ABA Medical Billing Audits: What to Look for If You’re Targeted and How to Protect Your Practice

Being targeted for ABA Medical Billing Audits can feel overwhelming, but with the right preparation and documentation, it doesn’t have to be devastating. Whether it’s a routine payer review, a flagged claim, or a deeper investigation, understanding what auditors look for can help you stay compliant, respond confidently, and avoid costly penalties.

In this guide, we’ll walk you through what to look for if you are targeted for an ABA billing audit — and how Taylor Prime Solutions helps providers prepare, respond, and stay protected.

🚨 What Triggers an ABA Medical Billing Audit?

Audits can be triggered by:

  • Excessive use of specific CPT codes (e.g., 97153, 97155)

  • High volume of claims for one provider or NPI

  • Repetitive patterns (e.g., same time in/out daily)

  • Missing or mismatched authorizations

  • Inconsistencies between documentation and billed services

  • Complaints or anonymous reports

💡 If you’ve recently appealed multiple denials or submitted large backdated batches of claims, you may also draw attention.

🧾 What Do Auditors Look For in ABA Medical Billing Audits?

If you’re being audited, here’s what payers and auditors typically review:

1. Session Documentation (Notes)

  • Is the session note complete for every billed service?

  • Does it include the correct CPT code, goal addressed, time in/out, provider name, and signature?

  • Do notes reflect individualized treatment (not copy/paste)?

📌 Refer to our post on ABA session notes for more documentation tips.

2. Authorization Records

  • Was the service pre-authorized and within the approved date range?

  • Does the CPT code billed match the code listed in the authorization?

  • Is the treatment plan updated and aligned with services delivered?

3. Treatment Plans

  • Are goals measurable, behaviorally defined, and regularly updated?

  • Do goals tie directly to services delivered?

  • Is the BCBA supervising the plan and tracking progress appropriately?

4. Billing Patterns and Code Usage

  • Is there evidence of upcoding (billing 97155 instead of 97153)?

  • Are supervision codes being used appropriately?

  • Are billing times realistic and non-overlapping?

✅ Auditors often flag claims that look like “cookie-cutter” schedules.

5. Provider Credentials and Attendance

  • Is the billed provider qualified to deliver the service?

  • Are the RBT or BCBA credentials active and verified?

  • Was the provider physically present (not supervising multiple clients at once)?

📁 How to Respond If You’re Targeted for ABA Medical Billing Audits

If you receive an audit notice:

  1. Stay calm — and respond promptly. Most audits have a deadline.

  2. Gather your documentation:

    • Session notes

    • Treatment plans

    • Authorizations

    • Data collection sheets

    • Provider credentials and schedules

  3. Organize everything clearly: Match claims with dates of service, codes, and notes.

  4. Prepare a cover letter that explains your documentation system and response.

🛡 Don’t guess — let an expert help you respond professionally and protect your revenue.

🔒 How We Help You Prepare for and Pass ABA Billing Audits

At Taylor Prime Solutions, we proactively help ABA providers avoid and survive audits. Here’s how we protect your practice:

  • Audit-readiness assessments (we check your billing + documentation before a payer does)

  • Compliance checks on CPT code usage, modifiers, and payer policies

  • Chart audits to identify documentation or credentialing gaps

  • Appeal support if you’ve already received a denial or recoupment demand

  • SOP creation to ensure your team follows clean billing practices

📞 Call us today at 844-TAYLOR-9 (844-829-5679)
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ABA Medical Billing Audits