ABA Growth Team - Tips and Tools for Success with your ABA Business!

Authorized vs. Rendered Hours: The Hidden Hundreds of Thousands You Are Leaving on the Table

Sat, 11 Apr 2026 18:57:50 GMT

Ask any ABA agency owner what their biggest bottleneck to growth is, and they will almost always say the same thing: " I need more RBTs so I can take more clients off my waitlist."

It makes sense. More clients equal more revenue, right?

Not necessarily. In fact, obsessing over your waitlist is often a distraction from a much more expensive problem hiding in plain sight. You don't necessarily need more clients to boost your cash flow. You need to actually bill for the clients you already have.

Welcome to the Utilization Gap.

The 1,000 vs. 650 Trap

Let’s look at the math. Imagine your agency has 1,000 authorized hours of therapy per week across your active client roster. You fought hard for those authorizations. Your clinical team did the assessments, fought the insurance companies, and won the hours.

But when you look at your actual rendered and billed hours for the week, you only hit 650.

Where did those 350 hours go?

They vanished into late cancellations.
They disappeared when an RBT called out and you didn't have a sub-coverage system.
They evaporated because your BCBAs’ caseloads are poorly balanced, leaving them unable to fulfill their supervisory hours.

If your average blended reimbursement rate is $65 an hour, those 350 unbilled hours just cost your clinic $22,750 this week. Spread that over a year, and you are leaving over $1.1 million on the table—all from clients who are already in your system.

Where the Leaks Happen: The Big Three Codes

To fix the Utilization Gap, you have to stop looking at your schedule as a whole and start tracking your rendered percentages across the three major CPT codes:

97153 (Direct Therapy): This is the bulk of your revenue, and it is the most vulnerable to the Utilization Gap. If your 97153 utilization is hovering around 60% or 70%, your scheduling matrix is broken. You need ruthless block scheduling and a strict, enforced cancellation and make-up policy to push this number into the 85%+ range.
97155 (Protocol Modification): This is where BCBAs often drop the ball. If a client is authorized for 4 hours of 97155 per week, but the BCBA is only rendering 2 because they are "too busy" putting out administrative fires, your margins are bleeding. You must track BCBA utilization just as aggressively as RBT utilization.
97156 (Parent Training): The forgotten code. Parent training is clinically vital, yet it is consistently the lowest utilized code. If you have authorizations for 97156 that are routinely expiring unused, you are sacrificing high-margin revenue that your BCBAs could be conducting via telehealth.

The Fix: Stop Counting Clients, Start Measuring Utilization

You cannot fix what you do not measure.

To instantly boost your cash flow without spending a dime on marketing or acquiring a single new client, you need to implement a Utilization Worksheet. Every Friday, your leadership team should be looking at exactly what percentage of authorized hours were actually rendered for 97153, 97155, and 97156. The following should be tracked by BCBA caseload:

Authorized hours for the week (by code)
Scheduled hours for the week (by code).
Note : a discrepancy between authorized vs. scheduled hours usually means a staffing/hiring issue.
Rendered hours for the week (by code).
Note: a discrepancy between scheduled vs. rendered hours usually means a problem with client and/or staff callouts.

When you track it, you can pinpoint the leaks. When you pinpoint the leaks, you can hold your staff and clients accountable. And when you hold your staff and clients accountable, your cash flow dramatically improves.

Stop Leaving Money on the Table

If you know your agency has a Utilization Gap but you aren't sure how to build the operational systems to fix it, we have two ways to help you right now:

1. The Q2 ABA Business Bootcamp
Join us for our upcoming interactive Q2 Bootcamp in June 2026. We will dive deep into block scheduling, caseload balancing, and the exact capacity matrices you need to push your utilization rates to maximum profitability.
�� [ Click Here to Register for the Q2 Bootcamp ]

2. The Grapevine Group Certificate Program
Need ongoing, executive-level support to implement these systems? The Grapevine Group is our premier monthly mastermind and certificate program. You get direct access to our proprietary capacity tools, weekly implementation calls, and a network of high-level ABA founders who are scaling exactly like you.
�� [ Click Here to Apply for the Grapevine Group ]

The Bank Balance Illusion: Why Your ABA Clinic Shows a Profit but You Can’t Make Payroll

Wed, 25 Mar 2026 16:19:11 GMT

You just had a record-breaking month. Your BCBAs hit their billable targets, your RBTs were fully utilized, and your practice management software shows the highest revenue generation in your clinic’s history.

You should be celebrating. Instead, it is Thursday night, and you are staring at your bank account, sweating over tomorrow’s payroll run.

