What Is A Single Case Agreement Mean

A case-by-case agreement is intended to meet the patient`s basic treatment or therapy needs and the cost benefits to the insurance company, without having to switch network providers. As a general rule, the following criteria must be met to guide the negotiation process. This includes the following factors: If you receive a CSA for an ongoing patient for further treatment, the negotiated rate is based on informed consent and patient consent when you begin treatment. Rate increases are consistent with your pricing policy in informed consent. You cannot charge the patient a lower horizontal rate out of your pocket and then charge the insurance company your full normal rate if the CAS has been dated in the past to cover the meetings. In the case of a patient who needs to move from your care to a new network provider or a patient who prefers to remain in your care, you may need to help the patient make the request to the insurer. In an off-grid scenario like this, it may be possible to use a case-by-case agreement to ensure that your client has the coverage he or she needs to receive the care he or she depends on as a doctor or therapist. Typically, the patient asks for an CAS from his new insurance provider. This means that it is useful to have a discussion about whether it would be beneficial to continue the relationship under an CAS in the event of a change in insurance coverage. The patient usually contacts a representative of the behavioral health of his insurance. But changing insurance doesn`t mean goodbye. There have been a few exceptions in which I have contracted with insurance companies for single case agreements (SCAs) that have been beneficial to all parties involved. Here`s what you need to know about SCAs to represent on behalf of your patients.

There are many therapeutic processes, such as ABA therapy, where continuity of care is essential to achieving treatment goals. When a customer switches to a new insurance provider, it is essential to maintain continuity of care or put in place a transition plan to a new network provider. In many of these scenarios, it is often necessary to negotiate an agreement on a case-by-case basis. If a new patient requests an CAS, the insurance can ask if the patient needs your specialty or geographic convenience. Similarly, CAS could be authorized if the treatment you can offer could reasonably be argued to keep the patient away from the hospital or to reduce the cost of medication. Case-by-case agreements must also use medical billing codes authorized for the CPT abA. It is important to spell them in the negotiation process with the insurer. This reduces the risk of deferred demand. In the event of a transition to a new network provider, the CPT code for the SCA may be specific to the number of sessions remaining. Insurance providers can only assign a specific code in this case or for patients.

The client has tried and cannot find a practitioner or supplier in his network that meets his needs in a way that allows him to feel comfortable. For treatment with ABA, this must be done before the start of treatment. When we are going through difficult times, we need mental health professionals more than ever. Understanding the process and elements of strong pretension for a single care agreement is one way to continue to serve and strengthen our local communities. This is particularly true if, in the past, there is evidence that the individual poses a danger to himself or others, or if he is at risk of suffering a serious setback from his mental health. Case-by-case agreements are most common in patients who have created trust problems and developed a professional relationship with their current ABA provider.

Comments are closed.