Running an Applied Behavior Analysis (ABA) practice is time-consuming and requires daily attention. Whether you handle ABA billing in-house or outsource, getting insurance billing claims processed correctly and on time is crucial to keeping your business financially viable.
ABA billing is complex, but with the right revenue cycle management systems and policies in place, you can keep your revenue flowing smoothly.
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ABA Billing Tips From Real ABA Clinics
Here are some tips and tricks that successful ABA practices and ABA billing staff use to simplify the process and avoid costly mistakes.
1. Get to Know Your Payors
When you’re running a business, every denied claim is a problem, and each insurer plays by different rules.
- Keep up-to-date information with each payor’s ABA policy, including CPT codes, limits, and modifier rules.
- Pay special attention to concurrent ABA therapy billing rules and the type of supervising provider to be billed under
- Track authorization timelines carefully. Ensure you set your Learner Notifications to send you a Notification when the Learner authorization is nearing expiry (30, 10, and 0 days remaining). Missing a re-authorization can cause a significant delay in revenue.
- Build relationships. Having a go-to contact with your client’s insurance company can make troubleshooting claim denials much easier.
2. Use the Right ABA Billing Codes and Modifiers
Accurate coding is crucial for efficient ABA billing. Minor coding errors are a significant reason for claim denials. Clean insurance claims are extremely important to keeping your cash flowing week to week.
- Double-check your CPT codes and who can bill them. 97153 is usually a technician code. Some payers will not allow BCBAs or BCaBAs to bill this code and will deny if the incorrect provider type is billed. Ensure each payer does not have restrictions on using 97155 for BCBA supervision, as this newer AMA code was not designated for supervision. Note this information in session notes to avoid audit denials.
- Modifiers matter. Different payors require unique combinations (like HM, HO, or HN).
- Stay updated yearly. Review CPT code updates each January and make the necessary changes. Pay attention to different payer schedules, as not all payers reset their information or fee schedules in January of the calendar year.
💡 Pro tip: Make a “cheat sheet” of your most-used ABA billing codes/modifiers and keep it near your workstation.
3. Documentation has to be rock-solid
Clinical Notes are key; ensure you have the proper Note Template for each payor.
If documentation is weak, even the best ABA therapy billing staff can’t get the claim paid.
- Encourage real-time note completion. BCBAs and RBTs should finish session notes the same day — it reduces errors and delays. Make this a process in your clinic that all staff must follow.
- Be specific. Insurers look for measurable data, clear interventions, and progress details. The automatically generated clinical note saves the therapist time by automating clinical note documentation. Save time = Save money.
- Include all pertinent information. Some payers require all information to be listed in the documentation: session start/end times, service code, service location, learner’s first and last name, etc.
- Conduct random Audits. Pick a few sessions each week to check for compliance before insurance claims go out.
4. Automate Smartly — Even on a Budget
You don’t need a massive ABA billing department to stay efficient. As your clinic grows, you can hire revenue cycle management services accordingly.
To start, one full-time biller may have time on their hands, but they can be tasked with helping in other areas of your practice.
As you gain more clients, you will want to have more than one biller so you are not understaffed if one becomes ill, takes a vacation, resigns, etc. Although your expenses will rise, it is worth the cost to ensure a steady cash flow and reduce stress.
- Use an ABA-specific practice management system that integrates scheduling, session notes, and ABA billing.
- Batch claims weekly rather than monthly to maintain a steady cash flow. As your practice grows, the requirement for more hours dedicated to ABA therapy billing will grow. Therefore, you will need to submit more often, i.e., twice per week or daily.
💡 Portia’s U.S.-based ABA billing team provides exceptional customer service and is knowledgeable in medical billing — we take the headache out of the process so you can focus on growing your business.
Affordable tools: Systems like Portia ABA Clinic Billing Software are built to support small and large ABA practices and offer both self-serve and full-serve ABA billing options.
When you outsource your billing to Portia ABA Clinic Billing Software, we take care of everything, so you don’t need to deal with the headache.
5. Stay on Top of Denials and Learn from Them
Denials aren’t just paperwork headaches — they’re feedback.
- Track denials for each payor, i.e., reason, amount, and what correction was needed.
- Categorize the issues. Are you seeing a pattern with missing modifiers or overlapping codes? Are certain payers/providers denying for the same reason? Find the trends and evaluate them.
- Respond quickly. Don’t let denials pile up — the faster you appeal, the faster you get paid.
💡 Tip: Review denial trends monthly. Use the information to improve accuracy and efficiency, and change policies accordingly.
6. Train as a Team
Everyone plays a part in ABA billing success.
- Host short training sessions to teach clinicians the rationale behind your policies (e.g., documentation red flags) and their impact on claims and denials.
- Keep a shared ABA billing guide that outlines your internal processes step by step.
- Encourage questions. The more your staff understands billing rules, the fewer corrections you’ll need later.
💡 Tip: Record a video walkthrough of your ABA billing workflow for onboarding new staff — it saves hours in the long run.
7. Monitor Cash Flow Like a CFO
With every successful business, financial health matters.
- Reconcile payments weekly. Make sure deposits match EOBs and your ABA billing system.
- Track key metrics:
- Days in A/R (aim for under 45, under 30 is ideal)
- Denial rate (under 10% is ideal)
- Average turnaround time (how long from service to payment)
- Follow up on unpaid claims every 30 days. Consistency is key.
💡 Tip: Stay on top of ABA billing. Keep your cash flow steady and predictable.
8. Don’t Be Afraid to Get Help
For some companies, it makes sense to keep ABA therapy billing in-house, while others find it more economical to outsource to a medical billing services company.
If you don’t know enough as the owner to monitor billing processes and staff, outsourcing may make sense. Don’t let ABA billing issues ruin your evenings or stress your team.
- Choose an ABA-specialized billing company. ABA Billing Specialists know the ins and outs of CPT coding and payor rules for specific ABA services.
- Keep ownership of your data. Even if you outsource, you should always have access to your ABA billing records, portals, and reports.
- Focus on what’s important. Partnering with the proper organization makes a world of difference. The children and families need your focus, and wearing multiple hats as both clinician and biller is time-consuming and unsustainable. If outsourcing can free up time to provide them with care, it is worth considering.
Work With The Portia Team
Running a profitable ABA therapy practice means making every claim count. With organized billing processes, strong documentation, and consistent follow-up, you can turn ABA billing from a source of stress into a well-oiled machine.
Remember: ABA billing isn’t just an admin task; it’s what keeps your company financially viable and ensures your team gets paid for the life-changing work they do.
At Portia, our ABA Billing Services team saves time, reduces denials, and ensures faster payments through expert, ABA-specific billing management.
Clinics can focus on delivering quality care — not chasing reimbursements. Check out our ABA practice management software today!
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