You are asking yourself the same question every scaling ABA agency owner asks at some point: "If my Profit & Loss statement says we are making so much money, where is all the cash?"

Welcome to The Bank Balance Illusion .

If you are running your ABA agency strictly off a traditional P&L, you are flying blind. Here is why your clinic looks profitable on paper while you are constantly fighting for cash—and exactly what you need to do to fix it.

The Danger of the Traditional P&L

Your accountant loves your Profit & Loss statement. It is a great tool for filing taxes, but it is a terrible tool for running a multi-million-dollar clinical operation.

The problem lies in how revenue is recognized. Your P&L records revenue the moment a session is completed and billed. On paper, you earned that money in real-time. But in the real world of ABA insurance billing, that cash doesn't exist yet.

You cannot pay your staff with accounts receivable. You cannot pay your facility rent with an "authorized unit."

The Payroll Gap

This discrepancy creates what we at the ABA Growth Team call the Payroll Gap .

Your outflow is rigid. Your RBTs, BCBAs, and administrative staff must be paid every 14 days, like clockwork. Your facility lease is due on the 1st.

Your inflow, however, is entirely at the mercy of insurance companies. You are carrying the cost of payroll for 30, 45, or sometimes 60+ days before the insurance payor actually cuts the check. The faster you grow, the more staff you hire, and the wider that Payroll Gap becomes. Growth literally drains your cash reserves.

The "Turnaround Multiplier"

To close the gap, you have to realize that not all revenue is created equal.

If you look at your Master Payor Matrix, you will see that different insurance companies have wildly different reimbursement timelines. Payor A might have a clean 14-day turnaround, while Payor B routinely takes 45 days and requires constant follow-up.

If your caseload is heavily weighted toward Payor B, your cash flow will always be choked, regardless of how high your billing rates are. You need to assign a Turnaround Multiplier to each payor to accurately predict when that billed revenue will actually hit your checking account, and then ruthlessly balance your BCBAs' caseloads to ensure a steady mix of fast-paying and slow-paying clients.

The Solution: Stop Looking Backward

A P&L tells you what happened last month. To survive and scale, you need to know what is going to happen next month.

You need to implement a 13-Week Cash Flow Predictor .

This is an operational model that maps your exact cash position 13 weeks into the future. It factors in your current cash on hand, your specific payor Turnaround Multipliers, your aging AR, and your upcoming payroll runs. When built correctly, it acts as an early warning system. It tells you in Week 2 that you are going to have a cash shortfall in Week 8—giving you six full weeks to escalate AR collections, secure a line of credit, or adjust schedules.

No more Friday morning panic. No more Bank Balance Illusion. Just predictable, executive-level control over your money.

Ready to Fix Your Cash Flow?

Reading about the Payroll Gap is one thing; fixing it is another. If you are a scaling ABA agency owner, you cannot afford to guess your cash flow. You need the tools to build your 13-Week Cash Flow Predictor so you can finally step out of the daily fires.

We have two ways to help you build this right now:

1. The Q2 ABA Business Bootcamp Join us for our upcoming interactive Q2 Bootcamp. We will tear down the traditional P&L, expose your margin leaks, and teach you the exact financial and operational mechanics needed to run a highly profitable clinic without burning out.
�� [ Click Here to Register for the Q2 Bootcamp ]

2. The Grapevine Group Certificate Program Need ongoing, executive-level support? The Grapevine Group is our premier monthly mastermind and certificate program. You get direct access to our proprietary financial tools, weekly implementation calls, and a network of high-level ABA founders who are scaling exactly like you.
�� [ Click Here to Apply for the Grapevine Group ]

The "Lonely CEO" Syndrome: Why You Cannot Scale Your ABA Agency Alone

Sun, 25 Jan 2026 21:45:14 GMT

Category: Leadership & Culture

It’s 7:30 PM on a Tuesday. The clinic is dark. The RBTs have gone home, your Scheduler clocked out hours ago, and your cleaning crew just walked in.

But you are still at your desk.

You have three tabs open: one for payroll (which is due tomorrow), one for a confusing denial from United Healthcare, and one for a parent email complaining about a technician's tardiness.

You are exhausted. You are overwhelmed. And most of all, you are lonely.

This is what I call "The Lonely CEO Syndrome."

In the ABA industry, this is the silent killer of high-potential agencies. It isn't a lack of clinical skill that caps your growth—it’s the belief that you have to carry the weight of the entire organization on your own back.

