Hello, my name is Stephen Smith, the owner of 3Pi Squared, and this is the ABA Business Leaders podcast. Before we get into the episode, I want to tell you a little bit about our membership program. 3Pi Squared has helped over 700 ABA practices start up and expand. Our membership has over 45 hours of content from experts in the fields of law, accounting, diversity and inclusion, childhood development, mindfulness, business development, HIPAA compliance, marketing and branding, billing and more.
We also have discounts on things like our 3Pi Squared handbooks, professional liability insurance, background checks, HIPAA compliant email, contacts, calendars and cloud storage. The membership also includes 33 CEUs, live Ask Us Anything events where you can come on and ask your questions as you're going through the program. And in our app, you can also add anonymous questions and get your answers.
To learn more about the membership, please go to our website www.3PiSquared.com and click on ABA Business Leaders. And now let's get to the episode. So yes, hello everyone watching and listening to this. So just a couple of quick updates, notices and announcements. So our Pi Day discount is still going on right now. So we have a 60% discount on our ABA Business Leaders membership.
That includes over 33 CEUs, our live events where we have two to three live events every month where you can come on and ask us anything about your business. And then, you know, the, I don't know, it's around 70 hours of content, self-paced content that we have. So as you're creating this amazing business, you have the knowledge base that you can really excel at this and create a self-sustaining ethical practice. Highly recommend that, probably because I'm selling it, but it's 60% off.
So it's only $200 right now and it will be that price for the rest of the week. So take advantage of our Pi Day discount. It's coupon code, Pi, P-I, Day, 2023. And you can get, save $300 for this 12 month membership. And then just a couple of other things that we're doing is that we have been working very hard on the KPI course that we're going to be doing. That will be the self-paced part of it will be included in the membership. So you'll get access to the videos, the recorded videos.
But if you want to join the course itself, we'll be creating that here shortly. But it will be a live event. It's probably going to be, we're looking at it right now, it's probably going to be eight live events where we go through KPI. Some of it, you're probably going to fall asleep too. And then there are others that it's really, really good stuff. And we're not just going to be saying, this is KPI, blah, blah, blah. But we're going to be providing real life examples.
ABA examples and how you can implement this in your company. Especially starting out, we're going to use three examples that are super important to measure your self-sustaining ethical high quality practice. So when you join as real time for the course, then like you said, there's going to be live courses. It's going to be interactive. It's going to be interactive.
There's going to be portions for coaching to talk about specifics of something that, a question that you have based on something that you're working through with your company, things like that. But I do want to say KPI stands for Key Performance Indicators. A lot of people, honestly, when Steven Kavitsy, he's like, we really needed, it's been, gosh, over a year ago now that we've put this on our, maybe even longer, that we've put this on our radar that we want to get for you guys in 2023.
And I had not heard of this before, at least. I understood that concept, but I had not heard of KPI. So Steven, just elevator pitch quick summary. So what is KPI, Key Performance Indicators? What does that mean? So I mean, it can mean many things, but Key Performance Indicators, really what we're looking at this, our focus is on is how do you ensure that your practice is self-sustaining? How do you ensure that you're providing high quality services? And so we're going to take that.
Those are our goals, right? And I think that's the vast majority of the practices that we work with. Those are our goals too, right? We want to provide high quality services and we want our company to be self-sustaining so we can continue to employ our staff and continue to provide high quality services. So what we're going to do is what indicators tell you that you're doing both of those, right? And then if things start falling off a cliff, what do I do to get back on track?
And so that's really going to be our approach. I think that the way that we're setting up the course, it's going to be very good for both new companies and existing companies. And we can really build off of the starting point very easily, right? You can make very small goals with Key Performance Indicators. And then you can get super complex, right? And so we're going to be doing both of that. We're going to be doing some simple Key Performance Indicators.
But then when we get into the quality side of things, this is a complex metric that you're going to have to figure out. There's a lot of nuance in it. And so we're going to be doing both of those, right? And then you can really build them out as you go. Right. The podcast that we did, I don't... How do you define quality? How do you define quality services? That was kind of the launch of that, the very beginning, getting that started. That's really the main intention of it, right?
How do you provide quality service? How do you know you are? How do you measure it? How do you make sure you're measuring the right thing? Correct. What do you do if you're... Where do you go from there? That's really what this is going to be about. Again, it's going to be real life, real ABA business examples. It's not going to be like, okay, we're working at the widget factory and then that's what we would do here. No, that's not what we're doing. So this is cured towards ABA businesses.
