Single Case Agreement Policy


Case-by-case agreements must also use ABA CPT authorized medical billing codes. It is important to describe them in the negotiation process with the insurer. This reduces the risk of late claims. When switching to a new network provider, the SCA CPT code may be specific to the number of remaining sessions. Insurers can only assign a specific code for this case or for patients. Many therapists use single case agreements (SCAs) to keep patients who are witnessing a change in insurance. An ACS is an agreement between a therapist and an insurance company with which you are not connected (OON) that allows you to be effectively treated in a network for the case of a particular patient. Patients benefit from continuity of care with the same therapist they are familiar with and therapists benefit from maintaining relationships with patients and often getting the same or similar rates. In case a new patient watches an ACS, the insurance may ask if the patient needs your specialty or geographic comfort. Similarly, if the treatment you can offer could reasonably be argued to keep the patient away from the hospital or reduce the cost of medication, FCC could be authorized.

A case-by-case agreement is designed to meet the patient`s essential treatment or therapy needs and the cost benefits to the insurance company, without having to switch to another provider in the network. To lead the negotiation process, the following criteria must normally be met. These include the following factors: in the case of a patient who needs to switch from your care to a new provider in the network or a patient who prefers to remain in your care, you may need to help the patient address their request to the insurer. For such a scenario, the pricing policy can be evaluated on a sliding scale. Although you cannot charge your insurer the standard full rate for past repeat sessions. This is especially true if there is evidence in the past that the person poses a danger to themselves or others, or if they were at risk of suffering a significant setback with their mental health. . . .

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