The "Super-BCBA" Trap

Most ABA agencies are started by incredible clinicians. You started this business because you cared about client outcomes. In the beginning, being the "Super-BCBA" worked. You did the assessments, you hired the staff, you sent the invoices, and you bought the sensory toys on Amazon.

You hustled your way to $1 Million in revenue.

But here is the hard truth: The skills that got you to $1 Million are the exact skills that will prevent you from getting to $5 Million.

You cannot "hustle" your way through scale. When you try to be the CEO, the Clinical Director, and the Operations Manager all at once, you become the bottleneck. Your business can only grow as fast as you can work—and you are already out of hours.

The Solution: The Leadership Triad

If you look at the agencies that successfully scale to $5M, $10M, or exit to private equity, they all share one common trait. The owner stopped trying to be a "Super-Hero" and started building a Leadership Triad.

To scale without burnout, you need three distinct "brains" running your business. These cannot be the same person.

1. The Visionary (You/The CEO)

Focus: Strategy, Culture, and Finance. Your job is not to schedule sessions or debate treatment plans. Your job is to ensure the business is solvent (cash flow), the culture is healthy (retention), and the ship is pointed in the right direction (strategy). If you are doing intake calls, you are neglecting your true job.

2. The Clinical Architect (The Clinical Director)

Focus: Quality, Ethics, and Outcomes. This person is not just a senior BCBA with a bigger caseload. They are the guardian of your "Standard of Care." They need the autonomy to build supervision frameworks, audit clinical notes, and train staff without you looking over their shoulder.

3. The Engine (The Operations Lead)

Focus: Efficiency, Logistics, and Billing. This is the person who ensures the bills get paid and the schedule is full. They bridge the gap between "Clinical Quality" and "Financial Reality." They fight the insurance denials so your clinicians don't have to.

Stop Training Alone

The biggest mistake I see owners make is attending high-level business training alone. They go to a conference, get inspired, learn a new system, and then go back to their office and try to "push" these new ideas onto a team that doesn't understand the vision.

It doesn’t work.

You cannot just delegate tasks; you have to delegate ownership. And to do that, your "generals" need to be in the room where the strategy happens.

From "Me" to "We"

This year, we made a radical change to our own group coaching program, the Grapevine Group . We realized that teaching owners how to run a business wasn't enough. We needed to help them align their entire leadership team.

That is why we changed our membership model. Now, when an agency joins Grapevine, we include three seats: one for the Owner, one for the Clinical Director, and one for the Ops Lead.

We did this because we don't want you to be the smartest person in the room anymore. We want you to be surrounded by a team that understands unit economics, clinical scorecards, and intake pipelines just as well as you do.

The Cure for Loneliness

If you are reading this at 7:30 PM on a Tuesday, take a breath. You have built something amazing. But if you want it to grow, you have to let go.

Build your Triad. Train your generals. And go home at 5:00 PM.

Ready to build your infrastructure?
Join the Grapevine Executive Certificate Program . We don't just coach you; we train your entire Leadership Triad to build the systems that set you free.
[ Learn More About Grapevine ]

Not sure if your numbers work?
Start by taking our free Profitability Stress Test online course to see exactly where your margins stand.
[ Enroll in our Free Online Course ]

Communicating Client Expectations: ABA Therapy is a Medical Service, Not a Daycare

dan@afterlife.group (Dan Dube) — Thu, 19 Jun 2025 02:10:31 GMT

Reframe Your Client's Expectations to Improve Outcomes

As ABA business owners, we're dedicated to providing high-quality, effective therapy to children with autism. A significant part of that commitment involves setting clear expectations with our client families . One of the most crucial points to emphasize, right from the start, is that ABA therapy is a medical service, not a daycare .

This isn't just about managing schedules; it's about safeguarding the integrity of the therapy, ensuring positive client outcomes, and fulfilling our responsibilities as healthcare providers to both families and insurance companies.

Why Punctuality and Adherence to Hours Are Non-Negotiable

When a child begins ABA therapy, a personalized treatment plan is developed, based on their unique needs and medical necessity. This plan outlines a specific, prescribed number of therapy hours per week . These hours are meticulously designed to help the child achieve critical developmental and behavioral goals.

