Revolutionizing ABA Therapy: The No Missing Pieces Journey with Raven

Revolutionizing ABA Therapy: The No Missing Pieces Journey with Raven

by | May 30, 2024 | ABA Industry, Blogs

In the realm of Applied Behavior Analysis (ABA) therapy, efficiency is paramount. The ability to streamline processes, accurately collect data, and provide seamless support can significantly impact the quality of care for individuals receiving therapy. In this blog, we delve into the experience of No Missing Pieces, led by COO Jennifer Arredondo, an ABA therapy organization, as they transitioned to using Raven, an ABA data collection platform, and how it revolutionized their operations.

No Missing Pieces, led by COO Jennifer Arredondo and based in Louisiana, is committed to providing high-quality ABA therapy services to their clients. However, like many organizations, they faced challenges with previous data collection platforms, which hindered their efficiency and productivity.

Recognizing the need for a more efficient solution, No Missing Pieces, under the leadership of COO Jennifer Arredondo, explored various ABA data collection platforms. They ultimately chose Raven due to its user-friendly interface, comprehensive features, and excellent support system.

No Missing Pieces quickly realized the numerous benefits of using Raven. From streamlined data collection to improved billing processes and enhanced preparation for audits, Raven became an indispensable tool in their arsenal.

One of the standout features of Raven is its efficiency and user-friendliness, appreciated by COO Jennifer Arredondo and her team. The intuitive interface and customizable scheduling options have made supervision sessions more productive and streamlined.

The team lauds Raven’s support team, particularly highlighting the responsiveness and dedication of Miguel Garcia. Their prompt assistance and willingness to resolve issues have further solidified their trust in the platform.

Based on their positive experience, No Missing Pieces wholeheartedly recommends Raven to other ABA therapy organizations. Their overall experience with Raven can be summarized in one word: efficiency.

Raven allows me to easily review session details, including notes and data points, which wasn’t possible with previous platforms we used. With Raven, I can see each data point made within a session, making audits much smoother.

Jennifer Arredondo | COO – No Missing pieces

Conclusion

The journey of No Missing Pieces with Raven exemplifies the transformative impact of leveraging technology in ABA therapy. By prioritizing efficiency, user-friendliness, and robust support, Raven has become an invaluable asset in enhancing the quality of care provided by ABA therapy organizations.

As the demand for ABA therapy continues to grow, embracing innovative solutions like Raven can empower organizations to optimize their operations and ultimately make a positive difference in the lives of individuals with autism and related developmental disorders. To embark on a similar journey of transformation, we encourage other ABA service providers to set up a call with Raven Health and unlock the potential for enhanced efficiency and client care.

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Building for Value-Based Care (VBC) Measurement: A CASP Conference Discussion

Building for Value-Based Care (VBC) Measurement: A CASP Conference Discussion

by | May 23, 2024 | Blogs

At this year’s CASP conference, an insightful discussion unfolded on the topic of value-based care (VBC) measurement, featuring industry leaders Yagnesh Vadgama, Doug Moes, Rebecca Womack, and Raven Health’s very own Tim Crilly. The conversation highlighted the challenges and opportunities in transitioning to VBC models within the autism services sector. The segment’s panelists drove home some key takeaways for the attendees.

Introduction and Perspectives

The discussion featured perspectives from various experts:

       

      • Tim Crilly: SVP of Partnerships at Raven Health, with a background in both clinical and managed care sides of ABA.

      • Rebecca Womack: Vice President of Quality Assurance at Verbal Beginnings, focused on policy and clinical solutions intersecting with payer requirements.

      • Doug Moes: Chief Clinical Development Officer at the Stepping Stones Group, providing a provider perspective on quality and outcome initiatives.

      • Yagnesh Vadgama: Vice President of Autism at Magellan, offered an overview of value-based care from a health plan perspective, advocating for a comprehensive approach that includes various aspects of autism care beyond ABA.

