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Medical Necessity

Why is understanding the topic of medical necessity so important?

Simply put, medical necessity generally requires documentation that the clinical need is legitimate and that the services provided are an appropriate response to that need (Adams & Grieder, 2014). Providers of applied behavior analysis must have a thorough understanding of this as a topic and how generally accepted standards of care in the field of applied behavior analysis (ABA) apply. The Model Coverage Policy provides the following as a definition:

"Services must be medically necessary to ameliorate symptoms of a diagnosed disorder, build adaptive behaviors,
and/or reduce maladaptive behaviors to enhance the patient’s health, safety, and overall functioning and/or to
prevent deterioration or regression."

How can a behavior analyst demonstrate services are medically necessary when performing an assessment, writing a treatment plan, or documenting services on a session note?

Reach out today to receive a quote for consultation services if you or your organization is in need of training, education, or guidance on the topic of medical necessity.


 

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