Small billing mistakes cost ABA practices thousands of dollars every year. A wrong code here, a missing authorization there, and suddenly you’re dealing with denials, delays, and revenue that never arrives.
The frustrating part is that most of these errors are entirely preventable. Understanding the most common pitfalls helps practices protect their revenue and reduce the administrative headaches that come with fixing avoidable problems.
Whether you build internal expertise or partner with ABA billing services, knowing what can go wrong is the first step toward making sure it doesn’t.
By proactively reviewing claims before submission, practices can catch costly errors early. Consistent staff training also helps ensure billing accuracy across the team. Strong documentation habits further reduce the risk of denials.
Regular audits reveal patterns that need correction before they become expensive. With the right processes in place and support from reliable billing services, practices can safeguard their revenue and operate with far more confidence.
Incorrect Use of CPT Codes (97151, 97153, 97155, etc.)
CPT code errors rank among the most frequent and costly mistakes in ABA billing. Each code has specific requirements for who can bill it, what services it covers, and how time must be documented.
Using the wrong code triggers denials and can even raise compliance concerns if patterns suggest systematic misuse.
Code 97151 covers behavior identification assessments conducted by qualified professionals. This is the initial evaluation that establishes baseline data and informs treatment planning.
Practices sometimes mistakenly bill 97151 for reassessments that should use different codes, or they bill it without the required components that justify the assessment designation.
Code 97153 represents the bread and butter of ABA billing: direct one-on-one therapy delivered by an RBT following established protocols.
Common errors include billing 97153 when a BCBA delivers the service (which should be 97155) or failing to properly document the time increments required.
Code 97155 applies when a BCBA provides direct treatment with protocol modification. This differs from 97153 because it involves the higher-level clinician making real-time adjustments to the treatment approach.
Billing 97155 for routine supervision rather than direct treatment constitutes a misuse that payers actively audit.
The fix requires clear documentation practices and staff training. Everyone involved in service delivery and billing needs to understand which codes apply to which situations. Regular audits catch errors before they become patterns that attract payer scrutiny.
Billing for Overlapping Sessions
Time-based billing creates opportunities for overlap errors that payers consider serious violations. When a provider bills for time spent with one client, they cannot simultaneously bill for time with another client.
This seems obvious, but scheduling complexities and documentation gaps make overlap errors more common than practices realize.
Overlap issues arise in several scenarios. A BCBA supervising multiple RBTs might inadvertently have their time billed to multiple clients during the same period.
Group sessions create confusion about how to allocate and bill time appropriately. Travel time between clients sometimes gets miscoded as billable service time.
Payers use software to detect overlapping claims across providers and dates. When they find overlaps, they don’t just deny the duplicate claim.
They often audit the practice’s entire billing history looking for patterns. Recoupment demands for past payments can follow, along with potential fraud investigations in serious cases.
Prevention requires robust scheduling systems and claim scrubbing before submission. Key safeguards include:
- Time tracking systems that flag scheduling conflicts automatically
- Claim review processes that check for same-day billing across clients
- Clear policies about how to document and bill supervision time
- Staff training on proper time allocation for group services
- Regular internal audits comparing schedules to submitted claims
These controls catch problems before claims go out, avoiding the much larger headache of dealing with payer audits after the fact.
Missing Authorization or Documentation
Authorization failures represent one of the most preventable yet persistent problems in ABA billing. Services delivered without valid authorization simply won’t get paid, no matter how clinically appropriate or well-documented they are. Payers enforce authorization requirements strictly, and “we forgot to check” is not an acceptable excuse.
Pre-authorization must be verified before every service episode begins. This means confirming not just that an authorization exists, but that it covers the specific services planned, has sufficient units remaining, and hasn’t expired.
Many practices check authorization once and assume it remains valid, only to discover weeks later that coverage lapsed mid-treatment.
Session documentation creates the other half of this problem. Even with valid authorization, claims require supporting documentation that demonstrates medical necessity and describes the services actually delivered.
Session notes must include specific elements: client identification, date and time, services provided, provider credentials, and clinical observations that connect to treatment goals.
Insufficient documentation gives payers grounds to deny claims or recoup payments after the fact. During audits, payers request records supporting billed services.
Missing notes, incomplete entries, or documentation that doesn’t match billed codes results in payment reversals regardless of whether services were actually delivered.
Building verification checkpoints into your workflow prevents these errors. Authorization status should be confirmed at scheduling, again before the session, and tracked against utilization throughout the authorization period. Documentation requirements should be standardized with templates that prompt clinicians to include all required elements.
Late or Incomplete Claim Submission
Timely filing deadlines exist for every payer, and missing them means forfeiting payment entirely. Most commercial payers allow 90 days from date of service. Some allow more, others less. Medicaid programs vary by state. Whatever the deadline, late claims get denied with no appeal option.
Administrative backlogs cause most late filing problems. Clinical staff complete services but delay submitting their notes. Billing staff fall behind on claim preparation. Someone goes on vacation and their work sits untouched. Small delays accumulate until suddenly the filing window closes.
Incomplete claims create similar problems. Missing information triggers rejections that require correction and resubmission. Each round trip consumes time, and if corrections take too long, the claim ages past the filing deadline. What started as a minor data entry oversight becomes an uncollectible charge.
The solution involves process discipline and monitoring. Claims should be prepared and submitted within days of service, not weeks. Aging reports should track unbilled services and flag anything approaching deadline risk.
Staff responsibilities for claim completion need clear assignment and accountability. When someone falls behind, the practice should know immediately rather than discovering the problem after deadlines pass.
Protect Your Revenue: How ABA Billing Services Prevent Costly Errors
ABA billing errors drain revenue from practices that can’t afford to leave money on the table. Incorrect codes, overlapping sessions, authorization gaps, documentation failures, and late submissions all represent preventable losses.
The common thread is that each error stems from process breakdowns rather than impossible complexity. With proper training, clear workflows, and consistent oversight, practices can eliminate most billing mistakes before they happen.
For practices lacking internal bandwidth to build this infrastructure, partnering with specialized ABA billing services provides immediate access to the expertise and systems needed to protect revenue. Either way, the cost of getting billing right is far less than the cost of getting it wrong.