    Defining Value-Based Care

    Yagnesh Vadgama explained that value-based care is not a novel concept in healthcare, with approximately 60% of healthcare already operating under some form of value-based arrangement, primarily in physical health areas like cancer and diabetes. He emphasized the need to look at autism care holistically, integrating various treatments and services to enhance overall quality and outcomes. “We have to start somewhere,” he noted, advocating for initial models based on case rates with potential for bonuses tied to outcomes on measures like the Vineland.

    The Shift from Fee-for-Service to Value-Based Models

    The panelists discussed the limitations of the current fee-for-service model, which often leads to inefficiencies and a lack of focus on overall quality. Rebecca Womack pointed out that value-based care forces participants to prioritize time efficiently, focusing on outcomes that matter to families and payers. She stressed the importance of selecting quality metrics that provide a good return on investment for all stakeholders.

    Doug Moes highlighted the importance of focusing on quality inputs, such as robust assessment and treatment planning, treatment integrity, and fidelity of implementation. He emphasized the need for partnerships and collaborative efforts to enhance the quality of life for individuals with autism.

    Addressing Clinical and Administrative Changes

    The transition to value-based care requires significant changes both administratively and clinically. Vadgama mentioned the success of value-based arrangements with providers like Kyo, which have led to greater staff retention and satisfaction. This model allows clinicians to focus more on care coordination and addressing the holistic needs of families rather than just meeting billing requirements.

    Womack highlighted the importance of not making assumptions about the knowledge base of practitioners, stressing the need for thorough assessment and training to ensure successful implementation of value-based care.

    Technology and Data Integration

    The role of technology in supporting value-based care was a major point of discussion. Moes expressed excitement about the potential of technology to ease the burdens on clinicians and improve data collection and analysis. He envisioned a future where AI and machine learning could provide reliable data extraction from audio and video samples, unleashing passive data collection and allowing clinicians to focus more on treatment delivery.

    Crilly pointed out the need for integrated systems that can pull together data from various sources to provide a comprehensive view of patient progress and outcomes. He mentioned the potential of remote patient monitoring codes and the benefits of incorporating wearable devices to track sleep and other health metrics.

    Standardization and Collaboration

    An audience member raised the question of standardizing data reporting between payers and providers. Yagnesh Vadgama acknowledged the importance of this and mentioned that it central to the industry’s roadmap for value-based care. The goal is to move towards more database-type submissions that allow for better tracking and analysis of provider performance and patient outcomes.

    Rebecca Womack emphasized the need for the ABA profession to define its own standards and communicate them effectively to stakeholders. She highlighted the importance of balancing clinical decision-making with payer requirements to ensure the best outcomes for families.

    Closing Thoughts

    The session concluded with a call for collaboration and continuous improvement. The panelists acknowledged that while the transition to value-based care is challenging, it offers significant potential for improving the quality of autism services and achieving better outcomes for families.

    Thank you to CASP for hosting such an insightful session!

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    ABA Startup Bootcamp: Prior Authorization

    ABA Startup Bootcamp: Prior Authorization

    by | May 14, 2024 | Blogs

     

    Welcome back to our blog series tailored for BCBA entrepreneurs embarking on the journey of opening their own ABA therapy clinics. You’ve come a long way since hanging out your shingle: after coming up with your new clinic’s name, you already have started payor contracting, credentialing, and enrollment. Congratulations – you’re ready to start seeing clients! All you have to do is start administering services and billing your in-network payors.

    Not so fast!

    Today, we will explore the crucial process of obtaining prior authorization from payors before beginning treatment with new patients. This step is vital for ensuring that the services you provide are covered under the client’s health insurance plan, thereby securing your clinic’s revenue and facilitating effective care delivery.

    Understanding Prior Authorization

    Prior authorization is a requirement that your client’s insurance provider must approve certain medical services before you perform them. For ABA therapy, this is particularly important due to the high costs associated with long-term treatment plans. Prior authorization helps ensure that the proposed services are covered under the client’s current health insurance policy and are medically necessary.

