ABA billing can feel like a maze: you do the clinical work, families show up, sessions happen, and then… claims get denied or payments stall for reasons that seem painfully small. Most of the time, it’s not “fraud” or anything dramatic—it’s simple process breakdowns that compound over weeks. The good news is that the most common mistakes are also the most fixable, especially if you build a few habits around coding, scheduling, and documentation. If your team is constantly chasing resubmissions or wondering why cash flow is unpredictable, it may be time to tighten the operational side or consider insurance billing for ABA providers support from a service like.
Using the Wrong CPT Codes
Coding issues are one of the fastest ways to trigger denials—especially when payers are strict about how services are delivered and who delivered them. The big one is mixing up 97153 and 97155. In plain terms: 97153 generally supports direct treatment by a technician under appropriate supervision, while 97155 is used for protocol modification and more clinical oversight activities. The tricky part is that payers often look for a clean match between what’s billed, who provided the service, and what the notes actually say happened.
Supervision rules can be another hidden tripwire. Even if supervision occurred, it has to be documented in a way the payer accepts, and it has to line up with policy requirements (which can vary by insurer and plan). A common scenario is billing 97155 when the documentation reads like a standard direct session, or billing 97153 while notes imply higher-level protocol adjustments that weren’t properly attributed. The best prevention is to standardize how your team describes services, confirm staff understand the boundaries between codes, and run quick internal audits before claims go out.
Missing or Expired Authorizations
Authorizations are the silent “yes/no” gatekeepers of reimbursement. You can deliver perfect care and still get denied if the authorization is missing, expired, or doesn’t match the service details. The frustrating part is that this error often shows up weeks later—right when you’re expecting a payment—because payers may process the claim before flagging the authorization issue.
The fix is less about heroics and more about a tracking rhythm. You need a reliable way to know, at any moment, which clients are approaching an end date, which are awaiting renewal, and which have limits that don’t match the scheduled hours. It also helps to set a “renewal buffer” so you’re not scrambling at the last minute when a family is mid-treatment. Some practices do this with spreadsheets, but that can get messy fast. A simple rule of thumb: tie authorization status to scheduling approvals, so sessions can’t be booked beyond remaining authorized units without a deliberate review.
Overlapping or Overbooked Sessions
Scheduling conflicts are a surprisingly common billing landmine. Even if the overlap was accidental (double-booked staff, a session that ran long, a late reschedule), payers may deny claims when time entries overlap—especially if the same provider is listed on both sessions. This can also happen when a supervisor is recorded as being present in two places at once, or when travel time isn’t separated cleanly from billable time.
Software can help a lot here, not just for calendars but for validation rules that prevent impossible schedules from being created in the first place. The best systems flag overlaps immediately, force resolution before timesheets are finalized, and keep everyone honest about start/stop times. That said, tools only work if the workflow is consistent: staff must enter times promptly, edits should be tracked, and you should have someone responsible for reviewing exceptions weekly. That’s how you stop “one weird week” from turning into a backlog of denials.
Here’s a practical checklist many clinics use to reduce overlap-related denials:
- Confirm schedules are locked at a set time each week (with a clear change process).
- Require real-time session time entry (or same-day completion) to limit memory-based errors.
- Set automatic overlap alerts for staff, locations, and supervisor attendance windows.
- Review exceptions weekly before claims submission, not after denials come back.
- Keep a short log explaining legitimate changes (cancellations, swaps, late starts) so notes and billing match.
Lack of Detailed Session Notes
If you want to get paid consistently, your notes have to do more than prove a session occurred—they need to support medical necessity, match the billed code, and show that the service delivered aligns with the treatment plan. When documentation is vague (“worked on goals,” “good session,” “client participated”), it invites denials, requests for records, or downcoding.
So what’s typically required? Think of documentation as a story with receipts. At minimum, payers often expect the date, duration, location (or telehealth details if applicable), provider credentials, client response, and specific interventions tied to goals. For certain codes, they may also expect evidence of protocol modification, caregiver training elements, or clinical decision-making—again, depending on what you billed. Notes should also align with scheduling and authorization: the number of units, the time window, and the service type should be consistent across your EMR, timesheets, and claims.
A helpful approach is to standardize note templates that prompt the right detail without turning notes into novels. Short, specific, and consistent beats long and generic every time. If your team struggles here, consider targeted training with real examples of “denied vs. paid” documentation, so staff can see what payers actually accept. It’s also worth doing spot checks: pull a few notes each week and confirm they match the code being billed, especially for 97153 vs. 97155 scenarios.
Conclusion
ABA billing problems rarely come from one big mistake—they come from small ones repeated across coding, authorization tracking, scheduling, and notes. The fastest wins usually come from tightening the workflow: train staff on code boundaries, build a simple authorization renewal system, use scheduling tools that prevent overlaps, and standardize documentation prompts that support reimbursement.
If you’re already stretched thin clinically, it can be more cost-effective to invest in training and processes—or partner with billing experts who live in the payer rules all day. If you want to explore support options or just see what a cleaner billing workflow could look like, you can check pharmbills.com.
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