ABA Practice Startup Kit

In 2016, the CDC estimated that 1 in 54 children has been diagnosed with ASD in the US. This is a 10% increase from 2014. With only an estimated 30,000 Board Certified Behavior Analysts (BCBAs) in the entire country, there is always a need for more providers that specialize in this type of therapy to open their own practices.

For BCBAs that are interested in starting their own practice, there is the possibility of great success on the horizon. The field is desperate for more qualified professionals and certain parts of the country are lacking greatly in their ABA resources. Starting your own ABA practice could really make a difference in the community in which you reside.

Starting your own practice comes with other perks like the freedom to run things the way you want to, flexible hours, and the ability to work autonomously. There are hundreds of reasons why you might be considering it. But there are a million other things to consider and prepare for before you jump right in.

Running an ABA therapy practice comes with a heavy workload, responsibilities, time-investments, and decisions that must be managed carefully. Do not be discouraged, though. Creating your own practice could easily be one of the most exciting and rewarding experiences of your life, you just need to take the time to prepare.

The better equipped you are for what goes into this journey, the more success you are likely to achieve once you start. If you are an ABA provider that is thinking about taking the next step toward opening your own therapy practice, follow this ABA practice startup kit.

The Size of Your Practice

One of the first things you need to consider when taking the leap is how big you want your practice to be. Is it going to be a one-man operation? Are you going to hire staff? Do you plan on working with Registered Behavior Technicians (RBTs)? Where are you going to offer your services? How much is this all going to cost?

Getting a good grip on the vision you have or your ABA practice is the best place to start. This will lay the foundation for the rest of your decisions down the line. Here are some ideas of what you could do:

Determine the Size:

Do you dream of your practice being a large organization with many moving parts or do you envision yourself working one on one with your clients? There are levels that exist in between these two options like running a small practice with only a handful of staff or maybe just working with a partner.

Regardless, determining, right away, what you want for yourself will help you make the next number of decisions.

What Kind of Staff are You Thinking of Including?

For some professionals, the word “staff” can mean a few different things. For someone wishing to run a small practice, it might just mean someone to help with scheduling, billing, and other administrative duties. For other providers, it might mean hiring other therapists to expand their client base and the revenue of your organization. What kind of staff do you see yourself having? There are other things to consider depending on your answer like credentials, hiring processes, code of conduct, supervision time, and more.

Where Will Your Practice Run?

There are many different spaces in which ABA therapy can be offered. For some, it is offered in the home of the client and for others, the client comes to the office. Regardless, you need to determine what physical space you plan to either rent or buy to support the size and function of your ABA practice. If you plan on having a wide range of clients coming in and out of your office, then you will need a big enough space to handle this. If you are offering in-home therapy, you might only need a small office.

Overhead:

Speaking of renting spaces and hiring staff, providers need to determine what kind of overhead they are going to run into when they start their practice. Are you going to seek funding for these upfront costs? How are you funding the start of your business? Some of the most common overhead costs associated with starting an ABA practice include:

• Website Costs
• Facility Costs
• Staffing costs
• Insurance
• Taxes
• Business Licenses
• Joining Insurance Panels
• Software (Scheduling, Documentation, Billing)
• Recurring Costs/ Memberships (Directories, Phone Services, Internet, etc.)
• Marketing

Do You Need Practice Management Software?

One of the most important costs and implementations to consider is whether or not you wish to use a Practice Management System (PMS). Practice management software is a tool that many providers use to increase efficiency, enhance accuracy, and improve processes within their workflow. “Practice Management” is the process of running things like scheduling, registration, patient tracking, reporting, and monitoring of productivity across an organization.

No matter the size of your ABA practice, PM software is specifically designed to help providers run more effectively. They improve the flow of daily operations and administrative functions and enable your team to accomplish more in their day while helping you stay organized across every process.

Features of a Quality PM Software:

With so many PM Solutions on the market, it is important to know what features are necessary. Some software partners might make claims for how they can help your ABA practice run smoother, but the actual software capabilities are what really matters. Any provider looking to start their own practice should look for the following features in a PM solution:

Scheduling:

Scheduling is one of the most important components of any PM solution. The right scheduling tool will enable your practice to avoid mistakes, input client non-availability (vacations, school, etc.), send appointment reminders, and create recurring appointments for clients. Scheduling tools should also include the ability to create and organize care teams, receive notices for scheduling conflicts, create custom schedules for different providers, and full patient portal integrations.

