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| Challenges to Families and Providers in Obtaining Payment for Services |
| Saturday, March 1, 2014 |
| 4:00 PM–5:20 PM |
| Grand Ballroom A-B (Suite Tower) |
| Area: AUT; Domain: Service Delivery |
| Chair: Wayne W. Fisher (University of Nebraska Medical Center, Munroe-Meyer Institute) |
| CE Instructor: Wayne W. Fisher, Ph.D. |
| Panelists: CATHLEEN C. PIAZZA (University of Nebraska Medical Center's, Munroe-Meyer Institute), CHRISTY WILLIAMS (University of Nebraska Medical Center), STEPHEN FOREMAN (Bingham Gardens) |
| Abstract: Children with autism often have co-occurring behavioral health disorders, such as feeding disorders (70%), aggression (26%), or self-injurious behavior (19%). Insurance companies often attribute these co-occurring disorders to the individual's autistic disorder, a problem referred to as diagnostic overshadowing, and then use this attribution to deny payment for treatment. This panel will include a discussion of a process that has been used to preauthorize patients for day-treatment feeding and severe behavior programs. Nearly 80% of all initial treatment requests are denied by insurance companies and thus must be appealed by the service provider. Often, it is necessary to have the family ask human resources personnel to contact the insurance provider as a part of the appeal process. In addition, claim follow-up is an essential component of the process to ensure that full negotiated payment is received for the services provided. Documentation and perseverance are perhaps the most critical elements in obtaining an authorization for a client to begin services. Using these procedures, the Munroe-Meyer Institute has obtained prior authorization and payment for about 90% of the patients for whom it makes initial requests. |
| Instruction Level: Basic |
| Target Audience: Psychologists, behavior analysts, graduate students, and any one interested in learning about how to obtain preauthorization for treatments from insurance companies when diagnostic overshadowing is involved. |
| Learning Objectives: Forthcoming. |
| CATHLEEN C. PIAZZA (University of Nebraska Medical Center's, Munroe-Meyer Institute) |
 Cathleen C. Piazza, Ph.D., is a professor of pediatrics and director of the Pediatric Feeding Disorders Program at the University of Nebraska Medical Center in Omaha. She previously directed similar programs at the Marcus Institute in Atlanta and at the Johns Hopkins University School of Medicine in Baltimore. Dr. Piazza and her colleagues have examined various aspects of feeding behavior and have developed a series of interventions to address one of the most common health problems in children. Her research in this area has been among the most systematic in the field and has firmly established behavioral approaches as preferred methods for assessment and treatment. In her roles as clinical, research, and training director, Dr. Piazza has mentored a large number of interns and fellows who have gone on to make significant contributions to the field. Highly regarded for her general expertise in research methodology, Dr. Piazza is a former editor of the Journal of Applied Behavior Analysis. |
| CHRISTY WILLIAMS (University of Nebraska Medical Center) |
 Christy Williams is the program associate for the Center for Autism Spectrum Disorders at the Munroe-Meyer Institute (MMI) in the University of Nebraska Medical Center. She has more than 30 years of administrative experience and has particular expertise in negotiating with behavioral health insurance providers. She currently serves as the insurance liaison supervisor for the Severe Behavior Program, Pediatric Feeding Disorders Program and the Early Intervention Program at MMI. She assisted in the development and growth of these programs with Drs. Wayne Fisher and Cathleen Piazza, and she has served as the lead administrator for these programs since their inception in 2005. Since that time, these programs have served more than 1,000 patients, and revenues have grown to more than $2 million per year. Ms. Williams also has served as an expert consultant for Florida Institute of Technology, Western Michigan University, and Keystone Pediatrics in Jacksonville, FL, regarding insurance clearance. Before joining UNMC, Ms. Williams worked for the United States Government in Europe and Korea. |
| STEPHEN FOREMAN (Bingham Gardens) |
 Stephen Foreman has worked with the special needs population for more than 10 years. He began his career in the classroom, where he discovered the use and practice of applied behavior analysis. Mr. Foreman earned his board certification as a behavior analyst in Florida and worked as a practitioner specializing in providing behavior supports to individuals with intense physical aggression in residential and family settings. In addition to his field work, he was also a select member of the Local Review Committee, in which he assisted in the clinical review and approval of local behavior support plans. Mr. Foreman then moved to Kentucky in 2009, where he had the opportunity to grow and direct one of the largest behavioral support companies in the state providing behavioral programming to hundreds of children and adults on various programs.Throughout his career, he has had the privilege to supervise students and other behavior analysts across multiple states and enjoyed watching their clinical skills blossom. He currently works as a behavior analyst for Bingham Gardens in Louisville, which is an intermediate care facility, working with adults with severe challenging behaviors. In addition, Mr. Foreman serves as the vice chair of the Behavior Analysis Licensing Board in Kentucky and is one of the founding members of the Kentucky Association for Applied Behavior Analysis and is currently the president-elect. |
| Keyword(s): diagnostic overshadowing, Insurance preauthorization, service authorization |
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