Why Your Therapy Practice Billing Is Probably Broken (And How to Fix It)

Look, I've been in this business for fifteen years now, and I can tell you that most therapy practices handle billing like they're still living in 1995. They wait for problems to happen, then scramble to fix them. It's exhausting, expensive, and completely unnecessary.

Here's what I see all the time: brilliant therapists who can work miracles with kids, but can't figure out why their cash flow looks like a roller coaster. The answer usually isn't complicated - it's their billing approach.

The Real Problem Nobody Talks About

Most practices treat billing like an afterthought. Session happens Tuesday, claim gets filed Friday (maybe), payment arrives... whenever. Meanwhile, rent is due, staff needs paychecks, and everyone's stressed about money.

I was talking to a colleague last month who runs an ABA practice. Great clinician, terrible at business. She told me, "I spend more time on the phone with insurance companies than I do with my actual patients." That's backwards.

The practices that really succeed? They flip this whole thing around. Instead of reacting to billing disasters, they prevent them. Sounds simple, but most people get this completely wrong.

Start Before You Start

This is going to sound obvious, but you'd be shocked how many practices skip this: actually verify insurance before the first session. Not just "do they have coverage" - really dig into the details. What's their deductible? How many sessions are covered? Do they need prior auth? Is there a copay or coinsurance? For ABA specifically, are there session limits per year?

I know practices that use ABA billing services just for this step because it's so time-consuming. But here's the thing - spending two hours upfront saves you twenty hours of headaches later. Every single time.

My friend Kivi learned this the hard way. She started treating a kid with autism, family seemed fine with everything. Three months in, insurance says they don't cover ABA for that specific diagnosis code. Guess who ate those session costs?

The 48-Hour Rule That Actually Works

Here's something concrete: get your claims filed within 48 hours. Not "when you get around to it" or "at the end of the week." Forty-eight hours, maximum. Why? Because details matter, and details fade fast.

Was that session 45 minutes or 60? Did you do any family training? Were there behavior modifications? Day three, you remember everything. Week three? Good luck.

The ABA billing companies that know what they're doing have this automated. Session ends, notes get documented, claim goes out. No human delay, no "I'll do it tomorrow" excuses.

Plus - and this is key - claims filed faster get processed faster. Insurance companies aren't doing you any favors, but they do process recent claims more efficiently than old ones. It's just how their systems work.

When Things Go Wrong (And They Will)

Even perfect billing gets denied sometimes. Insurance companies deny claims for sport, I swear. The difference between a good practice and a struggling one is how fast they handle these denials.

Bad approach: Let denials pile up, deal with them monthly, maybe quarterly. By then, half the information is gone and you're fighting uphill battles.

Smart approach: Check denials daily. Figure out why they happened. Fix the problem and resubmit immediately. Look for patterns - is one insurance company being difficult? Is there a coding issue? Address it before it becomes a bigger mess.

Professional ABA billing services do this systematically. They track everything, spot trends, and fix problems before they multiply. Worth every penny if you ask me.

Numbers Don't Lie (But Most People Ignore Them)

Your billing system generates tons of useful data that most practices completely ignore. Average payment time, denial rates by insurance companies, which CPT codes get challenged most often. This stuff matters.

I know a practice owner who discovered that one insurance company was taking 90+ days to pay while others averaged 30 days. Guess which company she stopped accepting new patients from?

Another friend realized that 60% of her denials came from incomplete documentation on one specific service code. Fixed the documentation template, denials dropped to almost zero for that code.

You can't improve what you don't measure. But you also can't spend all day measuring things. Get reports that actually help you make decisions, not just pretty charts that make you feel busy.

Your Clients Care More Than You Think

Here's something that surprised me: billing problems affect therapy outcomes. Seriously.

When families are stressed about unexpected bills or insurance hassles, it affects their engagement in treatment. When sessions get cancelled because of authorization problems, kids lose momentum. When payment confusion creates tension, therapeutic relationships suffer.

I've seen families drop out of great programs because the billing was a nightmare. Not because therapy wasn't working - because the administrative side was too stressful.

Clean billing means families know what to expect. They trust the process. They focus on their kid's progress instead of fighting with paperwork. That's worth something, even if it's hard to quantify.

Stop Burning Out Your Good People

The fastest way to lose a good therapist is to make them handle billing. They didn't go to graduate school to argue with insurance companies or chase down missing authorizations.

I see this constantly: talented clinicians spending hours on administrative tasks they hate and aren't good at. Then they burn out, quit, and you're back to square one.

Let therapists do therapy. Let billing experts handle billing. Seems obvious, but most small practices try to do everything in-house because they think it saves money. Usually costs more in the long run through inefficiency and turnover.

Good ABA billing services pay for themselves through better collections, fewer errors, and happier staff. Plus, your therapists can actually focus on what they're supposed to be doing.

Growing Without Going Crazy

Here's what nobody tells you about scaling a therapy practice: your systems need to.