Billing:

Integrated billing enables providers the opportunity to easily collect payments and track payment status, work with multiple payers, avoid billing mistakes, and stay on top of invoicing. Integrated billing is vital to perfecting your payment processes and growing your revenue.

Payroll and HR

Administrative responsibilities are essential for success, but can easily become burdensome without the right tool. Your PM system should be equipped with HR and payroll features to help your practice win. This feature will help providers track vacation and time-off requests, see new requests, automate schedule updates, customize payroll reports, and access dashboard tools that keep you up to date with credentials and their expirations and the ability to generate custom reports to track activity.

Authorization Management:

With authorization management features, ABA providers can easily create authorizations for each client, assign treatment types and activities with their correct rates and codes, assign treatment models, and track and record allowed hours. This feature will also keep you on track for when client authorizations are about to expire.

Reporting:

Custom reporting tools should be available at each level of management. Providers should be able to analyze trends and data over time, which is so important to ABA therapy. Reporting features should allow users to easily review data related to clients, employees, payroll, billing as well as scheduling. This data can be used to better understand the inner workings of your practice and use it to improve the quality of care and scale your growth.

Mobile App

One feature that really makes one PM solution stand out against the next is whether or not it has a mobile app. Mobile apps are an amazing solution that allows providers to work from wherever they need to. Since it is a web-based system, data is automatically able to generate on a mobile interface. It can allow you to easily render sessions on the go and even obtain parent signatures without having to carry a laptop. You do not even need an internet connection.

Provider Portal:

Your PM system should help you stay organized and an important part of doing that is a provider portal. This tool ensures that you and other providers on your team are matched properly with clients, excluding payors, activities, and credentials when applicable. Providers can securely access this portal to view schedules on any computer, tablet, or mobile device. The provider portal should also be equipped with HIPAA compliant communication tools that allow you to securely message clients/caregivers. This tool also can allow every member of your team to quickly review, edit, add or delete payroll items, submit vacation and sick leave, and submit their timesheets.

Document Management:

Documentation is an essential component of ABA therapy. This partnered with reporting is how providers track the progress of their clients. Your PM solution should be equipped with HIPAA compliant documentation that allows you to:

• Upload complete client intake forms into the system
• Upload unlimited documents per each client
• Easily organize all files
• And integrate a data collection tool so that all SOAP notes are connected with rendered sessions within your PM solution.

As long as you find a Practice Management System that encompasses each of these features, you will be able to achieve optimal efficiency in every process, stay organized through each effort, and build your way to success as a new practice.

How Will You Handle Billing?

The next item on the list of things to consider when starting an ABA practice is billing. There are a million questions and factors to consider when determining how you want to manage your billing.

Insurance?

One of the first you should ask is whether or not you will accept insurance.

Some providers decide not to accept insurance because they do not want to spend time joining provide panels and staying on top of that relationship. The issue with this is that many clients and their caregivers are looking for an ABA provider that takes their insurance.

Other providers choose to join as many panels as possible to try and cover all of their bases, but this is hardly necessary. Usually, there are a few big-name insurance providers in the area that you are planning to practice in. Providers should do their research to find out which payers are popularly used in their region and work on joining those panels if they want to accept insurance. This limits the number of relationships, payer requirements, and other details that you have to keep track of while optimizing coverage for clients in your area.

Revenue Cycle Management Services?