Dedicated, Paid Staff
For every therapy session, we have skilled and paid staff members specifically allocated to that client. When families consistently arrive late or cancel without adequate notice, valuable therapy time is lost. This isn't just an inconvenience; it directly impacts our operational efficiency and the effectiveness of the service we're contracted to provide.
Meeting Medical Necessity Guidelines
Client treatment plans are approved based on medical necessity guidelines . The prescribed hours are not arbitrary; they are deemed essential for achieving the desired clinical outcomes. Consistently missing or cutting short sessions due to lateness makes it incredibly difficult to meet these crucial hour requirements, which can have downstream effects on authorization renewals.
Our Obligations to Families and Payers
As a medical service provider, we have a significant obligation to both our client families and their insurance companies. Our primary goal is to help children achieve the outcomes outlined in their approved treatment plans. Insurance companies authorize a specific number of hours because they are medically necessary. Failure to consistently deliver these authorized hours not only hinders the child's progress but can also impact future authorizations and our relationship with payers.

The Direct Link Between Adherence and Outcomes

It's vital to help families understand that every therapy hour is a building block in their child's development. Just as consistent effort is required to master any skill, consistent attendance and full engagement in ABA therapy are paramount for progress.

Failure to meet the prescribed weekly hours will directly result in not achieving the desired outcomes. We've all seen how inconsistent attendance can slow progress, impede skill generalization, and prolong the time it takes to address challenging behaviors. This can lead to frustration for families and, most importantly, for the child who deserves every opportunity to thrive.

Partnering for Success: Educating and Empowering Families

Our role extends beyond providing therapy; it includes educating and empowering families to be active participants in their child's treatment journey. By clearly communicating that ABA therapy is a medical service, with all the responsibilities and expectations that come with it, we set the stage for a more successful and impactful therapeutic experience.

Success tip: Some of our most successful clients describe make-up policies in their client handbooks. We encourage our clients to have these discussions with clients right from the first intake call, and ensure that they sign off on policies in a client handbook during the kickoff meeting when treatment begins. We encourage a policy that promotes that any missed time is made up within 30 days to ensure that the client stays on track to achieve treatment goals. In some cases, this might mean adding time to the next several appointments. In other cases, clinic-based providers offer make-up blocks on Saturdays. Find the plan that works best for your company.

Let's equip our teams with the language and confidence to explain these critical expectations upfront, ensuring that every family understands the value of consistency and punctuality in achieving the best possible outcomes for their child.

ABA Scheduling - 5 tips for reducing the stress of staff scheduling!

Fri, 13 Jun 2025 21:41:59 GMT

Reduce anxiety, optimize utilization, and increase profitability!

Ask someone from almost ABA company’s operations or administrative team what the most frustrating part of their job is, and the answer you’ll hear almost every time is “scheduling”.

It doesn’t matter whether you provide services in clinics, schools, or homes… planning and updating staff schedules is DIFFICULT.

But there are steps you can take to minimize the pain and effort involved in managing schedules. Here are 4 tips that have worked for me in the past.

Tip #1: Don’t strive to accommodate your client’s availability!

Let’s remember: ABA therapy is a medical practice. You don’t ask your physician or dentist to change their schedule because your child has soccer practice. You take the options they have available for you and choose the best one. Unless you have a boutique ABA practice with very few clients, you will never be able to accommodate the availability of every family. So, stop trying! Offer what you can provide, and let them decide if they want that time slot or want to wait until their preferred schedule is available.

Tip #2: Use a block scheduling model.

I’m a big fan of block schedules. They make it much easier to plan availability of both staff and clients, and allow for you to be able to hire full-time staff (which lowers the risk of employee turnover). The key to success is maintaining a balance in your schedule. For example, if you take a client for an afternoon block, try to find a new client for the morning block so that you can provide a staff member with a full day’s worth of hours. This works for home-based clients as well; just remember to add drive time in between your blocks.

Tip #3: Create small teams to work with each client.

We saw our clients make the best progress in their therapy when we limited the number of BTs working with them to no more than 4 (for full-time 40 hour/week clients). We had a primary team of 2 staff who alternated blocks (1 in morning block, 1 in afternoon block), and 2 other staff members trained on the programming for that child in case a primary staff called out.

Tip #4: For clinic-based providers: always have a “floater” on the schedule.

For each of our clinics, we always had at least one “floater” RBT scheduled. Their primary duties were to provide breaks for the other therapists. When they weren’t doing this, we had them making materials or cleaning. If a staff member called out sick, the floater could take over the shift, and BCBAs would give breaks. For this reason, I recommend that the floater is a senior-level experienced therapist who can “jump in” with any client.

Tip #5: Enroll in our FREE video course on ABA Staff Scheduling Strategies.

This free e-learning class will provide you with some hands-on examples of how to use these tips to optimize your staff schedule and increase utilization. Enroll here .

