What I did on my summer vacation: Constructive Ideas for Autism Treatment Providers
Summer is the ideal time to finally get to some of those “I don’t have time now” projects. With clients and their families off on vacations, the absence of academic demands and a generally more relaxed atmosphere, summer is an opportunity to focus on getting your agency’s ducks in line.
Imagine the advantages of finally…:
creating really “good” report templates – imagine a world in which all your BCBAs’ reports include all the required information in a single format consistent with insurance company and other funding source requirements. No more having to ask them to go back and add or modify a section of their report, no more going round and round with the insurance companies to provide them with what they need, no more inconsistencies resulting from different people writing the reports. A really good set of report templates will ensure consistency across report writers, efficiency in report writing and less time and money wasted going back and forth with funding sources.
having gotten the insurance credentialing and contracting process going – You know you have to become an in-network provider and you also know that the process takes time, effort and a whole lot of stuff you know nothing about, which is probably why you’ve been avoiding this project altogether. Just waiting and hoping that “things will resolve themselves” is not going to fly. You’ve got to take action, and the longer you wait, the harder it will be. Depending on when your state passed its autism insurance reform law, you may find that the insurance companies operating in your market have already established networks of autism treatment providers of suitable size and geographic reach making joining their networks of providers much more challenging. You may need to “convince” them that you are somehow “worthy”. Help!
having really read your funding source contracts – many autism treatment providers jumped into the deep end and successfully completed the credentialing and contracting process with one or more insurance companies. If this is you – Bravo! But… have you actually read your contracts and are you clear on what they require of you? Of your staff? Do you meet with all documentation, personnel, clinical, administrative, privacy, and emergency criteria, to name just a few? Are you clear on timing deadlines for authorizations, appeals, billing? Do you know about potential claw back pit falls? Now would be an excellent time to actually read (and not in bed, at the end of a busy day when all the contracts will do is serve as the ultimate sleep-aid) and understand what your contracts demand of you. Ignorance could cost you in a big way!
creating a complete set of the required policies and procedures – So you finally read your contracts (congratulations!) and discovered that they require all sorts of things (including policies and procedures) that you don’t have or, in some cases, don’t even know what they are. Compiling a complete set of policies and procedures that meets with insurance company requirements and implementing those very same protocols is a more important project that it would seem. It ensures that you are in compliance with your contract (not a minor issue), in compliance with the law (also, not insignificant) and that should you be audited (a privilege which is built in to virtually every boilerplate insurance contract), you’ll be ready.
having gotten through that huge pile of filing – ensuring that your client and personnel files are up to date, that they include everything they are supposed to include and that they look like they should (no… a bunch of ratty, coffee stained papers and sticky notes with reminders are not good enough) are more than just aesthetics. Properly assembled and maintained files (both client and personnel) make your work more efficient, and your ability to exhibit your professionalism and expertise much more believable. But what is required? What should be included? How should they look? Help!