And I think it's going to be super helpful. And it'll just allow you to measure some of these things that can be very difficult to measure. And you can look at it more at a high level and see that, okay, we are providing quality services. And then again, this goes back to, okay, we have this thing now. What do we do with it? Right negotiate. So you can now prove with numbers, with data that I am amazing and you need to pay me more. And that, I mean, it is what it is. We need to be doing that.
And KPI is really the answer to showing that you are providing high quality services. So yeah, that's really it. And then once we get that one going here, which I hope will be at the start of next month, we'll start the course and then we will be doing our live cohorts again. So that's something that we will be bringing back. And so this will be a ABA business leaders membership, but a more interactive approach with live events.
And we'll go through key components of starting your practice, expanding your practice. And that's separate from the KPI. Yeah, this is separate from the KPI. So we'll also be launching that and that will probably be more at the end of next month. So the end of April, we'll be opening that up. So yeah, end of April, beginning of May. And we've had a lot of people asking because we haven't had the live cohorts in a while, probably a year. Yeah, a little over a year.
We've just had the like self paced with live events, but like the live Q&A is but yeah, so that's what we've had. We've had requests of people reaching out to say like, when are you going to have your next live cohort? So we're like, let's do it. So yeah, so well, that will be starting soon. And then then my values based course is almost over for this term.
But I am available for just like coaching on values and mission statement and, you know, setting up your work culture in the way that you want it to look. And then if I have the interest, I will be doing another course also coming up. Like I'm open to starting another course up if I have, I'd like to have at least a few people sign up that are available to attend the lives. It just got a little bit more out of it.
So I'll send some feelers out over the next week or two and see if anyone's interested in doing that. If not, like, just reach out to me and book me for a free consult. And on the booking site, I guess Stephen will link that for me and for him. Yeah, so reach out to us if you have questions or want to talk about any of these new things or old things or anything. Yeah, so we last week we did for our members, we had a live Q&A event and Stephen wasn't able to attend it.
Our family got hit by the stomach virus last week. Pretty bad. So as soon as it was really only a couple hours after our live that then I felt ill and then yeah, it's bad. So for those of you who attended the live, I will also reach out to you and let you know.
But we thought what we would do, there were a few questions that you guys had that I flagged as Stephen questions and I thought he could definitely give better insight and more insight because they are more on the business-y end of things. So I said I would get confirmation from him. So I'm going to bring a few of those questions to Stephen right now during our live here. Anyone watching this, if you have any questions, feel free to shoot them in the comments and we'll try to answer those.
I will do my best to answer those. Yeah, super. I'm trying my best to keep an eye out here. I think we're live in two groups. We are. We have the both ABA business leaders, the membership and the closed membership and then just a regular group. All right. I'll try my best to keep my eye out here for that. And at the same time, I will bring up some of the questions that were asked from the members live Q&A last week. And we have another members live Q&A coming up next week, I believe.
I think this is the 22nd. Stephen will get a notice for that. In the closed membership group, we did post a poll. Please if you can just take a few seconds and just tell us what days, times work best for you. That'd be super helpful. Just so that as we schedule these out, we just, you know, as many people as can come to these as possible is the best, right? There's people like to hear from each other. Yeah, yeah, absolutely.
I feel like there's, you know, right now, I don't know the exact numbers on the membership, but I feel like it's close to 150. So you know, we would love it if you know, more of you can attend these live events and they're helpful. So if you can tell us, you know, a better time or day of the week that would work, please let us know. Yeah. All right. So our first question here. So can you credential a BCBA or BCABA before they are an actual employee? Do they need to be an employee first?
Is it okay for them to be an employee and not actually begin working until after being credentialed? Like, so you're like, okay, I'm going to hire my first BCBA. Already know somebody who can, who wants to come work with me. But I know it's going to be a good six months before their credential. Do I like, I think it's kind of like, do I hire, do I have to hire them now to start the credentialing process? Like, do I have to pay? Like, tell me all the ins and outs of this.
So I mean, there are many ways that you can do this. Right. And so like, okay, are you hiring this person part time? Are you hiring them as salaried employees? Like that's the first question that I ask. Right. So if you're hiring them part time, or even if you're just doing it hourly and they're full time, well, like while they're not working, you don't pay them. Right. So if they're not working, then you don't pay them an hourly wage because they're not working. So there's really no issue here.
