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| Billing Insurance for Applied Behavior Analysis Based Therapy for Children With Autism Spectrum Disorders |
| Saturday, May 29, 2010 |
| 8:00 AM–11:00 AM |
| Bonham D (Grand Hyatt) |
| Area: AUT; Domain: Service Delivery |
| CE Instructor: Richard Meisch, Ph.D. |
| KRISTIE M. FRISSEN-THOMPSON (OptumHealth Behavioral Solutions) |
| Description: The workshop will describe strategies for maximizing a successful claim submission to third party payors. In addition, participants will come to understand that while many states have passed legislation mandating that services for autism and applied behavior analysis (ABA) be covered by third party payors, coverage is dependent on group size and whether the employer has selected a self-funded or a fully-insured plan, among others. That is, third party payors are required to reimburse for ABA-based therapy for autism in certain circumstances, not just as a result of the state mandate. As more self-funded plans are deciding to purchase a supplemental autism benefit and as more states pass mandates for autism, it is essential that anyone working as a certified behavior analyst (BCBA or BCBA-D) learn their way around a standard claim form, billing and diagnostic codes, and collect the member's insurance information.
Correctly billing insurance companies and other third party payors for autism-related ABA services is an imporant step to ensure reimbursement for those services. Correct billing will decrease denials, wait time, and overall frustration with the insurance industry. The presenter currently works for a large for-profit behavioral health insurance company managing an autism benefit which pays for ABA-based therapies. The information provided in this workshop is based on the presenter's experience in private practice and working in the insurance industry and will provide information related to general billing of third party payors, not just the presenter's employer. The presenter is not receiving commercial or financial support for the workshop. |
| Learning Objectives: At the conclusion of the workshop, the participant will be able to do the following:
list which states currently have state mandates for autism and/or ABA,
1. describe who is affected by state mandates,
2. describe the difference between state mandated services for autism and self-funded programs,
3. describe the essential components of and how to complete the CMS-1500 billing form,
4. know what the ICD-9 and DSM-IV diagnostic codes are for the pervasive developmental disorders, and
5. know the difference between the CPT billing codes. |
| Activities: The workshop will include a direct presentation of information, solicited and directed questions to participants about their own experiences with billing insurance companies and other third party payors, and actual completion of claim forms. |
| Audience: This workshop is intended for professional clinicians including BCBA-Ds, BCBAs, BCABAs, and office administrators concerned with understanding the billing practices for ABA services for children with autism spectrum disorders. |
| Content Area: Practice |
| Instruction Level: Basic |