If an audit notice landed in your inbox tomorrow, how long would it take to pull every note, authorization, and credential they asked for? Recently, I heard a practice owner say she could have it ready the next day. Amy Legan, co-founder of Aspire Behavior Solutions, joined me and our Director of Revenue Cycle Management, Kayla Lewis, for a webinar, and these lessons stayed with me. The first one goes back to my years as an in-home provider.
Doing right by learners and proving it can pull in different directions
A couple of years ago I lived near a base, and a lot of the households I worked with were military, so their coverage was Tricare. I was an in-home provider back then, which meant a lot of time behind the wheel. Some days I had exactly 30 minutes between one family's session and the next, just enough time to drive across town and walk through the door on time.
Then we could no longer bill 97153 (technician-delivered treatment) and 97155 (BCBA® treatment with protocol modification) at the same time.
I still wanted to watch my technician work with the learner, and I wanted to see how that learner responded to someone other than me. So I started showing up earlier and staying a bit longer, which meant I had less time to finalize what I was working on from the previous session… and a lot of skipped lunches. The clinical decision was settled. The paperwork around it wasn't: pay, scheduling, and documentation all needed new answers.
How was my technician paid when we overlapped during 97155? What did each of us need to write in our notes so it was clear the other person was in the room without actively working? Scheduling had to find the extra time somewhere, too. My organization had to answer all of it.
Looking back, staying true to the supervision that was required was the easy call, even though operationally it created a new burden. I was not willing to sacrifice what I knew was right and needed clinically. Showing it on paper took pay rules, schedule changes, and a new way of writing notes, and every piece fell on people who already had packed days. That's the weight I had in mind when Amy told me how her team handles it.
The first audit that matters is the one you run on yourself
Amy runs a small clinic, and she said something I rarely hear from a practice owner: “I don't mind an audit anymore.”
Her reason is that compliance already lives inside her team's day. So when an audit notice arrives, she can send the documentation the next day. She'll tell you any system works if it sits inside the workflow and doesn't become extra work. Technology doesn't replace training in her practice, either. Her team still learns how to document, and the systems back them up.
For practices right now, an audit is a “when,” not an “if” question. Payors are reading claims and documentation more closely and asking harder questions about medical necessity. If you've only seen an audit from the provider side, it's easy to picture it landing out of nowhere.
Many of the problems that have surfaced in the field come down to documentation errors, which are the ones a practice can control.
Technicians write stronger notes when documentation protects learners
I never loved writing session notes, but I trained plenty of people on them because each billed unit has to show what happened and why it was medically necessary. So I asked Amy what she says to an RBT® running back-to-back sessions who sees the note as one more task at the end of a long day.
Share the wins
She tells her team to write the note as if they're telling her about the session. What went well? What was hard? Payors want to read that the service is working, and technicians tend to enjoy telling it that way. It's easy to fill a note with barriers and maladaptive behavior, because that proves why the learner needs support. Progress belongs there too, where the payor can see it. When Amy asks her technicians whether they want to protect their learners, the answer is always yes, and a good note is one of the ways they do it.
Reinforce great notes like any other behavior
Amy's internal audits turn up great notes, too, and when she finds one she reaches out and says so. As a behavior analyst, she doesn't see why documentation should be the one exception to reinforcement. Templates help as well. If a payor expects certain details, making them required fields in the note template means a new technician doesn't have to memorize the list.
Related: Teaching RBTs to Write Better ABA Session Notes With Behavioral Skills Training
Why a denial shows up weeks after the session that caused it
Kayla walked us through the billing side, and she gave me a new way to see the gap between a session and a payment. Picture a session on a random Tuesday. The authorization expired the week before, but no one noticed and the appointment still got scheduled, service was delivered, and a claim was sent out. The denial lands weeks later, long after details of that specific session are remembered. Reconstructing what happened takes time, and the timely filing clock has been running since the service date.
Kayla's point was that these types of mismatches shouldn’t be happening if your workflows (and the system that supports them) prevent them.
See audit-ready workflows in action
If you do one thing this week, pull five recent session notes and check them against a single payor's requirements. Whatever's missing tells you where a check belongs in your workflow. In Motivity Practice Management, authorization status, provider credentials, and required note fields get checked as sessions are documented. Gaps show up while the session is still fresh.
Press play to hear Amy explain why audit checklists are payor-specific, see a note template that requires what a payor expects, and watch how Kayla breaks down the billing side.
And if you'd like to see how those checks would work with your own payors and templates, let's talk.