What we did, we had salary, all of our staff were salaried. So what we did with our BCBAs, right, when we did the interview process, that's one of the questions that we asked, how much time are you going to give your current company? Right. And this was a very important question for us, because if they said, yeah, probably just a week, we wouldn't hire that person.
Because if they're only going to give their current company a week, they're only going to give us a week and that's not going to work for us. So that kind of tells you a little bit about this person. So we would ask them to give as much notice as they possibly could and needed for the current company that they were working with. So maybe that's eight weeks, maybe that's 12 weeks.
And so they signed the offer letter, they agreed to start on this date, and then we immediately started credentialing with them. And then the hope is, is that you have diversified your funders enough that at least some of them are somewhat quick. And so Optum is typically quicker, Blue Cross Blue Shield adding someone is typically quicker, where Tricare and Aetna, good luck. At least that's my experience. So those can take six to nine months.
And it's like, dude, what are we going to do during that period? So if you have some that are quicker, where in four to six weeks they're in network, then they're taking on those cases while you're waiting for the other ones. So that's what I would recommend. But I would not start credentialing someone until they have signed an offer letter. I think that that would be the most important thing. So yeah. So I'm just reading that.
So the process to credential new employees can take as long as the initial. Oh, yeah, yeah, totally. Yeah, it's terrible. So it does depend on the funder, right? So like some funders, it's simply emailing them your updated roster, right? And it's like a week. And then other ones, it's they are submitting the exact same form that you submitted. And then you're waiting for it. You're just you're just waiting for it. And that like it's it's exhausting.
So yeah, I mean, that that's that's the issue, right? So it's what are you going to do in that process? Because it like this is another question I get. Well, like, OK, fine. You know, it's going to take six months for this person to get credentialed. But what we'll do during that time is we'll let them supervise, but we'll bill under another supervisor's NPI that's already in network. No, don't do that. That's fraud. Like that is literally the definition of insurance fraud.
You are saying that someone else did this. Right. And so don't do that. That's not that's a good idea. So like in that case, like there are a couple of things that you can do. You can ask for a single case agreement and see if they'll go for that. Sometimes they will. So you can say, look, this person, we submitted the application, we're already in network. Can we just get a single case agreement for six months while we're waiting on you all to figure out what you're doing?
And some of them will do that. And so you could try that. The other thing that some of them will do and again, talk to your funders, but many of them will allow the BCBA to work with the tech. So that may be an option as well. So maybe they're not getting the protocol modification and the parent training rates, but at least you're able to bill for them. Right. And so that may be another option that you can do. And there was, gosh, this has been years ago, but there was one that would backdate.
Yeah, they don't do that anymore. But what I was going to say is like, I would even, I would be very, I wouldn't do it because there were a couple of things to that. Like if you ever did come across someone and say, oh, you can just backdate it. Well, you're still not going to get paid for it until their credential. So do you have means to pay this person while you wait? If you do, okay, maybe. But then also like you have to make like get it in writing and like in a contract, right?
Like, I mean, honestly, like an email is probably not going to hold up. So, so, but I don't think it just goes to how much risk are you willing to pay? I mean, I don't think that I haven't heard of that at least I know for us. Like it was been a while since we hired an ABCBA though to credential. So, so I, but from what I'm hearing from others, it's not something that happens anymore. Blue Cross Blue Fields used to do that, but I'm pretty positive that they no longer do that. All right.
So we have another question. Do you have to credential RBTs? Not at this point. I do recommend that you get their, that you get an NPI number for each of your texts because that is something that is available now. Obviously I can't imagine a scenario where they won't have to be credentialed at some point. And so having that in place is a good idea. Now I know that TRICARE and we did not really work with TRICARE.
So anyone listening to this after the fact can please like, you know, just say, Hey, Stephen, that's stupid. You don't know what you're talking about. And correct me. But I'm pretty sure that you have to, again, you have to add your texts to the roster with TRICARE and that does take some time. That's not just an easy process. I think that this, this takes some time.
Now with most other providers, you don't normally have to add them to the roster and you're just billing under the supervisor, right? So you're billing under the BCBI. So in that situation, you're totally allowed to write that. That is the process. The RBT, you're not, you're not billing that on the session or the CMS one. So you're not billing the NPI number of the, of the RBT. You're billing the BCBA, right? And that's how they've set up the process.
