diagnostic reports, as well as behavioral assessments to justify medical necessity. |
| Activities: 1. Lecture 2. Small group activities 3. Pre-workshop submission of treatment plan 4. Mock medical necessity review and appeal meeting 5. Case review (treatment plan, denial, and all level of appeals to include external appeal) 6. Active group member/choral responding activities |
| Audience: 1. BCBA clinical directors, facility directors, and/or owners 2. Any BCBA who currently, or plans to in the future, provides medically necessary ABA therapy funded by medical insurance. |
| Content Area: Practice |
| Instruction Level: Basic |