    Step-by-Step Guide to the Prior Authorization Process

    1. Verify Insurance Coverage: Before initiating any treatment, verify the client’s insurance coverage. Determine if the insurance plan covers ABA therapy and to what extent, including any caps on the number of sessions or total coverage amount.
    2. Gather Required Documentation: Collect all necessary documentation to support the prior authorization request. This typically includes:
      • Client’s diagnostic information confirming an autism spectrum disorder diagnosis.
      • Proposed treatment plan outlining the goals and duration of therapy.
      • Clinical notes and assessments that justify the need for ABA therapy.
    3. Submit the Authorization Request: Submit the prior authorization request form to the insurance company. Ensure that all fields are accurately completed to avoid delays. Some insurers require submission via specific platforms or portals, so it’s important to follow the payor’s prescribed submission process.
    4. Follow Up Regularly: Insurance providers may take anywhere from a few days to several weeks to process a prior authorization request. Regular follow-ups can ensure your request is being processed and can help expedite approval. Be prepared to provide additional information if the insurance company requires further clarification.
    5. Communicate with the Client’s Family: Keep the client’s family informed throughout the process. Clear communication about the status of the authorization and any potential delays is crucial for maintaining trust and managing expectations.
    6. Receive and Review the Authorization: Once approved, you will receive an authorization notice detailing the approved number of sessions or coverage amount. Review this document carefully to ensure that it matches the requested treatment plan. If there are discrepancies, contact the insurer immediately to address them.
    7. Document Everything: Keep detailed records of all communications with the insurance company, including dates of submissions, follow-ups, and copies of the authorization. This documentation will be invaluable in case of disputes or audits.

     

    Tips for Streamlining the Prior Authorization Process

    • Educate Your Team: Ensure that all team members involved in the prior authorization process understand the steps and requirements. This includes training on how to complete forms accurately and manage follow-ups effectively.
    • Utilize Technology: Consider using practice management software that includes features to help manage prior authorizations, track the status of pending requests, and store client insurance information securely.
    • Build Relationships with Insurers: Establishing good relationships with insurance providers can facilitate smoother communications and quicker resolutions of issues that may arise during the prior authorization process.

    Conclusion

    Obtaining prior authorization is a critical step in the process of providing ABA therapy. While it can be complex and time-consuming, understanding and efficiently managing this process is essential for the financial stability of your clinic and the uninterrupted care of your clients. Stay proactive, organized, and patient—qualities that are as important in business as they are in therapy.

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    ABA Startup Bootcamp: Client Enrollment

    ABA Startup Bootcamp: Client Enrollment

    by | May 3, 2024 | Blogs, Uncategorized

     

    Welcome back to our blog series tailored for BCBA entrepreneurs embarking on the journey of opening their own ABA therapy clinics. Having covered the basics of payor contracting and credentialing in our previous posts, today we focus on another essential topic: the client enrollment process with payors. This process is vital for ensuring that your clients are covered under their insurance plans for the services you provide, which in turn secures your clinic’s revenue stream and supports financial stability.

     

    Understanding Client Enrollment with Payors

    Client enrollment with payors is the process through which your clients’ insurance coverage is verified and authorized for the services offered by your clinic. It involves confirming that the services you provide are covered under the clients’ health insurance plans and understanding the terms of coverage.

    Why is Client Enrollment Important?

    Properly enrolling clients with their respective payors ensures that:

    • Your clinic can bill for services rendered without facing denials for lack of authorization.
    • Clients receive their entitled benefits, which enhances client satisfaction and retention.
    • Your clinic maintains compliance with insurance regulations and payor contracts.

    Key Steps in the Client Enrollment Process

    1. Collect Client Information
    • At the initial point of contact or during the first visit, collect all necessary client information, including personal details, insurance information, and medical History.

    2. Verify Insurance Coverage

    • Use the information provided to verify insurance coverage through the payor’s online portal or via phone. Confirm the client’s eligibility for the services you provide and understand any co-pays, deductibles, or out-of-pocket expenses the client might be responsible for.

    3. Obtain Required Authorizations

    • ABA Therapy almost always requires pre-authorization from the insurance provider. It’s crucial to obtain these authorizations before starting treatment to ensure coverage. This might involve submitting treatment plans or assessment reports to justify the necessity of the therapy.

    4. Communicate with Clients

    • Clearly communicate with clients about their coverage details and any financial responsibilities they may have. Transparency helps in building trust and managing expectations.