But with BCBAs or BCABAs, if they credential BCABAs, they have a credentialing process. So if they have a credentialing process, that means you have to follow it. And if you're not following it, then you're committing fraud. That's just how, that's, that's how I look at it. So just something to be aware of.
Well, I think this is a great time to give a reminder that when you're even if like to do a, can't talk, a great reminder to talk about group versus individual, like, am I using the right words? Like when you're, oh yeah. When you're setting up your company. Yeah, set it up as a group. Yeah. Please, please. Like so many people, like I, I, it just happens where they're like, I, yeah, I don't think I'm going to hire anybody. So I'm just going to set up a sole proprietor. It's just going to be me.
And then like within six months, they're like, yeah, I can't do this anymore. I need a tech. And now they're in, they're not in a group. So they can't hire a tech and then they have to re-credential. And if you've done any rate negotiation during that time, you may lose those rates. I've also seen it where, you know, they set it up as a sole, they wanted to hire people and then they went to reapply as a group, networks closed. The, so like just, just set it up as a group. Highly recommend it.
Don't, don't do it as a sole provider. And there are some funders that will say, well, you're just a one BCBA and you don't have any techs and so you really should be setting it up as a, as a sole proprietor and say, no, no, thank you. As soon as I get in network, I will be hiring people and creating a group. I just, I need to get credentialed first and try to push back on that because that, that's also really important. All right.
So like looking at budgeting, like as you're looking at whether to do like a tiered approach or if you're going to like have your BCBA doing direct services or like, so looking at like the five three, like the direct code, right? Like keeping that in mind, but like how, how do you budget when rates differ across funders and you're looking to see like which tier, like if you should do the tier service approach, like what model of service you're going to provide.
And like, so I guess like the overall is like, how do you budget for that direct service rate across different funds?
So yeah, so in our, in our, um, ABA business leaders membership, uh, we have a budget calculator and so you can put in those contracted rates, put in your expenses, put in your payroll expenses and then your general expenses just for ABA, you know, owning a company, all the accounting software, you know, stuff like this, uh, put in all your expenses and you can see your profitability based on those rates.
And then you can do this for every contract that you have highly recommend doing this, right? Again, this is, this should be part of your rate negotiation tool anyway, but it's really important before you sign that contract to know whether these rates are going to cause you to lose money, um, or, or are they going to create a self-sustaining high quality ethical practice? And so if you're losing money on every case that you take, that's not going to work.
And so you're like, it's really important that you do that budgeting process. So I can't tell you what, you know, many people will come to me and say, well, are these good rates or bad rates? I don't know. I can't answer that for you. Um, and so like that's where the budgeting process, that's why we, we made this very specific ABA, uh, budgeting calculator in our membership, um, is, is so that you can answer that question for yourself. Well, and so kind of like talking more about like the cost.
Um, so I know there's a lot of formulas out there and like, you can Google like how much an employee is going to cost or, you know, like there's formulas. I don't know the specifics. Um, they're all confusing to me, but, um, so Ellie, how, how can you plan for how much an employee will cost? Like should you use those formulas that they have, um, you know, that you can Google? Well, I mean, part of the budget again that we have is putting in the payroll expenses, the workers comp expenses.
If you're doing benefits, are you doing like, are you doing non-billable time? How much are you allowing? So there are a lot of like, how much training are you providing? So you know, like, like there are some practices out there that they do a crash course. Oh, they have their RVT check. Okay. And then, you know, two days in there going out and working with clients. I don't recommend that. That's not something that we would have ever done, but Hey, I'm not, there's no judgment here.
You do you, man. Like if you think that that's quality services, I'm not like, I wouldn't do it, but, um, so like how much training time do you have? Right? So like, um, are they getting crisis management training before they go out? So that's a week probably. Are they getting, uh, are you checking their competency levels before they go out? Are you, uh, are you going to do pairing training with them? Um, are you going to train them on all the programs beforehand?
Uh, so there's just, there's a huge, uh, range of how much training is involved. Right? Um, and then are you factoring in the time the BCBA, uh, spent with this, this staff as part of that expense, which I, I recommend that you would. Right? So we do have an RVT, um, uh, cost of turnover calculator. Um, and the loss of a, of a tech is what I've calculated. I think is around $8,000. Um, but you know, again, it's going to depend on your practices in your company.
