Autism Provider Challenges State Over Verification System – CBS Miami

TALLAHASSEE (CBSMiami / NSF) – The state’s largest autism services provider has filed an administrative complaint against the Medicaid program alleging that an electronic visit verification system being tested in eight counties in southeast Florida is an obstacle to the Reimbursement and an overrun by the agency is for health care management.

The Stuart-based Positive Behavior Support claims that the so-called EVV system or someone with access to it changes and invalidates the behavioral analysis claims after submission.

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“The only way providers like (Positive Behavior Support) have to correct such an improper change before the reimbursement period expires is to personally monitor these submissions and try to manually reset them to their original state in the EVV system” the company wrote in the complaint. “The correction of errors caused by the system itself falls outside of the requirements announced by the agency to the providers and leads to an inadmissible delay in the reimbursement of their services.”

A government handbook makes it clear that providers can correct and re-submit payment claims as long as they do so within a certain time frame.

But Positive Behavior Support advocates claim that the EVV system deprives providers of that right because claims that are fixed and re-submitted are flagged as duplicates of the originals and rejected.

“This is not a PBS-specific problem. Rather, other providers in a similar location have the same problems with the EVV system, which shows that it is an industry-wide problem, ”wrote lawyers.

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Applied behavior analysis is a form of therapy for people with autism.

Concerned about possible fraud and abuse, the state has taken steps in recent years to step up oversight of applied behavioral analytics providers, including moving to an electronic visit verification system that details issues such as what and when services were provided .

The electronic system has been tested in southeast Florida, but will be deployed nationwide.

Positive Behavior Support wants an administrative judge to issue an order stating that the system imposes requirements and burdens beyond those in the manual, that the effects of the system amount to unpublished rules, and that the agency be instructed, ” Immediately no longer trusting in her. ”

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