Dan Dube is the Founder and CEO of ABA Growth Team, a concierge service provider to ABA business owners. He is also a self-proclaimed scheduling professional.

Top 9 Tips for Hiring High Quality Behavior Therapists (and 1 Bonus Tip for Recruiting BCBAs)

websitebuilder@thryv.com — Wed, 12 Jul 2023 18:17:30 GMT

ABA Business Owners: Are you struggling with finding quality candidates who have a genuine interest in working with people with disabilities? Is Indeed not working well for you?

See my list of tips that we have used over the last decade to improve the quality of our staff hires.

#9: Competitive pay

Okay, I started with the most obvious, but it’s important to have a reality check. The days of hiring BTs for $16/hour are over. People can get $18-20/hour to work in retail, and they won’t have to deal with biting, aggression, or toileting accidents. In some metropolitan markets, entry-level BT candidates are being offered $26-30/hour. The important thing is to be very aware of your reimbursement rates from payors, what your “loaded cost” per billable hour is, and your profit margin goals. Consider tiered pay rates (higher pay for working with clients with higher level of need) and pay for performance bonuses.

#8: Colleges

Another obvious one (I promise, the list gets more “out of the box” as we go on!). Colleges are full of promising young people who are looking for life experience in a field they are passionate about. I especially like to recruit college students majoring in “early childhood education” or “psychology”. Here are some tips for getting the most success out of college recruiting:

Attend college job fairs, and offer “on the spot” interviews. Staff your booth with at least one BT who is in the same age group as the students! (Nobody wanted to talk to the creepy old guy standing alone at a table, but when I brought a younger staff member with me, they flocked.) And bring candy and giveaways!
Build relationships with the heads of the career office, early education department, and psychology department. Offer to do full days of on-site interviews at the college.
Offer paid internships if you can! In 2017, we recruited 8 college students from a local college to do paid internships. 2 of these people have gone on to become BCBAs, and one of them is now a regional clinical director!
Sign up for Handshake. Handshake is the #1 way college students find jobs.
Offer to do a guest lecture.

#7: Open house/ In-person hiring event

Sponsor an open house hiring event at your clinic (if you have one) or at a public place (hotel conference room, library) if you don’t. Advertise it over all social media (pay to boost an ad for a defined target audience), post it on your website, and post it in public places, like grocery store bulletin boards. We once hired 10 people in 1 day using this approach!

#6: Strengthen your interview skills.

You need to be able to assess whether this candidate is just looking for a paycheck, or may have a true interest in the field. Experience is not always necessary! One of our best hires ever came from working in a retail job. One of our WORST hires was someone who had already finished all of their coursework and needed hours to sit for a BCBA exam.

#5: Discuss your “WHY”!

WHY does your agency exist and WHY do they want to work with you? WHY would they choose you over other agencies that might pay more? If they buy into your mission, vision and values (and you actually act them out), people WILL follow you.

#4: Identify what motivates your staff.

Money is great, but it isn't always the primary motivator. Consider regular staff feedback surveys. Understand what motivates people on your team. Sometimes, they just need to see your face and interact with you. We used to have a platform called Kudos, where staff could give each other shoutouts with points that could be redeemed for gift cards. It was great to see the staff visibly supporting each other, and that builds a strong company culture!

#3: Recruit specifically for “Direct support” and “LNA/CNAs”

There is a whole category of amazing and talented professionals who are classified as “Direct Support” staff or “Licensed Nursing Assistant (LNA)/Certified Nursing Assistant (CNA).” These people typically work in nursing homes or with severely disabled adults. And the dirty secret is that these incredible people are shamefully underpaid. They are usually compassionate, patient, and not afraid to work with anyone! Their current pay is usually $5-10/hour LOWER than the typical BT rate of pay. If you recruit these people, they will come!

#2: Employee referrals

It makes sense that if you create an environment where people enjoy working, they will tell their friends. You should encourage this by offering an employee referral bonus. Give them a bonus for any written referrals for candidates that you hire and keep on the payroll for at least 90 days.

#1: Offer Full-time and benefits!

Many ABA companies (especially home-based providers) look for part-time staff to support after school hours. If you only look for part-time, expect to see a revolving door of staff who will leave at the first opportunity to get a full-time job elsewhere (many times, after you’ve invested in training them and given them experience). Make the smart choice and hire full-time with benefits. How do you find and utilize them for 30-40 hours a week? Here’s a hint: move to a block schedule (future post coming on that topic).