So doing that budget, I would highly recommend. I'm trying to, my computer's about to die and so I'm trying to reach the power cord like without getting up and walking around the table. And I'm like realizing that I should just get it. I slipped and fell on the ice last week. I have like a water, a hot water bottle behind me cause I like bruised my tailbone. I have like a donut pillow.
I was trying to like keep myself from the embarrassment of like showing what I'm sitting on and behind, but here we go. Like I just need to plug up my computer. So I still have the information that I need in front of me. Um, while I do that, um, you know, it's the fun part about just being live on social media. It just is what it is.
So, and so if you're registered at the kind of going back a little bit, so if you're registered as a sole provider with an insurance company and RBT can't work with that client. Yeah, I'm pretty sure you can. Like again, like don't take my word for it. I don't take my word for it. Uh, my experience has been a no on that, but check with your funder because they may allow it. Um, but yeah, yeah, get it. Yeah. Get it in writing.
Yeah. Um, uh, and again, they may allow it and then you're good, right? If you have no plans on hiring another BCBA. Um, but yeah, they definitely will not allow you to add another provider to a sole proprietor. Um, now this isn't, this isn't like I'm a sole proprietor on my, uh, taxes. This is like when you submitted your application, did you submit it as a group or did you, do you have a group NPI or do you, did you just provide them your NPI?
Um, and so if you just provided them your type one NPI, then you won't not be able to hire another BCBA. Now again, in my experience, I don't believe that you can add a tech, but like again, don't take my word for it. So yeah, she, she was told that she couldn't, uh, they couldn't register as a group because they didn't have five providers. Yeah. That's what you were saying earlier. I'm, I'm, I'm, I will be like, yeah. And so really, really try to push back on that.
I know that some fund, like some funders are really tightening their grip on groups. I get that. Um, so you may have no choice, right? And that's fine, but just be aware that you're going to have to do it all over again. And then maybe you can get it in writing. If you rate negotiated with them that you please honor my rights when, if we do go to a group, because if you're not going to honor my rights and just let me go in as a group, so I know that some have stipulations.
I'm not mentioning funder names at this point, even though I probably already did. Um, but, um, so yeah, but try to push back on that if you can. And, um, and, and just put up a little bit of a fight and say, look, you know what? I'd be a group if, if I was in network, uh, so that I could start working with staff or working with clients. But until then, like, I can't hire people and just have them twiddling their thumbs. So you know, you let me be a group and we'll be a group.
Um, and, uh, it won't take that long. So in my experience, that's worked fairly well, but I know some of them are pushing back on them. And so the, the other thing is, can you wait for that funder? Right? So like, you know, okay, we got a network with five as a group, but the sixth one is being, you know, pain. All right. Well, is the rates that tremendous that you really need that group? Or is it just that that group is that funder is just so popular in your area that you have no choice?
Yeah. Then, then you're going to have to make that decision, um, based on, on those factors. Cool. All right. Still see more questions from, um, okay. So you get in with Optum, you pass it on. Then it's time to negotiate. Like, so of course, like before you sign the contract, you go try to negotiate at that point. Right. Um, and let's say you get a terrible rate. You try to negotiate before you sign the contract, but they say you have to wait one year. Yep. Then what?
Do you have to wait one year? I mean, yeah. I mean, like, did you sign the contract? Like are they, are they constantly saying that? What if you did, what if you're just still trying to finish up that process and you didn't sign it? And so they give you, you know, you get a hundred percent, you're like, yay, we passed the Optumonic and then they give us the thing and we read through it and we're like, oh, that's not enough money for us to stay in it. It's the same as it's so, okay.
So we're going to go back and say, okay, we need this. Um, and then tell them all the reasons why I'm right. And then they're like, yeah, no. Um, and a year, even though you haven't signed. Or if you have signed and then you realize, like, I think you're like locked in more, right? To have to wait for the year. I mean, you're not locked. I mean, you're, you're, I guess you're locked in a little. You could just send in your termination of. I've got the threat. No, I don't know.
Like you would just like, if you, if you feel the rates are too low, don't sign the contract. And that's all I can tell you. Right? Like I can't, um, now if you feel like the rates are acceptable, but they are low, but they're acceptable, then I guess you sign the contract and you hope that in a year, they honor what they said. Go ahead and do your work and have it all ready as soon as a year hits. You can start submitting. Correct.
