Missouri: Add Up the Day's ABA Minutes, Then Convert. One Claim Line per Code.

On September 9, MO HealthNet published an ABA billing tip that's almost entirely arithmetic, and the arithmetic is where the money is. Sum a code's active minutes for the whole day, convert once, and put the result on one claim line.

Our September 13 piece covered the division's earlier tips on the 90-day RBT clock, box 24J and five-day documentation. This one is about how minutes become units.

The turn: rounding per session overbills

The tip is blunt: “Rounding each small session up before adding them together overbills for services. Sum all active minutes for a given procedure code from the entire day first, then perform a single unit conversion.”

Its conversion table:

• Under 8 minutes: 0 units
• 8–22 minutes: 1 unit
• 23–37: 2 units · 38–52: 3 · 53–67: 4 · 68–82: 5
• Each further unit needs at least 8 minutes into the next 15-minute increment.

Here's why the order matters, using that table. Three separate 10-minute blocks of the same code in a day are 30 minutes, which is 2 units. Convert each block first and you get 1 + 1 + 1 = 3. In that example the difference is one unit, and it recurs every day the pattern does.

Then the claim: providers should “submit one single line with the total daily units per procedure code.” And: “Submitting multiple lines for the same procedure code on the same day will cause the claim to be denied as a duplicate claim in eMOMED.”

What the clock does and doesn't count

• Block times are out. Writing “8:00 AM to 4:00 PM (32 units)” without breaks “makes it appear that you billed for naptime and lunch.” Notes need exact start and stop times for each service. “If therapy stops, the billing clock stops.”
• Never billable: naps and sleep, free play, and down time such as waiting, transitions and paperwork.
• Billable only with a specific assessment or BIP goal: meals and snacks, toileting and hygiene. For enuresis, bill only while the protocol is being delivered.
• Drop-off and pick-up count only when the analyst or assistant analyst is giving caregiver guidance, “not just providing a status update.”
• Trial-by-trial data during a protocol is billable. Writing the progress note after the session isn't.

The worked example is a six-hour day of 97153 billed as 18 units on one line: 180 minutes, a 30-minute lunch, a 60-minute nap, then 90 minutes. If the analyst delivered 97155 during part of it, the analyst records their own start and stop times and bills 97155 on a separate line.

The consequence line: failure to document properly, “including subtracting non-billable time from units billed, may result in post-payment recoupment.”

The limits

The tip carries no effective date and doesn't say it changes any rule. It also leaves two practical cases open: the same code delivered on the same day by two technicians, and the same code billed under different modifiers. On its own wording, both would still be one line per code per day, but it doesn't say so.

What you must know or do

• Search last month's session notes for any single start–stop span covering a full day. Those are the notes the tip calls block billing.
• Pull a week of claims and look for a child with two lines for the same code on the same date. Each one is either a duplicate denial already or a split your billing system is making.
• For days with several sessions of one code, redo the math. Total the minutes, convert once with the table above, and compare with units billed. Any gap is overbilling exposure.
• Check that notes list naps, meals and toileting as non-billable unless the note names the assessment or BIP goal they served.