Revenue Cycle Management (RCM) services, also known as managed billing services, can be an incredible resource if you are not an expert on insurance billing and out-of-network billing. Hiring an RCM partner can be the thing that sets your ABA practice up for financial success. The right partner will offer services and tools like:

• A Team of Trusted Billers:
  • Where you have access to world-class billing team members that can answer payment questions that might come up
• Streamlined Claims Submission:
  • Where they handle both electronic and paper claim submissions depending on your funding source
• Hassle-Free Follow Up:
  • Where the RCM team follows up on claims so you do not have to. They will work with insurance companies and funding sources on all unpaid and denied claims to ensure you receive proper payment for your services.
• Comprehensive Reporting:
  • Where you receive account ledgers and claims denial reports that create an action trail, documenting all follow-up correspondence with insurance companies and funding sources.
• Client Benefit Verification:
  • Verify your client’s coverage before a single service is rendered so everyone is aware of their billing responsibilities upfront.
• Insurance Authorizations:
  • Where their team ensures you get paid on time by completing the appropriate criteria sheets and authorization forms. They will also contact insurance companies on your behalf to obtain approval for authorization requests.

Billing Software?

Will your organization implement any sort of billing software? ABA billing software can be useful for creating claims, documenting, creating invoices, processing payments, and more. The best solution for ABA providers looking to stay on top of their billing is to find a PM software solution that offers integrated billing components. This way, you are only implementing one software solution rather than multiple.

The right combination of software and services can help your organization easily stay on top of your revenue cycle. From the time a client sets an appointment to the time their bill is paid in full, you will be covered.

Who Will Your Staff Include?

As mentioned earlier, one of the early decisions you make when you decide to start your ABA practice is whether or not you plan to have staff. Staff members can be composed of all different types of roles. What roles you want to include in your staff changes the process for monitoring and managing them.

Types of Staff Members Within an ABA Practice:

Administrative

Administrative staff might include your person in charge of answering the phone, scheduling client appointments, processing payments, monitoring compliance, and other administrative tasks. This role would not require much supervision but would require you to invest time in their training. While the ideal candidate would be versed in each of these processes, there is still training that needs to take place to help them learn your systems and the appropriate processes for each task.

BCBA

As a BCBA starting an ABA practice, you might be familiar with what is required of a BCBA staff member. If you are planning on having other BCBAs at your practice, there are a few things to consider. New practice owners should take note of the experience, training, specialization, and personalities of their BCBA staff. There should also be a consideration for whether or not you plan to allow RBT and BCaBA supervision to occur within your practice.

RBT

If you plan to allow supervisions to occur within your practice then you might be considering hiring some Registered Behavior Technicians (RBTs). In larger organizations, RBTs are generally the ones providing the services to clients while their BCBAs supervise them.

Regardless of who you plan to hire, you must adhere to the standards of the Behavior Analyst Certification Board (BCBA) Who has released regulatory requirements for ABA providers. Following these standards closely will ensure your practice avoids any issues with staffing in the future.

How Will You Handle Data Collection?

Data collection is a cornerstone of ABA therapy. In a type of treatment where results are determined entirely through the tracking, documenting, and reporting of progress and data, ABA providers need a quality data collection tool. In 2021, it is no longer acceptable to collect this valuable data by hand, you need a quality software solution.

Data Collection Software Should Include:

• Collect Skill Acquisition Data
  • DTT Targets
  • Organize Automated Sessions
  • Record Single, Distribute Trials
• Collect Behavior Reduction Data
  • Diagnostic Info
  • Topographical Behavior Data
  • Rate Recording
  • Momentary Time Sampling
  • Whole/Partial Interval Recording
• Automatic Mastery, Maintenance, and Baseline Criteria
  • Define Mastery Criteria
  • Automatically Determine Mastered Targets as Criteria are Achieved
  • Notifications for Targets Mastered
• Advanced ABA Graphing Engine
  • Custom Visuals
  • Instant Updates
  • Annotations
• Automatic Progress Reports
  • Customizable Reports
  • Insurance Reports
• Integrated into Your PM Solution
  • Sync Client/Employee Records
  • Minimize Duplicate Entries

Provider Credentialing:

Provider credentialing is the process in which a behavioral health insurance carrier assesses an ABA provider’s qualifications and competency. If approved through this process, a provider can bill to that specified payer. If you are planning to accept insurance at your new ABA practice, you will need to complete the credentialing process with each payer you wish to bill to. The process might be different for each payer and can take anywhere from 60-120 days, sometimes longer if there are issues along the way.

