ABA billing and payroll

ABA sessions bill and pay through the same charges, claims and payroll as every discipline. This page shows the settings an ABA clinic usually sets; the details are in Supervised and concurrent services and Payroll settings.

Billing#

• Bill under the case lead or supervisor. Many payers want the analyst on the claim for a technician's session. Set Bill under on the payer's rule set, and name each coverage's case lead on the learner's Coverage tab. The technician stays on the charge as the provider who delivered the session.
• Analyst overlap. Add a concurrency rule with your payer's choice for an analyst's protocol modification code during the technician's treatment code: allow it, carve the minutes out, or split them off as non-billable time. Caregiver guidance during a session usually stays allowed.
• Level modifiers. For payers that want HM, HN, HO or HP on every line, add one modifier rule per provider level.
• Assessments. Assessment units include report writing time. Enter the minutes on the assessment visit's line; a per-episode unit cap on the payer's code rule holds anything above it in charge review.
• Multi-technician codes. Codes for severe behavior (0373T, and from 2027 97148 and 97159) need two or more technicians in the session. Book the analyst as Supervising and every technician as Primary or Assisting; booking with fewer technicians shows a warning. When the code has a per-technician add-on (97149, 97160), starting the session adds the add-on to the primary technician's visit for each technician past the first, at the primary code's minutes each. Set Technicians needed and Billed per extra technician on the code's rules in Procedure codes.
• Weekly claims. Set the payer's claim batch days so Create claims builds its claims once a week.
• Readiness. Check Billing readiness on the learner's Coverage tab before the first claim.

Payroll#

• Per unit and per learner. On a provider's pay rates, a per-unit rate for a code pays each unit of it. Open Only for one patient to pay a different rate for one learner within that code; it outranks the code's own rate.
• Drive time and mileage. Drive-time blocks pay at the provider's hourly rate for the drive-time appointment type (set it to your per-minute rate times 60). Confirmed drive miles pay at the payroll mileage rate as a reimbursement, never billed.
• Supervision without a billable code. Case supervision blocks pay hourly, and a visit with no billable line pays the provider's hourly rate even when their default is per unit.
• When sessions become payable. In payroll settings, Pay a visit once it is can wait for the payer's billable condition (caregiver signature or analyst review), the claim, or the payment.
• Late cancels per code. On a rate Only for code, turn on Pays for missed visits to pay a fixed amount when the learner late cancels or does not show for a session booked with that code.
• Overtime. Pick the weekly, California or Colorado rule, or set custom daily, double-time and weekly thresholds, in Payroll settings.

Flat pay per assessment#

Add a Per completed assessment pay rate for an analyst to pay a flat amount for each assessment they complete. An assessment counts as complete when its assessment report is final and signed; the report's author is paid, in the period of the signing date. A voided assessment pays nothing. The rate can be limited to a location or a learner like any other rate.