And then like the only, the only other option, like, you know, rate negotiation is this is not any magical thing, right? Like, so, you know, um, it's you before signing the contract, you rate negotiate with everyone, um, and see if they'll allow some increases. I've had success, um, before the contract, the initial contract is signed. Um, and then lately, uh, I'm, I'm seeing this more where, um, the it's, it's harder on that initial contract and they're pushing back. And so, okay.
Uh, but if the rates, if you're losing money because you're accepting a contract, you can't take it means you can't, right? And so if you're, if, if the rates are unacceptable and they're causing you to go in, uh, you know, go under, then you shouldn't be accepting that. Um, and so, you know, there are a couple of options that you have. It's okay. I'm not accepting this contract and here's my rate negotiation letter and what I need and I can't sign this.
Um, or you can accept the rates and then wait the year and then submit your rate negotiation. And if they still like, yeah, no, it's times are tough and we're just, oh, we're just a little old insurance company and we just don't got some money for you. Then, then you're going to have to terminate, right? Like you're going to have to turn.
And so then, you know, what I recommend is that on your termination letter, you attach your rate negotiation letter and say, look, like we don't want to terminate, but we're, we're, please start the process of the termination. Um, now if you're willing to rate negotiate, here's our letter and you know, let us know. And then we, we, we don't have to go through this terrible, um, um, thing of right, of terminating our contract. Right.
Because what you can't do is be like, okay, well, insurance companies sees rates are crappy. We lose money off of this. So we're just not going to take them. Yeah. Or we're only going to take a couple clients from this insurance company, but we'll, we'll, we'll just put them on our wait list or we'll let them know we're full or we'll let them know that we only take a few clients. That's not a reason why you, you accept clients because your rates are bad.
No, that's the, the, the reason you're in network with them and you have a contract, you have to, that's the reason why you terminate a contract because your rates are bad, but you can't just say, I'm, I'm, uh, I'm discriminating against this person because they have a bad insurance. You can't do that. I'm sorry. I mean, I, there have been many times when I've wanted to do that, uh, but that's not a reason why you cannot provide services, uh, ethically. I just wanted to bring that up.
No, I mean, it's a, it gets talked about. It gets asked in a, in a really like genuine, like, totally, like, how do I work around this? How do I, okay. Well, until I get this rate negotiation and hopefully get more money, like I can't take clients from these people. Yeah, not. It's, I, yeah, you can't, you can't. You can not take clients because you don't have availability. You can not take clients because you don't have the skill set for it.
So like if you're early intervention and this person's an adult and you don't have, you know, um, you know, there's multiple like ethical clinical reasons why you can't accept clients or why you put them on a wait list or you help them move on to someone else. But like, you can't, you can't not accept them because of. No, if you, if you're seeing frustration in my face or hearing frustration in the total of my book, this has nothing to do with ABA practices.
This has everything to do with why in the world are insurance funders giving us such terrible rates that we're losing money on case. Like you can't do that. They know this. And like when you go, like you, I know everybody's seen the stories and like, like a $25,000 one hour ER visit. Like, come on man, like seriously. And they're, they're okay with paying that, but they won't pay like they're giving us a $20 billable for nine five or nine seven one five three. Get out of here.
Like you got, you gotta be good. Like put, put your priorities, you know, change your priority cause this is ridiculous. So um, yeah, so I get it. Like it's, it's frustrating. It's difficult. I don't like being in this position where you're having to haggle on this stuff. No one wants to be in this position. It's the position we find ourselves in. And so if the rate is not going to sustain your practice, then you can't accept the rate.
And the more that people do this, the higher the rates will go. And then that's just the way it is. If no one's in their network, then they have an obligation to get people in their network. And uh, and, and that's like, it's like not much involved in this, right? If you pay us correctly, then we'll be in your network. Otherwise no, leave us alone. Um, and there are other fish in this. So yeah, that's it really. All right. So, okay. More insurance stuff. Oh yay.
So is there a way to know what to ask, who to ask or like across funders in terms of billing? Like, is there an industry standard? And you know, like we're talking about things like, uh, the units and the roundup and the daily caps for services, the way assessment works out, you know, how long you have to use the authorization, you know, cause like some are like six months somewhere within you have within week per week and like all, all of that things. Like, is there, is there a standard?