Challenges Associated with This Process:

It Takes Time:

This process can last months on end depending on how tedious each step is with the payer. From the time you start the process to when you are actually able to bill that payer for services provided to clients could be as long as 6 months. This is ok though. As a provider, you can still utilize superbills (forms that detail what you charged your client, the insurance codes, identification numbers, and dates so that the client can take it to their insurance) until you are approved.

Staying Organized:

This process can feel monotonous at times and so it is important that ABA providers stay organized throughout the journey. This means keeping folders, logs, and notes for where you are in the process with each payer and what you still need to complete on your end.

Payer Requirements:

Wouldn’t it be nice if you could just fill out one set of forms and send them out to each payer you are wanting to earn credentials for? Unfortunately, that is not how it works. Each payer has their own set of requirements that must be met in order to get approved.

Overhead:

This process takes time and it takes money. ABA providers starting their own practice need to consider what it is going to cost them out of pocket to join each different panel.

Benefits of Credentialing:

More Clients

If there is one thing that clients look for in a provider it is that they accept their insurance. By joining the most used provider panels in your area, you open up your pool of clients and are able to grow at a much faster rate.

Repeat Clients

Clients who see the cost of services after the first visit and feel that weight lifted off their shoulders when insurance has covered some or all of the cost is enough for them to schedule a repeat appointment. Accepting insurance is a great way to build patient loyalty.

Marketing Opportunity:

Sometimes clients/caregivers start their search by contacting their insurance to see who is in-network. Joining a provider panel is a great way to get your name out into the community and meet clients in their search for an ABA provider.

Marketing Your Practice:

Speaking of marketing opportunities, ABA providers that are hoping to open their own practice need to figure out how they are going to get their name out in other ways than just being on a provider panel. At first, your organization might not have a lot of money to spend on ornate advertisements like others might. That is ok though because there are plenty of affordable and effective methods for marketing your ABA practice.

Great Marketing Tools and Methods Include:

Blogs

Blogging is an incredible way to get your name out into the community, especially if you know the right way to do it. Taking the time to talk about industry topics, become a thought leader, and writing about subjects that matter can easily make you stand out as an expert in your field compared to others you might be competing against.

Community

Getting out into your community is another effective and affordable way to get noticed. Participating in community events, networking with other businesses, connecting with healthcare providers, and more are all effective ways to increase referrals and bookings.

Social Media

Social media is non-negotiable in 2021. Your organization has to be active on social media if it has any plans to grow. Clients will look you up on Facebook to see if you are posting, what you are posting, and how active you are online. This can make a huge difference in the way they perceive you depending on the kind of content you are putting out there.

Directories

Therapist directories are another great place to start when marketing your practice. Clients who start their search online might literally type “ABA therapist near me” and be taken to a directory site. These kinds of sites specialize in connecting individuals who need therapy to local providers. If you are not on these sights, patients might end up somewhere else.

SEO

SEO (Search Engine Optimization) is the process of utilizing keywords and phrases to show up more often online. Knowing how SEO works is one of the most affordable digital ways to market your ABA practice. It helps you show up organically (non-paid) on searches so that clients can find you more easily. SEO can be utilized on your website, in your blogs, and in other spaces to give you that extra boost online.

Starting an ABA practice could be one of the most exciting adventures of your life. Providers who might be considering making the move should not be discouraged by the number of things to contemplate as you start. The most important thing to take away from all of this is that with the right software, tools, staff, and attention, you could grow to become one of the best ABA providers in your area. If you are an ABA provider that is considering whether or not to start your own practice and you need to learn more about PM software, managed billing services, or data collection software, click here to schedule a demo.

Sources:

Behavior Analyst Certification Board. (2020, 03). BCBA/BCaBA Experience Standards. https://www.bacb.com/wp-conten... for Disease Control and Prevention. (2020, March 27). Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years -- Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2016. Morbidity and Mortality Weekly Report (MMWR). https://www.cdc.gov/mmwr/volumes/69/ss/ss6904a1.htm?s_cid=ss6904a1_w

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Applied Behavioral Analysis (ABA) is an exciting, challenging, and growing field in 2021. As the number one most accepted form of treatment for individuals that have been diagnosed with Autism Spectrum Disorder (ASD), this type of therapy focuses on the improvement and development of social, communicational, and behavioral skills through the use of positive reinforcement.