    5. Documentation and Compliance

    • Keep detailed records of all interactions with insurance providers, authorizations obtained, and notes on client coverage. These documents are vital for billing and compliance.

    6. Regular Updates

    • Regularly update client records and verify changes in insurance coverage. Insurance details can change, and staying updated helps in avoiding billing issues.

    Tips for an Efficient Client Enrollment Program

    • Leverage Technology: Use practice management software that supports insurance verification and authorization tracking. Many systems like Raven Health offer integrations with major insurance databases to streamline verification, authorization tracking, and more.
    • Train Your Team: Ensure that your front office staff is well-trained in insurance verification processes and client communication. They are often the first point of contact and play a critical role in the client enrollment process.
    • Stay Informed: Keep yourself updated with changes in insurance policies and healthcare regulations that affect ABA therapy coverage.
    • Create a Client Welcome Kit: Include information on how clients can verify their own coverage, terms of their insurance, and FAQs about ABA therapy coverage, which can preemptively answer many client questions.


    Conclusion

    Client enrollment is a crucial step in managing your ABA therapy clinic’s operations effectively. By ensuring that your clients are properly enrolled with their payors, you safeguard your clinic’s ability to operate profitably while providing necessary services to your clients. Stay tuned for more insights in our next installment, where we will explore strategies to enhance client engagement and satisfaction in your clinic. Remember, an informed approach to client enrollment not only supports your business’s bottom line but also enhances your service delivery, contributing to the overall success of your ABA therapy clinic.

     

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    ABA Startup Bootcamp: Payor Credentialing 101

    ABA Startup Bootcamp: Payor Credentialing 101

    by | Apr 26, 2024 | Blogs, Uncategorized

    Congratulations! You’ve made the decision to take the leap and start you own ABA therapy clinic. As a first step you have already started the payor contracting process. Almost immediately, the first payor you contact lets you know that you need to go through a credentialing process. What’s involved with that?

     

    One of the critical steps in establishing your new clinic involves navigating the payor credentialing process. Being organized and doing this the right way for your very first payor is crucial as it allows you to partner with insurance companies, making your services accessible to a broader range of clients and ensuring that you receive timely payments for services rendered. Here’s a step-by-step guide tailored for new BCBA clinic owners entering the world of payor credentialing.

     

    Understanding Payor Credentialing

    Payor credentialing is the process by which insurance networks assess and verify a healthcare provider’s qualifications and professional standing. This process is vital for any new ABA clinic as it directly impacts your clinic’s ability to bill through insurance, which is a significant component of your business model.

     

    Step 1: Prepare Your Documents

    The credentialing process is document-intensive, requiring you to provide detailed professional information. Here’s a checklist of what you might need:

    • Professional Resume: Detailed and up-to-date.
    • Copies of Licenses: Including your BCBA certification and any other relevant state or professional licenses.
    • Proof of Insurance: Malpractice and liability insurance certificates.
    • Tax Identification and NPI Numbers: Ensure you have these identifiers ready.
    • References: Typically, three professional references are requested.

    Having these documents prepared in advance can significantly speed up the process.

     

    Step 2: Choose Your Payors

    Decide which insurance companies you want to work with. Consider factors such as which insurers are popular in your area, the ease of dealing with specific payors based on other BCBAs’ experiences, and the rates they offer. Once selected, contact each payor to obtain their credentialing application and details about the process.

     

    Step 3: Complete Application Forms

    Fill out the credentialing application forms thoroughly. Any inaccuracies or omissions can delay the process, so it’s crucial to double-check all entries. Submit the required documentation as specified by the payor. This often includes submitting copies of your licenses, resume, and proof of insurance.

     

    Step 4: Follow Up Regularly

    After submitting your applications, proactive follow-up is essential. Credentialing can take anywhere from 90 to 180 days, and sometimes longer. Regular follow-ups help ensure that your application is being processed and can help identify any issues early on.

     

    Step 5: Review and Negotiate Your Contracts

    Once your credentialing application is approved, you’ll receive a contract from the payor. Review this contract carefully, possibly with legal assistance. Pay attention to rates, the services covered, and other obligations. If necessary, negotiate terms to better suit your clinic’s needs.

