What makes NSL different from other consultants?
Not only does Nicole have over 20 years of experience working in the industry, she has completed numerous insurance audits, has established working relationships with many state advisory boards, and has expert knowledge of the field of ABA.
What’s new in ABA?
Currently, Georgia has established the Georgia Behavior Analyst Licensing Board, which will require all Georgia BCBAs to become licensed with the state by September 30th, 2025 to continue practicing and providing services in the state.
Will insurance providers cover telehealth? What’s required for coverage?
Most insurance providers do not cover telehealth services for most billing codes. However, CPT codes 97151, 97155, 97156, and 97157 are usually covered, provided all individual provider billing requirements are met. Additionally, certain states may have residency requirements for credentialed BCBAs to render services as approved telehealth providers.
What are interstate compact agreements?
Interstate compact agreements are agreements entered into by 2 or more states which allow licensed individuals in one participating state to practice across state lines in other participating states. The exact ability of practitioners to act in multiple states at once varies depending on the exact nature of the agreement.
Will insurance cover ABA services to children provided in a school setting?
More often than not, this is a complex question. Most insurers will say that they will not reimburse for any services that a child is entitled to under the IDEA. ABA is considered a medically necessary service which most children on the spectrum need to maintain their current academic placement. Providing the correct documentation and clinical support to verify that ABA services are medically necessary, your agency can advocate to provide ABA treatment to any child in public, private, and homeschool settings.
Why do my claims keep getting denied?
Some of the most common reasons for ABA claims denials can include incorrect CPT codes, incomplete and/or inaccurate documentation, duplicate billing, billing for non-covered services, and untimely claims submissions.
What is the difference between licensure and credentialing?
Licensure refers to the state process of granting permission to BCBAs to provide ABA services within the state. Credentialing refers to the medical credentialing process, by which medical practitioners have their education, training, licensure, background, and insurance verified.
What is the difference between Medicaid, MCO, and fee-for-service?
State medicaid agencies are public health insurance programs funded by the federal and state government for low-income families, whereas MCOs are private insurance companies contracted by the state to deliver Medicaid services. Fee-for-service is a system wherein providers are paid separately for each service rendered, as opposed to an overall bundled healthcare package.
What is necessary for a comprehensive background check?
Most comprehensive background checks, as required by insurance companies include a federal background check, I-9 eligibility verification, fingerprinting, sex offender registry checks, as well as cross-reference with the OIG exclusion database.