BONUS TIP for Hiring BCBAs:

Everyone uses Indeed to recruit BCBAs, and what happens? It usually ends up in a bidding war, and freshly minted BCBAs with no actual experience are being paid $80-100K/year or more! I went in a different direction and used LinkedIn Recruiter Lite. Get a free trial for 30 days and see for yourself. The Lite version will scour your network for 1st, 2nd, and 3rd degree connections (this works better if you already have a lot of LinkedIn connections). A couple years ago, I hired 5 BCBAs in a 3-month period with this approach.

Any more ideas? Reply with more feedback! I'd love to hear it.

Follow me for more tips!

6 Factors to Consider When Selecting a Practice Management System

websitebuilder@thryv.com — Wed, 12 Jul 2023 18:17:30 GMT

So many practice management systems out there...some have been around for over a decade, and it seems that new ones pop up every few months. How can you choose the best system for your practice? See my tips below.

I’m fortunate to have a rather unique background when it comes to evaluating practice management systems. I am a former co-founder and CEO of both a cloud software company and an ABA business. In the last 10 years, I have reviewed just about every practice management system out there, and have negotiated contracts with several of them.

Based on that experience, here are 6 factors that I think are crucial if you are considering investing in a practice management system for your company.

(Please note: I will not make any specific software recommendations here, because each solution has their own strengths and weaknesses, and every client’s set of requirements is unique.)

#1: The system must NEVER go down!

Practice management is a “mission-critical” application. In most cases, you will have BTs taking data on tablets, and both clinical and operational management will need constant access to the system in order to do their jobs. Make sure that your contract ensures that the system will have an “uptime” of at LEAST 99.5% (the bare minimum for any cloud software application).

Last year, a major practice management software company made headlines when their system crashed several times a day. My employer at the time was affected by these outages, and it caused severe issues internally at the company.

I have a strong preference for systems that are built on enterprise platforms with large user bases that have been proven to never go down. For example, there are a few practice management systems out there that are built on top of the Salesforce platform, which has proven performance at a large scale of users globally. (Systems that run on Salesforce include Artemis ABA, Lumary, and TotalTherapy.)

#2: “All in one” is not always better.

My doctor once told me that “multi-symptom” cold medications that contain ingredients to fight different symptoms do an “okay” job at managing the symptoms, but not as good a job as the individual medications for each symptom. This analogy can apply to practice management systems. In some cases, a large system that “does it all” really only does an adequate job at each task, whereas some focused systems (like data collection) do a really great job at that task. You will need to evaluate your priorities when looking at solutions. (There are some packages out there that “do it all” really well.)

#3: Pricing models

Most of the pricing models I’ve seen fall into one of 3 categories: 1) user-based licenses with unlimited clients (the number of your staff using the system), 2) client-based licenses with unlimited users (one license for each client you are supporting), or 3) a hybrid model, where you pay for each internal user, with a surcharge for each client. In my opinion, the most cost-effective of these options is the user-based pricing model , because hopefully your practice will have more clients than staff. In an ideal scenario, the software provider should provide a different price for “clinical users” than for “admin users” (which should be cheaper, since they won’t use all of the clinical features).

#4: Be cautious of features like “labels”, which are prone to human error.

This is a little “techie”, but it is very important. As I mentioned, a previous employer used a large practice management system, and heavily used a feature called “labels” to classify and make associations (for example, which region an employee worked at, which clients were served by a specific BCBA, etc.). On the surface, this is a very useful feature for querying the system and getting quick results. The problem is that you are dependent on your users to: 1) remember to apply a label every time, and 2) apply the CORRECT label every time. This is ripe for human error. I saw many reports with incorrect financial tracking information because labels were applied incorrectly, and there was no way to validate it. This defeats the entire purpose of a practice management system.

This is another reason that I like systems based on a Salesforce platform, which is a true database. You can make data entry fields be “required”, and then provide a drop-down list of values. This helps to ensure that users must enter the data and largely takes away the ability for a user to enter an incorrect data value. Your reporting is much more trustworthy in a system like this.

#5: Read the ENTIRE contract.

In one instance where I was negotiating a contract with a large practice management vendor, I noticed that when I printed their standard contract it was only a few pages long. However, there were lots of links in that document. I’m guessing that most ABA business owners only read the 2-3 pages and then sign.

I clicked on every hyperlink and printed out each linked document, and the total contract was approximately 100 pages long! It had lots of uncomfortable things hidden in the linked documents, such as automatic contract renewals with a baked-in price increase and an automatic increase in licenses each renewal period. Make sure you always know the fine print in any contract that you are signing!

#6: Contracts are ALWAYS negotiable.