     

    Tips for Speeding Up the Process

    • Organization: Keep all your documents organized and readily accessible.
    • Accuracy: Ensure all information is accurate to avoid back-and-forth corrections.
    • Professional Help: Consider hiring a credentialing specialist to manage the process.

     

    Conclusion

    Getting through the payor credentialing process is one of the first major hurdles you’ll face as a new BCBA clinic owner. While it can be time-consuming and sometimes frustrating, it’s a crucial step in setting up a successful ABA therapy practice. With careful preparation, organization, and persistence, you can navigate this process effectively, laying a solid foundation for your new clinic.

     

    Starting your own clinic is no small feat, but with the right approach to credentialing, you’re paving the way for a thriving practice that can make a significant difference in the lives of many.

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    ABA Startup Bootcamp: Navigating Healthcare Payor Contracts

    ABA Startup Bootcamp: Navigating Healthcare Payor Contracts

    by | Apr 19, 2024 | Blogs

     

    Starting your own Applied Behavior Analysis (ABA) therapy clinic is an exciting venture for any Board Certified Behavior Analyst (BCBA). However, the journey involves a number of critical steps, particularly when it comes to dealing with healthcare payors. Entering into contracts with healthcare payors is essential for ensuring your clinic can serve a wide range of clients, enter into and remain in network with payors, and secure financial stability for your clinic. This blog post will guide you through the necessary steps to successfully contract with healthcare payors and highlight strategies to expedite the process.

     

    Understanding the Contracting Process

    The process of entering into a contract with a healthcare payor can be intricate and time-consuming, often taking several months to complete. Here are the key steps involved:

      1. Credentialing and Enrollment

          • Credentialing: This is the first step where the payor verifies your qualifications (including licensing), experience, background, and legitimacy to provide healthcare services. This process can take anywhere from 90 to 120 days.

          • Enrollment: Once credentialing is approved, you proceed to enrollment, which involves getting set up in the payor’s system to submit claims and receive payments.

      1. Application Submission: Prepare and submit a detailed application to each healthcare payor you wish to contract with. This application should include all required documentation, such as your credentials, licensing information, proof of insurance, and a detailed description of your clinic’s services.

      1. Contract Negotiation : Upon accepting your application, the payor will typically send a proposed contract for your review. This stage involves negotiating the terms, including rates, services covered, and other operational details.

      1. Contract Execution: After negotiations, both parties will sign the contract, finalizing the agreement. Only after this step will you be able to bill the insurance for covered ABA services.

     

    Tips To Expedite The Process

    While the process is generally lengthy, there are several strategies you can employ to speed it up:

      • Prepare Comprehensive Documentation: Before you start the application process, gather all necessary documents and ensure they are accurate and complete. This reduces the likelihood of delays due to missing or incorrect information.

      • Understand Specific Payor Requirements: Each healthcare payor may have different requirements. Familiarize yourself with these specifics to ensure your application meets all their criteria.

      • Follow Up Regularly: After submitting your application, regularly follow up with the payor. This keeps your application on their radar and helps push the process along.

      • Seek Expert Help: Consider hiring a consultant or using a credentialing service familiar with the healthcare payor’s processes. They can provide invaluable assistance and potentially speed up the process. They can also be particularly helpful in negotiating better rates, which are critical for stabilizing your clinic’s early financial history.

      • Leverage Technology: Utilize electronic submission methods if available, as they are typically faster than paper-based submissions.

    Setting Realistic Expectations

    It’s important to set realistic expectations about the timeframe for securing contracts with healthcare payors. The entire process, from credentialing to contract execution, can take anywhere from six months to a year. Planning for this time is crucial to avoid financial strain during the early stages of your clinic.

    Conclusion

    Securing contracts with healthcare payors is a crucial step for any new ABA therapy clinic. While the process is complex and can be lengthy, understanding the steps involved and employing strategies to expedite the process can make a significant difference. With patience, persistence, and careful preparation, you can successfully navigate this journey and set your clinic up for success.

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