FROM THE WEBINAR: WORKING WITH THIRD-PARTY BILLERS
Your biller should never have to guess
The ABA master billing sheet is one workbook, owned by your agency, that states how every service code bills to every payer, with a source for every rule. Get the workbook and its plain-language field guide free.
Get the Billing SheetWHY CLAIMS PAY WRONG
Most billing errors start with two people who each assumed the other one checked
The agency assumes the biller knows the payer's rules. The biller assumes the agency said how it wants things done. When neither holds, someone picks a modifier that usually works, the claim pays, and nobody hears about it until an audit. Three things make this worse in ABA than in most specialties.
- The same modifier means different credential levels at different payers.
- Telehealth rules live in a separate policy that the ABA policy only points to. Billers who read one document miss the exception.
- Claims that pay wrong look exactly like claims that pay right. Denials get fixed. Overpayments get deposited.
A rule nobody can trace to a source is a guess. Guesses that pay are more dangerous than guesses that deny, because nobody looks at them.
TWO FREE RESOURCES
The workbook, and the guide that explains every field in it
Master billing sheet, leader's version (Excel)
Four tabs: a Read Me with the five filling-in steps, a payer template, a completed example payer, and a change log. Eight contract-level facts and fourteen code-level columns per payer, each with a source, a link, an evidence tier, and a verifier. A flag column shows which rows your biller is still guessing on.
Field guide for agency leaders (PDF)
Eighteen pages in plain language. Every field gets four short paragraphs: what it is, why it matters in billing, where to find it, and a filled-in example. Includes the six-tier evidence scale, questions to ask your biller, and a 28-term glossary that says what goes wrong when each term gets misunderstood.
TWO STORIES FROM THE EXAMPLE PAYER
What the sheet catches
Both come from a biller applying a rule that works at most payers to a payer where it does not. The payer is fictional. The pattern is not.
The telehealth POS trap
National guidance says telehealth uses place of service 02 or 10. This payer's telehealth policy, a separate document from its ABA policy, wants modifier GT and the POS where the client sits. A biller who reads only the ABA policy sends the first batch with POS 02. Those claims deny, which is the lucky outcome. At a payer that accepts POS 02 but pays a different rate for it, the same mistake pays wrong every month and nobody looks.
The HN overpayment
At many payers, HN marks a bachelor's-level clinician. A biller with that habit appends HN to 97153 when a BCaBA delivers treatment. This payer reserves HN for 97155 and 97156 and reads it on 97153 as a higher tier of service. Every claim pays, above the contracted rate. Six months later a routine audit pulls the 97153 lines and recoups the difference on all of them, plus interest. Nothing ever denied.
On the sheet, both rules sit on the payer tab with a section number, a link, and an evidence tier. The biller has no reason to guess.
ONE EMAIL, EVERYTHING
Get the billing sheet and the field guide
Enter your name and email once. Both files, plus every other checklist, decision guide, and template in our resource library, open on the next page. Download only what you need.
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WHO BUILT THIS
The sheet is the map. The digging is the work.
Filling in the template takes an afternoon. Gathering the sources, ranking the evidence, and getting a payer representative to confirm a modifier rule in writing takes several hours per payer, and more for MCOs that layer their rules on top of the state's.
Michael Fabrizio and Rose Feddock built ABA Compliance Solutions for agency leaders who carry that risk but did not go into the field to read payer manuals. Billing is one of the places that risk shows up. The free compliance diagnostic below tells you where the others are.
Take the Free DiagnosticBEYOND BILLING
The sheet covers your claims. What about everything else?
Billing is one slice of your exposure. The free compliance diagnostic covers the whole picture: twelve questions, about three minutes, and it names the area carrying your biggest risk right now.
Take the Free Diagnostic