I’m not a lawyer. (That would be my brother.) But, I do know enough about the law to be aware that a contract is a legally binding document between 2 parties. Both parties have the ability to negotiate the terms. If you don’t like the terms in a standard contract from a practice management software company, tell them what you want changed. You will almost always either get what you want or reach a fair compromise.

Negotiating ABA Insurance Contracts: Keep These 2 Factors in Mind!

websitebuilder@thryv.com — Wed, 12 Jul 2023 18:17:30 GMT

I get asked frequently about tips for negotiating (or renegotiating) ABA reimbursement rate contracts with insurance payors.

This is something that I had to learn the hard way when my wife and I started our ABA company a decade ago. Like many other providers, we made some of the classic “rookie mistakes”: we took the “standard” rates that commercial insurance payors offered without questioning them, we accepted their slowness in paying our submitted claims, and we survived a multitude of ridiculous claim denials…all while we were in the process of “proving” ourselves to be worthy providers in their network.

After a couple of years of dealing with this, I had reached the breaking point. Our cash flow was continually in crisis, due to low rates and slow reimbursement cycles. It was time to renegotiate with our payors. But this time around, I was ready and armed with these 2 sets of facts:

Minimum acceptable rates
Adequate provider network

Factor #1: Minimum Acceptable Rates

How do you know if a rate offered by a payor is a “good” rate for your business model? You need to understand your costs! You need to be able to answer this question: What is your “ loaded hourly rate ”?

Calculate Your Costs

A loaded hourly rate gives you an estimate of the rate that you need to charge to cover all of your costs, in order to break even. The loaded rate is calculated as follows:

Loaded Hourly Rate = All Monthly costs / Total monthly billable hours

Let’s break this down to make it more understandable:

All monthly costs

Over a sample period of time (6-12 months), calculate your company’s average costs per month. This number should include all payroll costs (for both billable and non-billable employees), and all overhead costs (rent, insurance, software fees, marketing, etc.). For our example, let’s say the average total monthly cost is $100,000.

Total monthly billable hours:

Use the same sample period of time (6-12 months) to determine the number of billable hours each month. If you have a practice management system, you should be able to pull a report or query that summarizes this information for you. This will include hours for all billable codes for RBT/BT therapy sessions, as well as BCBA billable hours for supervision and parent training. If you have other sources of revenue besides insurance billing, include those hours as well. Take an average number of these monthly billable hours over the sample period. For our example, let’s say that our average number of billable hours each month is 2,500.

When you have determined these numbers, use the formula to calculate your loaded hourly rate. For example:

$100,000 (average monthly cost) / 2,500 (average monthly billable hours) = $40/hour (loaded rate)

You have just determined that you need to make at least $40/hour just to break even. In this example, if your current insurance contract with a payor is paying you less than $40/hour, then you are losing money on every hour that you bill to that payor!

Add Your Profit Margin!

Once you have determined your loaded rate to get a baseline number to cover your expenses, you need to add in a profit margin. I recommend calculating 3 scenarios: a minimum acceptable rate , a reasonable rate , and a wish rate . To continue my example, I will calculate 3 rate proposals: a 15% profit margin (acceptable rate), a 20% profit margin (reasonable rate), and a 25% profit margin (wish rate). If our baseline loaded rate is $40/hour, then our 3 scenarios look like this:

Minimum acceptable rate: $46/hour (15% profit margin)
Reasonable rate: $48/hour (20% profit margin)
Wish rate: $50/hour (25% profit margin)

Start your negotiation by asking for your wish rate. But, do not accept anything less than your “minimum acceptable” rate.

If they refuse to meet even your lowest acceptable rate, it’s time to walk away and focus your energy on revenue streams that will be healthier for your business. We left the Cigna network in New Hampshire in 2019 because their “best” rate was below our loaded rate costs…and they were unwilling to negotiate, even though we were one of the largest providers in the state! Speaking of which…

Factor #2: Adequate Provider Network

This one is a little bit more abstract, and is highly dependent on the number of “in network” ABA providers in your region for a particular payor. Essentially, insurance providers are supposed to offer an “adequate provider network” for their subscribers. (For Medicaid, this is a requirement under federal law.) Many payors will claim (sometimes truthfully) that you are welcome to choose to leave their network, as they have many other providers in their network that can take the cases.

But, if you do your homework, you can sometimes counter this argument (depending on the market factors in your region):

Talk to parents who reach out for you to inquire about services. Ask them if they have been calling other providers. In many cases, they will tell you that everyone else has a long waitlist.
If you have a friendly relationship with other providers in your region, reach out to them and inquire about their waitlist for a particular payor in the event that you may want to refer some prospective clients to them. They will also likely admit that they are maintaining a waitlist.

