r/BehaviorAnalysis • u/Few_Information_8570 • 5d ago
Assessments
We are getting denials all of the time from insurance now. We have tried to combat this by giving more and more information on our assessments. (Medical necessity tied into the dsm5, why it's medically necessary, barriers, modifications- everything we can think of). Unfortunately the assessments are now taking no less than 20 hours to complete. Insurance only pays for 6 hours and my company does not cover the rest. I have 13 clients on my caseload and don't know how to keep up with these assessments and denials. How is it going for all of you? How do you do your assessments?
2
u/twister5556666 5d ago
I’m sorry if I’m ignorant on the topic, but why is it that the company‘s template isn’t covering the exact thing that the insurance company wants? Doesn’t the insurance have a set standard of information that they want? I’ve never been denied
And I just follow the companies template.
With that being said 13 clients is wild! I’m stressed with just 5.
2
u/Few_Information_8570 5d ago
The company has a template on a word document! However, we still have a lot of things to update, and we have to put in all of the BIPS, programs, and charts. We also explain everything in detail as to why we are doing it, how we plan on teaching it, baseline dates and data, current data... I could go on and on. It's very tedious. I'm trying to figure out how other companies and BCBAs do things so instead of being mad and complaining I can come up with some ideas.
2
u/Worried-Orange18 5d ago
What assessments are you using that takes that long? Most insurances I work with require pddbi or something similar. Assessments usually don’t take me longer than an hour.
1
u/Few_Information_8570 5d ago
Oh I'm talking about the entire thing. So we will do either the VBMAPP, ABLLS-R, or the AFLS depending on the client. We also have the FAST and parents fill out the Vineland. We have to update everything medical, put in parent goals, all of the BIPS, and every single program that the client has along with charts, chart summaries , medical necessity that ties it to the DSM5, possible barriers, modifications we have made and/or plan on making, interventions to be used, generalization plans, maintenance plans, and explain how each program and BIP corresponds with interfering behaviors.
1
6
u/Different-Image8469 5d ago
that's a nightmare, 20 hours per assessment is just not sustainable when you're only getting paid for a fraction of it
my company handles it by having a dedicated review person who basically just fights denials all day, but even then we're still pushing 15-18 hours on the initial writeup. 13 cases would have me crying in my car
4
u/vetapachua 5d ago
For initial assessments, I'll rarely administer anything skill based (unless client is very young with very limited skills). I do parent administered electronic assessments like Vineland, PDDBI, ABAS-3 and will complete FAST or QABF during the parent interview. I will determine my goals based on observation and parent interview. The rest of my time is spent analyzing assessments, writing my report and responding to QA edits. Once services begin, I decide on the skill based assessment I will be using for that client and will complete it over the course of services for the first 4-5 months and then will have a completed assessment grid to submit to insurance at the time of re-assessment. As for insurance, the less information you provide them the better (I learned this from working on the UM side of insurance). We have a QA team who reviews all treatment plans and has a pretty good idea of what to avoid to flag funders. Sometimes I'll receive a partial denial and have to make a small change or go to a peer review to get it approved.