How to Prepare Your ABA Practice for an Insurance Audit

Insurance audits can feel overwhelming, but preparing ahead of time reduces stress and protects your revenue. Auditors review billing, documentation and compliance practices, and even small mistakes can lead to denied claims or recoupments. By taking proactive steps, your pediatric therapy or ABA practice can pass audits confidently.

Organize Patient Documentation

Complete and accurate records charts are essential. Make sure intake forms, assessments, progress notes, and signed consents are up to date and easy to locate. Using consistent templates across your team simplifies audits and reduces the chances of missing information.

Review Billing Records

Billing accuracy is a common focus during audits. Verify that CPT codes, units, and service dates match your documentation. Reconcile any denied or unbilled claims, and consider conducting monthly internal audits to catch errors early. Staying on top of billing not only prepares your for audits but also protects revenue.

Check Provider Credentials and Licenses

Insurance companies expect that all providers have current licenses, certifications and accurate NPI numbers. Don't overlook re-credentialing requirements, particularly for medicaid, as missing deadlines can cause gaps in reimbursements. Keeping a calendar of credentialing deadlines helps your practice stay compliant and avoids lost revenue.

Update Compliance Policies

Your HIPAA privacy and security policies, employment documents, and consent forms should be current and accessible. Documenting corrective actions from past audits also demonstrates your commitment to compliance. Clear and organized policies make audits smoother and reduce the likelihood of penalties.

Prepare Your Team

Educate your staff on proper documentation and billing procedures. Conduct internal review sessions so everyone understands expectations, and encourage reporting of errors promptly. A well-prepared team is a practice's best defense against costly audit findings.

In all, preparing for an insurance audit doesn't have to be intimidating. By keeping documentation organized, reviewing billing, maintaining credentials, updating compliance policies and training staff, your pediatric therapy or ABA practice can confidently navigate audits and protect revenue.