So there is a standard, just no one's following it. So that, that's the problem. So there, I think it's ABA, um, ABA codes. I don't know what the website is anymore. If anyone listening to this remembers the site, but you can look it up. Like there are a couple of sites on this that, uh, give this, but even if you go with the CMS book, right, you can purchase it. It's very straightforward.
Um, and what can be concurrently billed and what can't be concurrently billed and like who does what, right? Um, but like there are no modifiers based on the CMS as far as I understand it. Um, but you'll have some funders that have modifiers. You'll have some funders that say it can be concurrently billed and it can't be concurrently billed or if it can be concurrently billed where it has to be. So they can't be in the same building.
Like they have all these stipulations, how many hours you can do a day. Uh, like this is, this is not, uh, every funder is different. So these are questions that you should be asking your network rep. Same with session notes, right? Like session notes are, are what they require in their session notes, which is like, that's it. That's all you got.
So when you go into those recruitment audits, um, you, you need to make sure that your session notes meet their standard, uh, or otherwise now we're fighting, right? And even if you meet their standard, you're probably going to be fighting with them anyway. Um, so it's, uh, talking to your network rep to make sure that you have everything possible that you, that they require in their session notes, seeing if they have examples, many of them do now. Um, so getting those examples of session notes.
But the thing is, they're like, I mean, I hate to say that, but it's like, but they're not like freely giving them. It's not like, oh, you're in network with us. Here's the, here's our network packet. Here are all the things. And I mean, and maybe some are that I'm not aware of. So I mean, I hate to, like, I don't know all, all the cases, but like, like you have to ask where you have to advocate for yourself. But even like, there was one funder that had a training class on billing.
I was like, wow, this is amazing. I went to the training and I asked all the questions and like, you know, we were into the concurrent billing stuff and they're like, oh yeah, no, I wish I'd recorded it right at this point. And so then, you know, we found the like later they said, no, you're not allowed to concurrently bill. This was back in the, when it was the T codes. Uh, so this was a while back. Um, and so, you know, and then it, you know, we went back and forth.
Luckily I had, after the training, I followed up with emails and said, look, I'm, I just want to make sure that I am okay with this example. And I gave them like very straightforward examples of situations that we find ourselves in regularly that would account for concurrent billing. And they said, yep, absolutely. That's what we said at the training. And so I kept those, right. And, and, and then we had a recoupment audit and they're like, you can't currently bill this and all that.
And so then you have to go back with like, so no, I mean, even, even when the, like the same with session notes, like my, again, this, my experience, anyone have a different experience, feel free to leave a comment, uh, say, no, that's not been my experience even. Or if you, if you have the same experience again, feel free to leave a comment.
But with session notes, I feel and recoupment audits, I feel the same thing is that you go through this recoupment audit with their session note and the standard way that they require it. And then they will still come back and say, nah, it's not right. It's wrong. But then they don't give you any specifics on what is wrong about it so that you can fix it. But they're going to say it's wrong. So they get their money back. So what is it? Is it, they want their money back or is it wrong?
That's a question that I still have not yet been given an answer that I've not been given. So I don't know what to tell you. So get it in writing, get it in your contract if at all possible, especially around concurrent billing, uh, if you can. And then, um, you know, if they, you know, the other thing is like protocol modification, right? So some are very specific on what protocol modification means.
And it literally means to some funders that unless you are modifying that program, you are not allowed to build this code. And others are a little bit more lenient. And so getting a clear definition on what they allow for, for in that code is super important. Um, because again, if they, if you're on the phone with your network rep and they're saying, yeah, no, that's fine. Right. And, and, and then six months later, the re the auditor is checking and says, no, that's not true.
Um, then I don't know what tell you, right? You're probably paying back money. So, um, so you have to get it in writing at minimum in an email, but I do highly recommend anything around billing. Uh, you try to get it as an addendum to your contract, um, so that you have that in writing, um, so that, cause you're going to get a recruitment audit and they're such a, They're a lot of work. Yeah. They're a lot of work. Yep. Yeah. All right.
So I have, I believe one more question for you and then I think we have, um, about 10 minutes or so. If anyone else listing has a question that they want to throw in before we leave, um, we probably might have time to answer one more. Um, but, uh, copay.
