Georgia Association for Behavior Analysis  

The Georgia Association for Behavior Analysis (GABA) was founded in 2001 to provide: (1) a professional network and resource for behavior analysts in Georgia; (2) a forum for members to collaborate, disseminate recent research, share ideas, and discuss needs; (3) a voice to promote the ethical and effective use of behavior analysis; (4) a resource for those seeking ABA services in Georgia; (5) the organization of an annual regional ABA conference; and (6) a provider of continuing education for professionals in Georgia.

 

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GABA on Facebook

Recent message from ABAI:


We are the steering committee for a group that has been working on CPT codes for applied behavior analysis (ABA) services on behalf of the Association for Behavior Analysis International, Association of Professional Behavior Analysts, Behavior Analyst Certification Board, and Autism Speaks. We have recently heard from some health insurance providers and billers that they are receiving claim denials for certain ABA services. Some insurance companies are justifying those denials based on Medically Unlikely Edits (MUEs) that took effect on January 1, 2017. A MUE for a HCPCS or CPT code is the maximum number of units of service that a provider would report under most circumstances for a single beneficiary on a single date of service. MUEs are set by an agency contracted by the Centers for Medicare & Medicaid Services (CMS) after circulating proposed MUEs for CPT codes to medical specialty societies and other stakeholders. The CMS MUE program was developed to reduce the paid claims error rate for Medicare claims.

Last year, we learned that CMS had established overly restrictive MUEs for the Category III CPT codes for adaptive behavior services that some health plans use for ABA services. We immediately took action. After consulting with a group of ABA stakeholders, we sent a letter to CMS noting our concerns with the MUEs. CMS responded in November of 2016 by modifying the MUEs in accordance with our recommendations for all but three of the codes. Unfortunately, those three codes are critical to the effective delivery of ABA services: 0365T, adaptive behavior treatment by protocol administered by a technician; 0369T, adaptive behavior treatment with protocol modification administered by a physician or other qualified health care professional (QHCP); and 0370T, family adaptive behavior treatment guidance administered by a physician or QHCP.

Although third-party payers are not required to follow the MUEs established by CMS, many use them in their claims processing systems and policies. In response to recent reports that some payers are using the MUEs that went into effect on January 1 to severely restrict reimbursement for some ABA services, our steering committee has solicited input from stakeholders. We will use that information to develop a request for CMS to reconsider the MUEs for the three codes listed above in accordance with our previous recommendations. We hope to send the letter to CMS by the end of this month, and will update you once we've received a response. In the meantime, providers who wish to appeal denied claims based on the MUEs should visit the CMS webpage for guidance. Additional information on MUEs can be found here. If you have any questions regarding the MUE process, please contact Jenna W. Minton, Esq., consultant to this committee (mintonhealthcarestrategies@gmail.com; 517.927.8696).


Sincerely yours,

Jenna W. Minton for the ABA Services Steering Committee:
Travis Thompson, Association for Behavior Analysis International
Gina Green, Association of Professional Behavior Analysts
James E. Carr, Behavior Analyst Certification Board
Michael Wasmer, Autism Speaks State Government Affairs
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Why should Georgia Behavior Analysts attend this event?

1. One free drink ticket (if you RSVP!)
2. Two FREE CEs (if you attend, sign in/out, complete eval form)
3. Three friendly behavior analysts are hosting and would love to have you!
PS -- Dr. Kim's presentation will rock your socks!
PPS -- Cupcakes!
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Georgia Association for Behavior Analysis shared Sarah Murphy's photo. ... See MoreSee Less

Nearing completion of the 2017 schedule...check it out!

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Georgia Association for Behavior Analysis shared Sarah Murphy's photo. ... See MoreSee Less

Nearing completion of the 2017 schedule...check it out!

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Nearing completion of the 2017 schedule...check it out! ... See MoreSee Less

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