Billing from the BCBA’s Perspective

Todd A. Ward, PhD, BCBA-D (bSci21Media, LLC)

Michele Robinson and Emily Roche (ABA Billing)

Jamie Pagliaro (Rethink Behavioral Health)

It’s Friday afternoon.  You’re about to end a long week driving hundreds of miles to supervise your caseload and conduct assessments for new cases.  You barely had time to update your programs for the week, let alone finish new treatment plans.  Yet, you found the energy to get them done, and just as you are about to call it a week, a tinge of anxiety hits as you realize you haven’t yet sent in your billing documents to the office.  “I’ll email them over the weekend” you say to yourself as you head out to dinner with your family for the evening.  Then Sunday comes around and you have yet to finalize that folder of supervision notes sitting in your laptop.  “I’ll do it Monday; it’s a work day after all.”  Then Monday comes around and your odometer begins rolling again.  This is a vicious cycle that many behavior analysts experience on a weekly basis, and can contribute to declines in productivity and morale, and even act as the last push over the edge for a burned out BCBA. 

When you first decided to become a BCBA, billing was likely not on your mind.  No one ever says “I can’t wait to become a BCBA so I can immerse myself in billing codes.”  But the reality is that ensuring an effective billing process is probably the single most important thing an ABA provider can do, and the reason is simple — if you don’t bill, you don’t survive as an organization.   

Billing determines nearly everything that we do within an ABA service provider – the number of hours that you can supervise a case, the credentials and training of front line staff, the amount of parent training allowed for a case, the amount of time allowable to conduct an assessment, and best of all, the types of goals allowable in your treatment plan.  That’s right, all those years you spent training in a science of behavior applicable to virtually every type of social, verbal, academic, and daily living skill you can think of, becomes relegated to the confines of insurance companies.  You don’t have the final say in your plan, they do.

So, it’s in the interest of an ABA company to ensure a smooth billing process across all levels of the organization – from front line staff, to BCBAs, to office staff that directly interact with insurance companies on a daily basis.  Recently, Michele Robinson from ABA Billing, and Dawn Mackey from Rethink Behavioral Health discussed best practices for billing and collections.  Among their suggestions was the idea of creating a “billing scrub.”  Billing scrub refers to the checks and balances put in place to verify the internal accuracy of your billing documents, the degree to which hours billed match the billing codes of the insurance company, and the timelines involved in submitting claims. Robinson and Mackey rightly suggest that an ABA company should let the BCBAs focus on providing quality services and let the office staff prepare the billing documents, and the latter types of staff were the focus of their presentation.

However, the billing scrub is intimately connected to the BCBA as well even though he/she might not interact with insurance companies directly.  You see, the BCBA is situated between front line staff and office staff.  The supervision documents sent by the BCBA to office staff rely on data provided by front line staff.  The progress shown in the data, and the validity of the data themselves, are affected by the training given by the BCBA to the staff working a particular case.  Training is affected by the available time of the BCBA, and time is affected by the size and geographical spread of a caseload.  As a BCBA’s precious time dwindles, so can the thoroughness, accuracy, and timeliness of the supervision notes sent by the BCBA to the office staff.

If you are a BCBA short on time, struggling to complete your weekly supervision notes, here are some tips:

  1. Keep your documents electronic.  Nothing kills time like printing and scanning, and in 2016 doing so seems a bit archaic.  Keeping your supervision notes electronic through the entire process could free up multiple hours in your week.
  2. Bring your laptop to supervision sessions.  Bringing your laptop allows you to enter in the week’s data right there during your supervision session.  You don’t have to take any paper home with you, and you don’t have to have your staff email you data at the end of the week.
  3. Type out running notes during your supervision session.  As you are meeting with your client, staff, and parent, type notes as you meet with them of what was discussed.  Don’t get too carried away either – bullet points are fine.  You can go back later and refine the text to narrative form, but try to do it when the session is still fresh in your memory
  4. Your car is your office.  Your car is better than Starbucks because you don’t have to pay for drinks and if your phone has a personal hotspot you can link your laptop to the Internet. Use this time to refine the bullet points from your supervision session into something presentable to an insurance company. Also, if you need to take a call from a parent or staff, you have fewer privacy concerns (and noise) than if talking in public.
  5. Set your schedule early. You have a lot of different activities to balance so planning out a monthly schedule will help you fit everything in. If you start each month with a framework that covers all your necessary sessions and responsibilities, chances are you won’t be scrambling at the end of the month to fit in more supervision. Only planning day to day or even week to week is an easy way to run out of time for necessary sessions and will cause you to make billing errors. The best way to effectively utilize your insurance authorizations is to have a schedule planned at least a month in advance.

Hopefully these tips will make the billing process a bit more pleasant for you, the busy BCBA.  I’m sure you have other tips to add, so please let us know them in the comments below!

About ABA Billing

With over 25 years of progressive accounting management and software experience, coupled with over 7 years of ABA specific back office functions, ABA Billing offers top-notch, personal touch billing services to ABA providers as affordable rates.  We are a service organization built on the motto of having a “Helper’s Heart” – believing strongly in delivering exceptional customer results. For more information, visit

About Rethink Behavioral Health

Rethink Behavioral Health provides the tools every behavioral health provider needs to manage their practice and deliver quality ABA treatment effectively & efficiently. Rethink’s easy to use web-based software streamlines client care with sophisticated yet intuitive tools for both clinicians & administrators. For more information, visit

Todd A. Ward, PhD, BCBA-D is President of bSci21 Media, LLC, which owns and  His company aims to disseminate behavior analysis to the masses through non-academic publication outlets.  Todd is an editorial board member for Behavior and Social Issues and previously a Guest Associate Editor for the Journal of Organizational Behavior Management.  He has worked as a behavior analyst in day centers, residential providers, homes, and schools, and served as the director of Behavior Analysis Online at the University of North Texas.  Todd’s areas of expertise include writing, entrepreneurship, Acceptance & Commitment Therapy, Instructional Design, Organizational Behavior Management, and ABA therapy. Todd can be reached at [email protected]

1 Comment on "Billing from the BCBA’s Perspective"

  1. Daniel B. Sundberg | October 14, 2016 at 10:56 am | Reply

    Nice Perspective on this.

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