If you are reading this post, it’s likely you are acquainted with the difficulties of starting a new ABA business. Even if you are a seasoned provider, adding business ownership to your roles and responsibilities is a game-changer – and, without support, can range from overwhelming to impossible.
Enter: our 10-step roadmap to starting an ABA practice. It’s based on industry best practices, insights from ABA thought leaders, and tried-and-true workflows, processes, and methodologies.
How best to use our roadmap.
Print it out! Or, paste it into a document and type your answers. Since each ABA practice is unique – from the clients served to the techniques employed during therapy – you need more than a cookie-cutter manual to truly start your business on a solid foundation that aligns with your vision. It includes the important action items you’ll need to complete as part of the startup process along with strategic questions for you to answer in order to define your business, its mission, how you will be perceived by potential clients, and more. Ready to get started?
1. Think about what sets you apart.
Before you start taking the steps involved in starting your own ABA business, ask yourself the following questions. Writing down decisive answers will form the foundation for your practice.
✎ Self reflection.
- Why are you starting your practice?
- What is your vision, mission, and ultimate goal?
- What do you strive to make your practice unique for?
- What are your cash reserves? Do you have the money for staff? Can you cover overhead costs while building up a client base?
2. Choose a service model.
As a BCBA, it’s important to determine which service model fits you best. Honestly assess your skill sets, background, and interests. Think about where you’re most interested in making a difference. Then, write (or type out) your answers. Some different service models are listed below.
- Center-based services
- Home-based services
- Community-based services
- School-based consultation
- Early Intervention
3. Meet federal, state, and local requirements.
Once you’ve determined your vision, goals, and service model, it’s time to think about one of the most critical items: compliance. This section will detail the steps required in preparing you to contract with funding sources and payors prior to going live. The list below details what you need to set yourself up for a complaint, audit-ready practice – and one that is set up correctly and in accordance with ABA guidelines and business standards from day one.
- Establish a TIN (tax identification number). This can be done online – click here for an IRS resource that will walk you through the process.
- NPI - National Provider Identifier. Individual providers have a Type 1 NPI, and organizations have a Type 2. This CMS resource explains more about NPI numbers.
- Look into what must be completed for Liability and Workers' Compensation Insurance. Research your state and federal requirements to learn what must be followed and tracked. From there, take the appropriate action.
- Business formation requirements. Select a business formation type such as LLC (Limited Liability Corporation); DBA (Doing Business As); and INC (Corporation - C or S). Consider tapping into a trusted advisor that can help you understand what your options are, walk you through the steps of each, and understand the impact of each formation.
- Don’t be afraid to ask for help. SCORE mentoring, linked here, is a resource partner of the US Small Business Administration (SBA). They offer free(!) business mentoring, workshops, and education to business owners.
4. Get credentialed and contracted with payors.
So: you have a TIN, an NPI, all your required insurances, and everything else you prepared in anticipation of contracting and credentialing. Now it’s time to get credentialed and contracted with payors.
- Contracting refers to entering into a contract as an organization or as an individual with that funding source.
- The process differs from payor to payor -- so carefully consider which funding sources to pursue, and take your time in completing the payor applications.
- It’s important to understand the different setup steps for credentialing and contracting with different payor types (e.g., private insurance companies vs. federally-funded or state-funded programs like Medicaid; private pay vs. school contracting).
- For this component, you must complete the information on CAQH, a credentialing database for clinicians, to kickstart the contracting process with funding sources.
- Be sure to add the designated CAQH email address to your contacts list, because you will have to re-testify every few months.
5. Tap into cash reserves.
For many new business owners, cash reserves flow from numerous sources in order to get their company off the ground. Take an inventory of where you could access capital to support your practice during the often capital-heavy timeframe. Some ideas:
- A second form of employment
- Take some time to make a list of cash reserve options available to you.
6. Self-assess, delegate, and enlist help.
As we mentioned earlier, an honest self-assessment will enable you to determine which aspects of the business you’ll take full ownership of, what you’ll delegate (if you so choose), and areas you might consider outsourcing. To start, honestly answer the following questions.
- What are your strengths and preferences?
- What are your weaknesses, or where could you benefit from some training or learning opportunities?
- What are some business areas that you don’t feel particularly skillful, comfortable, or happy about performing? For example, some prefer a helping hand with billing and claims.
- Do you possess a weakness that you’d love to turn into an opportunity?
From here, you may want to think about areas you’ll consider delegating. It’s a great option to take this route if you are uncomfortable or don’t feel confident managing certain business areas. Remember, if you try to wear too many hats, it will ultimately take time away from clients – and lead to lost revenue.
- Think about your shortcomings (we all have them!). It’s impossible to excel in all areas of life. Can you think of any business areas that elicit a feeling of fear or dread?
- A common one among BCBAs is billing.
- Make a list – and refer to it later on. Are there responsibilities associated with business ownership that you – to put it simply – don’t have the expertise or experience to execute? Or perhaps anticipate struggling with? Take note of them. Later on, you can refer back to the list and consider delegating to an employee or third-party resource.
- An important reminder. Remember: struggling to complete tasks you aren’t confident performing not only puts you at risk of making mistakes, but eats up time – and nonbillable hours – that could be spent with clients, growing your business, or taking a much-needed break for some self-care.
7. Establish your clinical niche.
It’s important to attract and serve clients that are right for your clinical model and area of expertise. Determining your market and deciding which factors should dictate who you take on as a client versus who you refer out is incredibly important for both you and those you serve.
A few quick reasons to establish a clinical niche.
- It helps you stand out among other practices
- Clients and families will have clearer expectations
- Establishing accurate pricing becomes easier
8. Get compliance-ready.
This is critical - get out your highlighter. Before you start services, be sure to meet all applicable compliance regulations pertaining to your business in your locality, state, and country. These include HIPAA compliance, payor protocols, PCI regulations, and anything pertaining to staffing or any office/center you may have.
9. Ready, set… start services!
Starting services with a new client is exciting – and it likely is for the client and their family, as well. Make sure to complete these key due diligence items prior to the start of services to ensure your relationship is one that starts off on the right foot and services are kicked off without a hitch.
- Review your client’s assessment. Take the time to understand your client’s most important needs, what is most socially significant for him or her, and what is most important to the family.
- Take the time to listen and understand client and family needs. When putting together a client’s programming, ensure that you are driving the success of what the family needs -- not what you think the child needs. Remember to stay true to what is most important to them. After all, parents and caregivers know their children far better than anyone else.
- Advocate for your clients. Make sure you can clearly demonstrate this pathway to the client’s payor to substantiate why the services are important, why service hours shouldn't be cut, why you need weekend hours, community hours, and so forth.
10. Value yourself and your mission.
While the beginning of business ownership is a whirlwind, remember: it’s important to periodically step back and return to your story. You can even pull out the answers you wrote down to the questions in this guide. Regularly reflect on your mission, check in with yourself (and your staff!), and ask yourself questions to ensure you are running your business in alignment with its mission.
- Are you properly serving your clients?
- Are you serving families of clients, too?
- Have you noticed whether they seem satisfied with the care they are receiving?
- Are you offering the level of communication they desire?
- What about your staff, the community, and your funding sources?
We also want to drive home the importance of checking in with a very critical person… yourself! Treat yourself as you would your staff. Take the time to participate in professional development activities – not only to expand your knowledge but to grant you a step back from the day-to-day hustle and provide you with a clearer, “big picture” view of where your business stands. From there, you can work on what to tweak, change, do more of, and do less of.