Speech & ABA Therapy Practices
Authorization-driven insurance revenue, hourly RBT payroll, and school district contracts create real financial complexity behind the sessions. Hunter Green CPA keeps it organized and current.
Services Today, Payment Later
Speech therapy and ABA practices share a difficult financial reality. Your clinicians and behavior technicians provide hours of services each week, but the revenue from those sessions takes weeks or months to arrive. Insurance authorizations gate everything. You cannot bill until services are approved, and once you bill, you wait. Meanwhile, payroll runs every two weeks without fail.
ABA practices face an even more pronounced version of this. The field is one of the fastest-growing clinician-owned business categories in healthcare, and for good reason. But rapid growth paired with significant reimbursement lag creates real cash flow pressure. You might have a full caseload and a growing team, yet still feel uncertain about whether the money will be there when you need it.
Payroll as the Dominant Cost
Payroll as the Dominant Cost
In an ABA practice, Registered Behavior Technicians and behavior technicians make up the majority of your workforce. They are hourly employees, and their wages do not wait for insurance to pay. The gap between when you pay your team and when you collect for their work is the central tension in managing an ABA business.
Multiple Payers and Contract Types
Multiple Payers and Contract Types
Revenue comes from private insurance, Medicaid waivers, school districts, and sometimes direct contracts with programs or facilities. Each payer has its own authorization requirements, billing timelines, and payment schedules. The books need to account for all of it without losing track of what is actually getting collected.
Tracking What Actually Gets Collected
The number on your billing report is not the same as the number in your bank account. Claims get denied, adjusted, or paid at a lower rate than expected. Authorizations expire mid-treatment. A practice can look busy and still struggle financially if nobody is watching what is actually coming in versus what was billed out. This is the core problem we solve with clean, current books.
We track collected revenue against billed revenue so you can see the difference clearly. You will know which payers are paying as expected and which ones are creating problems. We also track your labor costs at the level where they matter, so you can understand what each hour of service actually costs to deliver.
Revenue by Payer and Contract
Revenue by Payer and Contract
Your books should show you where your money actually comes from. We track revenue by payer source, whether that is a commercial insurance carrier, a Medicaid program, or a school district contract. This helps you see which payers are reliable and which ones create collection headaches.
Labor Cost Visibility
Labor Cost Visibility
With payroll as your largest expense, you need to see what it costs to deliver an hour of service. We organize your books so labor costs are visible and trackable against revenue. This is how you understand your real margins, not just your top-line billing numbers.
What Gets Complicated
The timing mismatch between payroll and collections is where most ABA and speech therapy practices run into trouble. You pay your RBTs and clinicians on a regular schedule, but insurance reimbursements do not follow the same calendar. If your books do not give you clear visibility into receivables and cash flow, you can end up short on a payroll week even when the practice is growing.
School district contracts and program work add another layer. These contracts often pay on their own schedules, sometimes quarterly or after the school year ends. The revenue is real, but it does not arrive when you expect if you are used to billing insurance. Keeping track of what is owed and when it should arrive is part of running the practice responsibly.
Receivables That Lag for Months
Receivables That Lag for Months
It is common for ABA practices to have significant accounts receivable that represent work performed weeks or months ago. If you are not tracking this carefully, you cannot project cash flow accurately. You need books that show you what is outstanding, how long it has been outstanding, and whether collection is on track.
Contractor Classification
Contractor Classification
Some practices work with independent speech-language pathologists or BCBAs on a contract basis. If you pay contractors more than $600 in a year, you need to issue 1099 forms. Getting the classification right and keeping clean records matters for tax filing and for avoiding problems with the IRS.
Building a Practice That Can Grow
With clean books, you stop guessing about whether you can afford to hire another RBT or open a second location. You can see your cash position clearly, project when receivables will convert to cash, and understand your real margins by payer and by service type. Growth decisions become grounded in actual numbers rather than optimism.
Hunter Green CPA works with speech therapy and ABA practice owners to keep the financial side organized and current. We handle the monthly bookkeeping, prepare your books for tax time, and help with tax planning that fits a growing practice. Our Bookkeeping and Tax Package bundles the books and tax returns into one monthly price, and we handle 1099 preparation for any contractors you work with. If you are ready to get the financial side of your practice under control, reach out for a consultation.
Payer and Service Profitability
Payer and Service Profitability
When your books track revenue and costs at the right level, you can see which payers and which services actually make money. This helps you make informed decisions about which contracts to pursue, which payers to push harder on collections, and where to focus your clinical capacity.
Tax Planning for Growth
Tax Planning for Growth
A growing ABA or speech therapy practice often means a growing tax bill. With proactive planning, you can structure your entity, time your expenses, and set up retirement contributions in ways that reduce what you owe. We help practice owners think ahead rather than just reacting at tax time.
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