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5 Tips To Change

Your Success Level.

Dr. Tim Courtney On The 5 Tips That Can Greatly Increase Your Success With Treatment Plans.

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headerlogo

5 Tips To Change

Your Success Level.

Dr. Tim Courtney On The 5 Tips That Can Greatly Increase Your Success With Treatment Plans.

Play Video

5 Tips To Treatment Plan Success

1. Learn the definitions of medical necessity, so you can prove that your treatment recommendations are medically necessary, not just beneficial.
The whole premise of everything you need to prove is mapped out in that definition. Medical necessity has been defined in multiple different places, but there are commonalities across all the definitions. These crossovers contain the key you need to decode the writing process for your recommendations. It’s not just about writing things that are accurate, it’s about meeting very specific criteria mapped out for you. Once you know how to do this, the process becomes easy to repeat over time.

2. You must know the information payers put out about their requirements.  
Payers may have requirements that are not necessarily gospel, but you need to know what they’re looking for; they'll have guidelines, suggestions, recommendations, and standards they distribute. You need to read that information, be aware of it, and find anything and everything you can to learn what the payer is looking for in order to prove medical necessity. It doesn't mean you have to jump through all the hoops. It does mean you should be very aware of their locations.

3. Become A SPECIALIST.
You need to understand what the symptoms and impairments of autism are. You were trained as a generalist in human behavior as a BCBA. You've learned the concepts and principles of human behavior. Everything you’ve learned is crucial and will help you address those impairments. You also need to develop an understanding of autism, which can be a gap in your knowledge since you’ve been trained as a generalist. You're providing care for this population, so you need to know how they're impaired and what symptoms they're exhibiting. That's what you're addressing trying to get them medically necessary care.

4. Choose Your Language Wisely.
Every word must be carefully thought out because it helps with the overall notion of proving medical necessity. You're gonna have to defend every word you write, so it's really important to make sure what you write helps to clarify that services are medically necessary.

5. Flex Your Clinical Judgement.
It trumps all. YOU are the expert and only you can defend your treatment recommendations. When you gain confidence in your ability to do this, it changes your mindset entirely. Your focus remains with getting care approved, not on feeling the need to defend yourself or worrying that you're playing a guessing game. It’s about doing the right thing continuously. The notion here is when your recommendations and suggestions are based on your clinical judgement, that is a highly defensible position and is actually is something insurance companies can't supersede. They can't say, “That's your idea but in OUR clinical opinion…” They can only say whether or not your recommendations meet the standards of the plan, which goes back to tip number 2. When you say, “This is based on my clinical judgement, experience, knowledge, expertise, and training.” that is a STRONG position and a highly defensible one. Your goal is to further strengthen your clinical judgment and know that it's okay to say your recommendations are based on that judgement. This is a key area I’ve been stressing for a long time. Often people want research to be their defensible position, and that's how you get into a research vs. research battle, which rarely works out for your patient. It’s best to use evidence informed and based on research but ultimately say, “In my clinical judgement, this is what is needed.” With authority.

Want To Learn More?

Check out our Treatment Plan Series!

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