Resources for Upcoming CPT Code Changes:
Here are a few resources:
If you are unaware of the upcoming CPT code changes (going into affect January 1, 2019) or if you are aware, but are uninformed, please take the time to watch the recorded webinar offered by APBA (APBA Webinar on New CPT Codes for Adaptive Behavior Services ($15/$24)).
In addition, please review the following document recently disseminated by ABAI/APBA/BACB/Autism Speaks (they worked with the AMA on the CPT code changes): ABAI Suggestions/Resources for Preparing for New Codes
As you're preparing to transition to the new codes, this conversion table may be helpful: Updated CPT Code Conversion Table from ABAI
In addition to those resources, here's a summary of some of the discussion points from our Town Hall:
The CPT code changes go into effect January 1, 2019. In order to minimize complications when billing for ABA services, it is essential to talk with third-party payers and ensure your billing codes align with the payers' contracts. Otherwise, there is a high probability claims will be denied. (This could have numerous negative consequences, especially for smaller businesses.)
Most insurance companies are focused on transitioning their systems to the new CPT codes so they are prepared on January 1st and will work on renegotiating contracts with providers later in the year. Although payers may reach out to providers, it's more likely that providers will need to reach out to payers and renegotiate contracts. The link above to the ABAI Suggestions/Resources for Preparing for New Codes gives a list of questions that will be helpful for providers to send to their payers.
At the Autism Law Summit, some of the larger insurance companies were in attendance and mentioned their systems will be ready for the new codes as of January 1, 2019. That included Cigna, Aetna, and Anthem. As a word of caution, each provider will want to verify this information with their local payer contact.
These changes will significantly impact how ABA claims are processed. In our industry, we're just learning about some of the ramifications of billing errors and billing fraud. Recently Jon Bailey did a webinar titled, Ethics of Medicaid Fraud: Scenarios and Q&A with Dr. Jon Bailey, BCBA-D. The webinar might have useful points of consideration as you're preparing your organizations/businesses for the upcoming billing changes. It can be accessed here: https://store.special-learning.com/products/product-387. (*Disclaimer: The webinar was hosted by Special Learning. UtABA has no affiliation with Special Learning and is not endorsing Special Learning. Instead, we're simply trying to share resources that might help providers who have questions related to ethics and Medicaid Fraud.)
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