Okay. So, you know, there's some like situations with assessment to that, like, um, what am I trying to say, like guidelines from some insurance though, you may not know the guidelines ahead of time, but, um, the, about like how like copays, right? Like, and so like, of course, like if you're doing assessment, um, you want to try to like get it done in as much time. And I don't know the code for that. What's the code for assessment? Oh, I can't remember.
I've got my, I, I, But they used to have it where it was a flat rate, which was really nice, right? For this very question, because then you could just, it was a flat rate. You got one unit, right? And it was like worth a whole lot of money, right? It was worth like 10 hours of time. And then you could just submit it. It was like what they call like a package, right? You know, something. And so then you would just submit it once and there was only one copay.
But now with the new codes, it's like a unit just like every other unit, like it's 15 minutes. So, um, and so that, that means that you have to do it over multiple days and there are multiple copays. And so there's really no way to get around that. You have to, you have to charge a copay every day that you work. Um, and if they have limits on how much you can bill assessment in a day.
So maybe they have a two hour limit, which I, I don't, again, as far as I know, there's no, there's no limits on these codes. Um, and so again, this is depends on the funder. Um, and so you, maybe you need to be reporting that to your state. Um, so that because they're not, they're, the insurance company is not doing something that they sh they're, they're doing something they shouldn't be doing. Right?
Um, every state has, has a department where you can complain about insurance, uh, funders to, to the state. So I do highly recommend doing that is, because again, as far as I know, there are no limits on these codes. Um, and, um, but if that's where you find yourself, right? Like this, then that that's what you can do.
Now if you're doing a reauthorization, so you're doing your treatment plan updates, then you can try your best to, to only do the treatment plan updates on days where they're getting direct service or parent training so that you can then line them up. So there's a single copay where, where, right? So like if, if they're getting direct service Monday through Friday, then don't bill treatment plan updates on Saturday. That's kind of a, that's it. That's all I got for you. Does that make sense?
Yeah, yeah, I know. Um, yeah, so you have to build copays and you have to collect copays. Like that's just part of your agreement. Yeah. Yeah. You can't be legal. Yeah. No, your contract. Um, and yeah, that's something that I was thinking about.
It's on my list of things that, that we can, uh, like we've got a lot going on right now, but like down the road, I really would like to do some kind of like a course or class or just a podcast on, um, understanding authorizations and like, you know, like maybe even trying to get someone in that. Yeah. I mean, we have, we're working, we've been talking with two, two like popular billers.
Uh, and so we have in the ABA business leaders membership, uh, like a kind of crash course on something even more. Yeah, no, we definitely want to go in depth. Yeah. We want to go more in depth. It's important for everyone to really get a good understanding on the fundamentals of billing and yeah. Know what to ask, know what to look for. You know, even if it's just like a checklist of here's the things to look for and to ask like just so that you know what you're looking for.
I mean, we do go through that, right? But I, I like, I, you know, we, again, we're discussing with these other billers and it would just be nice to have like a round table with, with information from other people. It's always really cool. It's always good. All right, guys. So for today, if, um, if anyone has a topic that they want us to discuss or a guest, um, we, we, we now do we, is that live on the website now? It is. So we have a spot on our website that three pi squared slash podcasts.
Yeah. If you want to join our podcast, if you want to be a guest or if you know someone who you would recommend, like go and fill out the form and, um, we would love to, to get some guests on. We haven't had any while. Um, and that is our intention is to bring more guests back on. It's just, you know, we've been working on other things, but yeah, so we have it now. So, uh, you know, join us if you want. And then, you know, like really again, take advantage of the Pi day discount.
Uh, and I really appreciate it if you could share the group with people that would love to join it, right? That could use the help. Um, and then, you know, our podcast, right? Like, you know, we provide this free content and how we do that is, um, because people buy our memberships, right? We need, we need to eat. Um, and so, um, like, like sharing our podcasts, reviewing it, if you like what we're doing, really appreciate that. Uh, it really helps. It really, truly helps.
And so, uh, you know, please, if you wouldn't mind doing that, taking just a few seconds and reviewing our podcast or sharing it with someone that you think could, uh, uh, learn from it, uh, that would be awesome. Yay. All right. Well, we, uh, thank you for your time and, um, we'll be back again next week. Yeah, we'll see you next week. Thank you for listening to our podcast. Hopefully it was helpful.
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