Audit-Proof Your ABA Practice: How to Prepare for Insurance Audits

Insurance and Medicaid funding for ABA therapy has dramatically expanded over the last decade. This is largely because of the Centers for Medicare & Medicaid Services’ 2014 clarification that Medicaid programs must cover autism diagnosis and treatment. State insurance mandates also require most health insurance plans to cover autism care, making ABA therapy more accessible. While expanded coverage has been life-changing for many families, it’s also brought more scrutiny from insurance payors in the form of audits. As a result, ABA providers must be more careful to ensure services meet the payor’s requirements. With insurance and Medicaid audits being an inevitable part of the process, ABA practices must take steps to audit-proof their practice.

Insurance mandates, paired with the growing demand for ABA therapy, have increased the chances of being audited. Reports of fraud and non-compliant billing have further fueled payor scrutiny. Recently, the Office of Inspector General reported Indiana made at least $56 million in improper payments to ABA providers. Concerns over widespread fraud, abuse, and waste throughout the country are prompting Medicaid and private payors to take a closer look at claims. As a result, providers now face a more rigorous review process. For most–if not all–ABA practices, audits have become a standard part of doing business. 

The best way to prepare for a Medicaid or insurance audit is to proactively establish compliant practices that safeguard your documentation and billing processes. When a payor initiates an audit, you don’t want to be caught off guard–searching through paper session notes, reaching out to multiple providers, and digging through disorganized records in multiple locations.

Here’s how you can be audit-ready:

1. Centralize documentation and billing in a single location
   
   Working out of multiple disconnected systems is a recipe for disaster, especially during an audit. Integrate your client data, session notes, and billing into a single platform to reduce the risk of missing vital documentation needed for an audit. With everything in one digital platform, you’ll be better positioned to respond to audits quickly and efficiently. 

2. Develop and implement comprehensive training on billing practices
   
   Audit readiness starts with understanding Medicaid and insurance billing requirements. Because of the complexity of ABA billing and the variation in payor guidelines, ABA providers must understand both general billing and individual payor requirements. 
   
   Compliant billing and documentation is a shared responsibility–from RBTs and BCBAs to organizational leaders and billers. As such, organization-wide training at every level is necessary to avoid costly errors that may arise during an audit.
   
   Ensure your team is trained on:

• Proper use of billing codes.
• Authorization requirements.
• Documentation standards. 
• Payor-specific requirements.
• Timelines for timesheet conversion and billing submissions.

3. Initiate internal billing audits
   
   Prepare for the inevitable insurance audit by doing regular internal auditing. Routine internal audits will help identify and correct errors and pinpoint opportunities for additional training.
   
4. Standardize your documentation
   
   Standardized documentation removes the guesswork for Behavior Technicians and Behavior Analysts and reduces the response effort for session notes and reports. Create documentation templates that enable consistency, thoroughness, and accuracy across staff. Some organizations create individual templates for each payor. However, an easier solution is to create one template that meets all the requirements of your most stringent payor(s).  
   
5. Use an all-in-one practice management and data collection platform
   
   A Medicaid audit or insurance audit often involves reviewing large volumes of documentation. That’s why having a centralized system makes it easier to access and verify records. A dynamic, all-in-one platform like ABA Matrix can keep your practice compliant and simplify audit preparations. Seamless access to data, session notes, and billing records makes for a smooth audit experience. 

While insurance and Medicaid audits are often unavoidable, you can audit-proof your practice. Don’t wait until an audit is initiated–it may be too late to fix compliance gaps by then. Evaluate your practice’s audit readiness today.