Overview of the Medical Model and Ensuring Payor Alignment: Contracting, Credentialing, and Compliance
Original Air Date: May 18, 2026
CEU offered: NONE
Webinar Duration: 60 minutes
Instructors:
- Michele Beal
- Kim Urwiler
Abstract:
Applied Behavior Analysis (ABA) therapy is a medically necessary, evidence-based treatment for Autism Spectrum Disorder — and payors treat it as such. Yet for many ABA providers, the gap between delivering excellent clinical care and meeting payor expectations remains a persistent source of denials, audits, and revenue loss. This webinar provides a practical, ABA-specific overview of how the medical model framework shapes every aspect of the payor-provider relationship, from initial contracting and credentialing through authorization management, claims submission, and audit readiness.
Presenters will walk through the full lifecycle of the payor-provider relationship, identify the documentation and compliance expectations payors apply to ABA services, and offer actionable strategies for aligning clinical practice with payor requirements — without compromising the quality of care delivered to individuals with ASD and their families.
Learning Objectives
- Explain how ABA therapy fits within the medical model and identify the clinical, credentialing, and contractual requirements payors use to evaluate ABA providers — including CPT code expectations, medical necessity criteria, and treatment plan standards specific to ABA practice.
- Describe the payor-provider relationship lifecycle — from contract negotiation and network credentialing through prior authorization, claims submission, and post-payment audit response — and recognize where documentation gaps most commonly create compliance risk for ABA organizations.
- Apply compliance and documentation best practices to ABA service delivery, including session note requirements by CPT code, authorization tracking strategies, denial management workflows, and the foundational elements of a proactive organizational compliance culture.
Instructor(s)
CMRS Michele Beal
Michele Beal is a nationally respected leader in revenue cycle management with a specialized focus on ABA therapy billing, RCM workflow optimization, and regulatory compliance. With over two decades of experience in healthcare reimbursement, Michele has built a career in helping autism service providers navigate the evolving and often challenging world of payer contracting, claims management, and audit preparedness.
As the founder of ABAB and MKS Consulting, two highly regarded national firms serving ABA providers, Michele established herself as a trusted expert for organizations at all stages of growth, from early-stage practices to large-scale agencies operating across multiple states and payer systems. In early 2023, she merged her firm with Rethink Behavioral Health, where she served as VP of RCM Quality until the end of 2024. She now serves as the Executive Vice President, RCM & Payer Relationships at Bierman Autism Centers, where she drives strategic oversight and operational excellence across all facets of the revenue cycle.
Michele’s unique blend of clinical funding insight and compliance expertise enables her to conduct in-depth risk assessments and ensure organizations maintain integrity in their billing operations. In an environment of increasing regulatory scrutiny, she equips providers with the tools and knowledge to stay audit-ready and avoid costly missteps.
Her mission is simple but powerful: to bring providers peace of mind through clarity, compliance, and confidence in their revenue systems—so they can focus on what matters most: delivering life-changing services to the families they serve.
Kim Urwiler
Kim Urwiler has more than 25 years of leadership experience in behavioral health, managed care, and multi-site healthcare operations. She currently serves as Vice President of Corporate Compliance at BlueSprig Pediatrics, where she leads enterprise-wide compliance, audit, and quality initiatives across a national network of centers.
Kim brings deep expertise in regulatory compliance, including CMS, Medicaid, HIPAA, and NCQA standards, with a strong focus on aligning clinical quality, operational performance, and payer requirements. She has built and led large-scale compliance and risk programs, developed audit frameworks that improve outcomes and reduce recoupment risk, and implemented innovative, technology-driven solutions to enhance efficiency and oversight.
Throughout her career, Kim has held executive leadership roles overseeing complex healthcare systems, including managed care organizations and behavioral health hospitals. Her work has consistently focused on strengthening regulatory readiness, advancing value-based care strategies, and fostering a culture of accountability, integrity, and continuous improvement.
Kim is passionate about supporting providers and clinical teams in navigating the evolving healthcare landscape and is committed to ensuring that ABA services are delivered in a way that is both clinically excellent and fully aligned with payer and regulatory expectations.