Missing Piece Blog

How Retention and Payroll Impact the Financial Health of Your ABA Practice

Running an ABA practice can be very difficult, with various challenges affecting different aspects of your business. In this blog, we take a deeper look at the different areas of ABA practices and some of the difficulties you may face and share potential solutions that can help you address them.

Client retention

Client retention by definition is your practice’s ability to retain clients and is one of the most important aspects of your business since you need clients in order to run your practice. Unfortunately, it is also one of the hardest to manage because there are many factors that are outside of your control that could lead to you losing a client. 

Here are some of the difficulties you may face with client retention.

Not knowing how to measure client retention

You probably never thought about having to measure client retention, and as a result, you don’t know how. Maybe you don’t fully understand the way it can affect your practice. 

In her article “How to measure client retention rates in private practice”, Danielle Kong, 

a private practice business coach, describes how client retention allows you to build trust with your clients, explains why it’s cheaper to retain clients than find new ones, how it lowers your marketing costs for client acquisition and retention, improves your potential revenue, and offers many other practice benefits. 

She uses the formula “the average difference between the number of sessions your clients attend and the number of sessions initially recommended by you” to calculate client retention.

Encouraging client loyalty

Client loyalty has numerous benefits for an ABA practitioner. One of the main advantages is that it allows you to better judge your expenses and income in the medium- to long-term, allowing you to manage your practice better since they are unlikely to drop you at a moment’s notice. A loyal customer can also act as a “brand ambassador”, encouraging others who might need an ABA practitioner to try out your services and help your business grow. Finally, retaining clients also means you don’t have to spend money trying to find new ones; it helps keep your marketing costs low and allows you to prioritize other areas of your business regarding spending.

There are multiple ways to encourage client loyalty, the most important of which is offering a good service. This doesn’t just apply to treatment but also to other aspects of your business. For example, do you communicate regularly with your clients and keep them up to date on the progress of the person you are working with? Are you reliable in regards to sticking to your appointment schedule? Do you make sure they understand how billing works? Communicating about these and other aspects of your service and making sure they know everything they need to know is key to developing client loyalty.

Employee retention

Another issue affecting many ABA practices is employee retention. In her Forbes article “Improving Retention in ABA Services”, Ronit Molko, the author of “Autism Matters”, shares how the low-end turnover estimate could be 30%, with the upper-end being as high as 75%. This is problematic for any ABA practitioner not just because of the disruptions it causes in their practice but also because of the high costs of retraining individuals. 

Here are four of the most important challenges identified in Molko’s article that could lead to poor employee retention.

1. Unrealistic job expectations

When someone first starts working in an ABA therapy practice, they may not have the right idea of what they should expect from the job. This may be due to being “oversold” on the position. Additionally, an employer may hire an individual who doesn’t have the right personality for the work, leading to issues that eventually end with their resignation. Finally, unrealistic job expectations can go as far as not being in line with the business’s goals, again leading to a lack of job satisfaction and an employee’s eventual resignation.

An employer must ensure they give an honest description of what the position entails, even if it might make it harder to find a candidate to fill the role.

2. Lack of training

Working at an ABA practice is not an easy job, and it’s up to the practice owner to ensure that employees are properly trained to handle all the challenges that arise, as well as being prepared to offer them skills they can use throughout their careers. No matter the reason, a failure to properly equip your employees will likely lead to frustration and an employee quitting.

It’s important that employees be given more than just adequate training. Employers must invest in an employee’s future career as well, regardless of whether or not they might remain at a specific practice.

3. Lack of leadership

Molko identifies that sometimes employees may feel a lack of support, not because they lack training, but because they lack the guidance and leadership that an employer could provide. For example, an employee at an ABA practice may be required to attend to work offsite and then feel isolated while attending to the client. Leadership must be able to offer support to staff while they are working in the field as a standard part of ABA therapy practice management.

Leaders must also ensure that staff expectations are clear, as well as dealing with other difficulties that employees may face, such as employee engagement, and then provide the feedback and support that an employee needs in order to deal with the issue.

4. Inconsistent pay

The issue that Molko identifies in regard to employee retention is inconsistent pay, but this isn’t due to ABA practice management software payroll issues. She discusses how situations may arise where clients need to cancel a session or schedule it for a future date due to their own scheduling difficulties. This means that, if this cancellation occurs ahead of time, the ABA practitioner will not receive payment. This lack of payment will, in turn, affect employees’ salaries on a week-by-week basis, creating dissatisfaction with the role. 

She suggests some options to help mitigate the uncertainty of pay, including employee stock or options, 401(k) programs, and cash bonuses for high performers to help address the unhappiness an employee may feel when their regular paycheck isn’t consistent.


Billing is a very complex process in ABA therapy, with multiple issues that could affect the overall financial health of your ABA practice.

Incorrect data capture and data entry

Unfortunately, it’s relatively easy to make mistakes in data capture and data entry. For example, a client may have hard-to-read handwriting that results in an employee capturing the wrong information on your systems, leading to a denial further down the line. Additional time must then be spent correcting this mistake before submitting the claim again.

You must capture the correct client information to avoid issues like this, either by doing due diligence and following up on any information that you or an employee may not be sure of, or by ensuring no mistakes creep in when capturing information provided correctly.

Using the wrong ABA billing codes

ABA billing used to be far more complex before 2019 because generic codes were used for ABA therapy processing. This often led to ABA billing errors. Today ABA practitioners rely on a variety of CPT codes to ensure ABA practitioners make the correct claims from insurers. However, despite this move towards a more understandable billing system, errors can still creep in when ABA practitioners send claims through. With new CPT codes expected in the future, this problem is likely to exist for some time.

Whether you are handling ABA claims yourself or have an employee handling them for you, it’s essential that you make use of the right codes to avoid complications and denials from an insurer. You can help minimize the incorrect use of codes by reaching out to an insurer before you make a submission to make sure you are using the correct CPT codes.

Missing claims and appeal deadlines

Another problem that many ABA practitioners have to deal with is possibly missing claims and appeal deadlines for denied claims. Failure to meet these deadlines may result in an ABA practitioner losing out on revenue. 

This is why it’s so important to process your claims and appeals as quickly and as accurately as possible, as this will help avoid any delays that could lead to a potential loss of income.

Making claims an insurer doesn’t cover

It’s important to know exactly what an insurer does and doesn’t cover before you provide services to a client. This can avoid potential complications, such as an insurer not covering a service you have provided to a client or you then having to seek the client out to get them to cover the cost of the service personally. 

Call up an insurer before you provide a service to ensure they will cover the services you will be providing. If they don’t, contact the client to make sure they will be able to pay the costs for your services directly.

Get help with ABA billing from Missing Piece

Your ABA practice will face many challenges as it grows, but ABA billing shouldn’t be one of them. When you partner with Missing Piece, you’ll gain access to over 10 years of expertise from an experienced ABA billing services provider that has assisted practices across the United States, ensuring you can focus your time and energy on dealing with other parts of your practice, such as offering your clients the best treatment possible. 

Contact us to find out more about how Missing Piece can make it easier to run your practice.