ABA billing requires meticulous attention to detail. Many payors have begun utilizing AI technology to audit claims, resulting in a heightened likelihood of catching errors and missing information, and therefore denying more claims.  

Let’s uncover some of the most common billing challenges that come with steep financial consequences for ABA practices through denied claims and failed audits.

• Differences in payor requirements–Many providers find it challenging to stay on top of the variations in payor requirements. While there are some similarities in billing from payor to payor, there are also differences in what each funder requires.

• Proper use of CPT codes–Incorrectly using CPT codes, whether intentional or not, can result in denied claims and increased payor audits. It’s important to fully understand how each code is intended to be used and keep up with updates to coding standards.  

• Incomplete or incorrect information–Errors in information (e.g., client’s name, provider credentials) or missing requirements can result in an automatic denial.  

• Manual workflows–Manual billing processes place an undue administrative burden on ABA practices, increasing the risk of error.  

• Evolving regulations–Funder requirements can change over time. Failure to adapt to these changes can lead to payor non-compliance.  

• Lack of billing oversight–Without internally auditing claims, errors can slip through the cracks. Despite these risks, ABA practices often struggle to find the time and manpower to efficiently conduct pre-billing audits.