Today we are diving into what is required to setup a well functioning ABA practice. Many BCBAs find this part the most difficult as it is not much fun and requires detailed effort, but in the end is one of the key pillars for a successful practice.
- Accreditation
- Registration and Licensing
- Compliance with Business and Industry Regulations
- Policies, Contracts and Legal Agreements
- Liability Insurance
Accreditation/Credentialed
Depending on where your business is located you may have different requirements to meet. This particular list is based on the USA as other countries generally have national health services or government funding for autism treatment, but the process of getting recognized as a provider will be similar.
- National Provider Identifier Number (NPI) – Access the National Plan and Provider Enumeration System (NPPES) – https://nppes.cms.hhs.gov/#/ – to obtain your 10-digit ID number that is required for healthcare providers to bill insurance companies.
- Create a Council for Affordable Quality Healthcare Number (CAQH) – You can go to their website at – https://proview.caqh.org/ – to register for an account and a CAQH Provider ID. This will involve providing documents and other information necessary to get the ID that can be used when registering with insurance companies.
- Insurance Companies – Identify the insurance companies that your clients are likely to be using. Best to start with the big national insurance companies such as Aetna, Blue Cross Blue Shield, Cigna, Humana and UnitedHealthcare, but do not overlook the regional players or government programs such as Medicaid.
- Insurance Setup – When you contact the insurance companies to become an in-network provider, they will ask you to follow a process for registration as outlined below. Before you do get your basic paperwork in place such as: your professional license and certification, NPI, CAQH, EIN IDs, proof of liability insurance, resume and any additional certifications. or specialized training you’ve completed.
- Obtain, Complete and Submit your application. Each company is likely to have a slightly different set of tasks and where you perform them.
- Regularly check on the status of your application. These are huge companies and do not move with lightning speed, expect the process to take between 2 and 4 months.
- Upon approval you will need to review and sign a contact with the insurance company. Best to have a lawyer advise you on the contracts, especially your first one.
- Advise staff of the approval and update systems. Also advise clients that you have signed on with a new company.
Registration and Licensing
While this section could have easily been included in our previous post on, Business and Financial Planning we decided to include it here instead.
- Business Structure – The structure you choose will be very depending on who is involved in creating and/or funding the startup of the clinic.
- Sole Proprietorship – Simple but does not offer the protections of a corporation or LLC.
- Partnership – Allows for two or more people to be involved with the clinic without becoming a corporation.
- LLC – This is somewhere between the Partnership and a full corporation. Some liability protection without the extra tax requirements of a corporation. Requires articles of organization to be created.
- Corporation – This is much more involved (taxes, articles of incorporation, etc) so best considered for a larger group of people starting the clinic or when you are looking for outside investment.
- Business Registration – Register your ABA practice with federal, state/provincial and local government entities as needed. Locate the business name registration entity in your area. Typically this is done at the state/provincial level, but also check national registries if you expect to grow beyond your initial jurisdiction.
- Business Number – When you register your business you will get an ID. These are some examples from around the world. Employer Identification Number (EIN) – USA, Business Number (BN) – Canada, Company Registration Number (CRN) – UK and Australian Business Number (ABN). These examples are at the national level but depending on where you are, you may need to register with state/provincial and/or local governments for tax purposes.
- Business Licenses – Depending on where you are this may be simply focused on the business, but in some cases you may need certification or professional license to practice in your selected region(s).
Compliance with Business and Industry Regulations
In the previous section we discussed the higher-level licenses, registrations and certifications you may need. Here are some additional areas that you will likely need to check off when starting and operating your clinic.
- Privacy and Protection of Client Information – One of the most talked about set of regulations in this area is the Health Insurance Portability and Accountability Act (HIPAA) in the USA. Other countries such as Canada – Personal Information Protection and Electronic Documents Act (PIPEDA), Australia – The Privacy Act 1988 and UK – Data Protection Act 2018 and the General Data Protection Regulation (GDPR). Based on your location you will need to comply with the appropriate act. Note, that while similar, these acts are not direct substitutes for each other, just in case you are wanting to start an international practice.
While the acts may be different for the most part they will require the following:
- Privacy Acts Requirements– While the above acts may be different in certain ways, for the most part they will require the following:
- Understanding of the legislation and what parts apply to your clinic.
- Development of privacy policies and procedures to address the requirements of the act and its implementation.
- Employee training is key to ensuring that your clinic does its best to protect client information. This should include sessions during initial onboarding of new staff and periodic refreshers.
- Policies and procedures that handle breaches. This will include how and when you will provide the notifications to government and impacted clients. To prevent breaches you should conduct regular risk assessments, such as who has access to what data as their roles may change in the organization over time.
- You will almost certainly have people or entities that need access to the client data, but are not part of your clinic. The statutes outline what types of agreements need to be put in place with 3rd-parties and how you are to assess them from a security and privacy point of view.
- Acts Governing People with Special Needs – There are many acts that touch on people with special needs, their safety and education. Depending on location these acts may vary if you are practicing within your own clinic versus a more public setting such as a school.
- Labour Laws – You will need to ensure that your clinic meets with the federal, state/provincial and local government statutes that cover areas involving employment and labour. These may cover discrimination, wages and general working conditions.
- State and Local Regulations – In many cases there will be national laws governing your clinic but do not ignore the state/provincial and local ones. While most will be stand-alone and unique to the region, there could be local laws that augment a federal law.
Policies, Contracts and Legal Agreements
This is a key area to address as it determines the relationship between any business and its clients. There are also unique elements for ABA clinics. It is best to ensure that your business policies are codified in your contracts and other legal agreements.
- Liability – Any therapy provider as a business entity will carry liability. Depending on where you are located you may be able to incorporate your business in a manner to limit liability, such as an LLC. Even if that is the case you will want your contracts written to contain protection for you as well as your clinic and staff.
- Fees, Billing and Payments – The contract(s) created for your business will outline the methods of payment, billing schedules as well as cancellation fees and other costs.
- Policies – Virtually every business needs to have policies concerning topics such as confidentiality, nondisclosure, privacy as well as terms and conditions of service. As your ABA clinic and staff will handle sensitive data, you will want to schedule regular policies reviews especially those concerning a patient’s diagnosis and medical history.
Liability Insurance
While we hope you will never need it, getting liability insurance is a must to protect you and your business. This typically covers potential claims arising from alleged negligence or errors in providing services. There are quite a few options available so work with your broker to find a policy that is right for you.
- Professional Liability Insurance – Protects against the items such as legal costs, negligence, malpractice claims and even reputation.
- Regular Policies – These policies known as claim based and cover you while the policy is valid, but do not protect you for the long-term. For example if an incident occurs near the end of a policy, but if the lawsuit does not start before the end of the policy, it will not be covered.
- Long-Term Policies – Occurrence based policies protect you after the policy has expired. That is an incident could occur now and you will still be covered in the future should a lawsuit arise.
That concludes our look at preparing your clinic for both legal and administrative purposes. Hope you found it useful and check our next post coming soon about location selection.
References
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