ABA Therapy Billing Services

Track the remaining unit balance weekly and warn clinical staff before it runs low. ABA authorisations approve a fixed number of units, and sessions delivered beyond that are almost never recoverable on appeal. Because schedules are set in advance, a balance can be consumed faster than anyone notices. A weekly figure in front of the clinical team prevents it.

Because the rendering provider is recorded at billing rather than at documentation. Direct therapy delivered by a technician and protocol modification by an analyst are different codes at different rates. Reconstructing who was in the room afterwards is unreliable and creates repayment risk. Capturing it on the session note makes the claim correct automatically.

No. Authorisations generally approve separate buckets for assessment, direct treatment, and supervision, and they do not transfer between categories. Billing supervision against a treatment authorisation produces a denial even when units remain overall. We load each bucket separately so services are always billed against the authorisation that actually covers them.

Several weeks before the current authorisation expires. Renewals require submitted progress data and payer review time, and any gap between periods means unfunded care or an interruption in the child's treatment. Starting late is the most common cause of both. We prompt the reassessment early enough that the new period begins without a break.

Objective measurement against the treatment plan goals, not a narrative description of how the child is doing. Reviewers look for baseline figures, current figures, and movement toward defined targets. Submissions describing engagement or effort without numbers are the ones that get denied. Structured goal data makes renewals far more predictable.

From documented start and stop times, never from the scheduled appointment length. Sessions run short for many legitimate reasons, and billing the scheduled duration overstates units in a way that invites recoupment. Recording actual times protects the claim and gives you defensible evidence if utilisation is ever reviewed by the payer.

Often yes, depending on the payer and the state. Some plans require technicians to be individually registered or linked to a supervising analyst before their services can be billed. Delivering therapy before that linkage exists produces denials on every session. We confirm requirements per payer and hold claims until the linkage is active.

As protocol modification by the analyst, with documentation showing what the analyst actually did. Being present is not the same as delivering a billable service. The note needs to record the clinical work performed, such as adjusting a protocol or training the technician on a change. Vague presence notes do not support the claim.

Yes, though they may fall under different funding. Services delivered in schools are sometimes covered by an education programme rather than health insurance, which changes who pays and what documentation is required. We identify the funding source per setting rather than assuming health coverage applies to every location a child is seen in.

Authorised units against units actually delivered, by client and by period. That single view shows where care is at risk of running unfunded and where approved capacity is going unused. Both are problems. Most agencies discover under-utilisation only at renewal, when the unused units have already expired and cannot be recovered.