You can use these facts to inform the payor that they are failing to offer an adequate provider network, as you have researched with parents and other providers and everyone is carrying a long waitlist. This is putting an “unnecessary administrative burden” on their subscribers, and it is causing a “ unnecessary delay in timely access to medically necessary services ”. (These specific phrases can be a trigger for insurance companies.)

If you are able to accept new clients with little to no wait, inform the payor of this and emphasize that this will add value to the adequacy of their provider network. It won’t always work, but it is another weapon in your negotiation arsenal that can come in handy.

Conclusion

Working with insurance payors is one of the biggest challenges an ABA provider will have to deal with. It is often a “David and Goliath” situation, where you as a small company have to attempt to negotiate with a large, faceless corporation.

But, never forget that a contract is between 2 parties, each of whom have equal rights to negotiate. Arm yourself with facts and know what you want to accomplish before entering into the negotiations. And, if the other side is not willing to reasonably accommodate and compromise fairly, don’t be afraid to walk away. If enough ABA providers start doing this, the lack of an adequate provider network will bring payors back to the negotiating table.

Learn more from our 2-CEU Course!

Using KPIs to Renegotiate Insurance Contracts

This 2-CEU course provides information on how to set up and monitor Key Performance Indicators (KPIs),
and how to use KPI data as evidence of quality to renegotiate rates from insurance payors.
Price: $79

Purchase now

ABA Growth Team - Tips and Tools for Success with your ABA Business!

Authorized vs. Rendered Hours: The Hidden Hundreds of Thousands You Are Leaving on the Table

The 1,000 vs. 650 Trap

Where the Leaks Happen: The Big Three Codes

The Fix: Stop Counting Clients, Start Measuring Utilization

Stop Leaving Money on the Table

The Bank Balance Illusion: Why Your ABA Clinic Shows a Profit but You Can’t Make Payroll

The Danger of the Traditional P&L

The Payroll Gap

The "Turnaround Multiplier"

The Solution: Stop Looking Backward

Ready to Fix Your Cash Flow?

The "Lonely CEO" Syndrome: Why You Cannot Scale Your ABA Agency Alone

Category: Leadership & Culture

The "Super-BCBA" Trap

The Solution: The Leadership Triad

1. The Visionary (You/The CEO)

2. The Clinical Architect (The Clinical Director)

3. The Engine (The Operations Lead)

Stop Training Alone

From "Me" to "We"

The Cure for Loneliness

Communicating Client Expectations: ABA Therapy is a Medical Service, Not a Daycare

Reframe Your Client's Expectations to Improve Outcomes

Why Punctuality and Adherence to Hours Are Non-Negotiable

The Direct Link Between Adherence and Outcomes

Partnering for Success: Educating and Empowering Families

ABA Scheduling - 5 tips for reducing the stress of staff scheduling!

Reduce anxiety, optimize utilization, and increase profitability!

Tip #1: Don’t strive to accommodate your client’s availability!

Tip #2: Use a block scheduling model.

Tip #3: Create small teams to work with each client.

Tip #4: For clinic-based providers: always have a “floater” on the schedule.

Tip #5: Enroll in our FREE video course on ABA Staff Scheduling Strategies.

Top 9 Tips for Hiring High Quality Behavior Therapists (and 1 Bonus Tip for Recruiting BCBAs)

See my list of tips that we have used over the last decade to improve the quality of our staff hires.

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#9: Competitive pay

#8: Colleges

#7: Open house/ In-person hiring event

#6: Strengthen your interview skills.

#5: Discuss your “WHY”!

#4: Identify what motivates your staff.

#3: Recruit specifically for “Direct support” and “LNA/CNAs”

#2: Employee referrals

#1: Offer Full-time and benefits!

BONUS TIP for Hiring BCBAs:

6 Factors to Consider When Selecting a Practice Management System

#1: The system must NEVER go down!

#2: “All in one” is not always better.

#3: Pricing models

#4: Be cautious of features like “labels”, which are prone to human error.

#5: Read the ENTIRE contract.

#6: Contracts are ALWAYS negotiable.

Negotiating ABA Insurance Contracts: Keep These 2 Factors in Mind!

Factor #1: Minimum Acceptable Rates

Calculate Your Costs

Add Your Profit Margin!

Factor #2: Adequate Provider Network

Conclusion

Learn more from our 2-CEU Course!