1 - Let's Start a New ABA Business

Updated: Nov 10, 2022

Got the Itch?

You found this blog - probably by searching something like, "how to start an ABA business," or something like that. I searched the same thing several years ago. I had the itch. Looks like you do too.

You've probably worked with a company for some time, a few years. You're good at your job - your technicians respect you, your families depend on you, and your clients are excelling because of you. The only problem is, this center, this organization - it's not run how you might run it. Maybe they insist on ridiculous caseloads for the BCBAs. Maybe they don't value their technicians, and turnover rate is high. Perhaps scheduling is wonky, and you're working stupid hours. Or maybe, you're just ready for a change. Whatever it is, it looks like you've got the itch.

You already can't stop thinking about it, the idea of having something entirely your own. The risk is intoxicating. Sure, there's an opportunity to make more money too, that thought has crossed your mind, watching your current employer drive away in her Mercedes to her penthouse condo in the city. But its more than that. You've dreamed of this, dreamed of creating something from nothing, making a difference , leaving your mark. But what's next? The hard part comes next.

Save, Plan, Prepare

You've made the decision to do the damn thing. Now it's time to start planning. I made the decision 8 months before leaving my previous job. I needed time to save, plan, and prepare.

Save: Previously, most of the money I was saving was being allocated to a 401k or an IRA. I stopped pushing money into those funds and began to save. You'll need to look at your budget to determine how much your capable of saving, but I recommend pushing the boundaries on what you can do without. The hardest part of this dream is the part when you aren't making money, and it's coming soon.

Plan: Begin planning your exit, the next 3 months, and the next year. These are general plans. When do you want to quit by? How much money do you want to have saved? How many weeks notice do you want to give your employer? Do you have transitions plans in place for your clients? If you leave, are you doing it ethically? For the next 3 months following your departure, you're not going to make any money (unless you find a private pay client). It's going to be tough. What can you do during this period to stay afloat, to stay productive? I offered part time services as a contractor to my previous employer, and I ubered at night. You'll have to plan accordingly. Plan the next year. Where do you want to be? How many clients do you want to have?

Prepare: Start preparing for life after your employer. Besides saving, I looked into business loans, started scoping out properties for lease, researched prominent insurance companies in my area, became familiar with medicaid and their ABA laws. There is much to do during this time. It depends on how much planning you've accomplished, but if you've decided on a business type (sole proprietor, LLC, corporation), then you can decide upon whether or not you want to bill as a group or as an individual. Chances are you have an individual NPI number already. These are things you can start preparing before you leave.

I hope you didn't quit your job yet. You need to save more money, trust me. More time, too. Time and money will become your enemies early on. Here are some things you can do before you leave your employer:

13 Steps to Getting Started

Come up with a name for your company (make sure it's available as a business and that there is domain availability
Register your business (whether it's an LLC, SCORP, CCORP - that's up to you and your CPA). I registered as a single member LLC, but my CPA later advised me to file as an SCORP.
Get a tax ID number (EIN) - You will need this for a lot of stuff later.
Get an NPI number - (if you're already a BCBA, you should have an individual NPI number already. If you intend on eventually having multiple providers at your center, you'll want to get a group NPI as well.
Create a CAQH profile - again, you should have already had one of these created if you're a BCBA or QHP. You'll want to make sure all of your documents are in here and updated.
Get individual liability insurance - this is something that i hope you already had, but it's important to get this for yourself, especially if you intend on practicing alone.
If your business is registered with the state, you've got an EIN and your NPI numbers handy, you're ready to open a business account.
Begin looking for and pricing office space - you'll need this information to create a business plan later. It also helps to get a jump on possible locations that are available. If you're working in home, great! That'll save you some money and headaches.
Get a logo. (I used the Fiverr app, and my services cost approximately $120. I received a quality logo, favicon, cover photo, business card template, etc.
Make a website. (I used Wix. It's very easy to use, and they even have a setting called ADI, where the website will literally build itself based on the information you give it.)
Purchase a domain name. (I used Namecheap, but there are hundreds of choices. You'll want to choose a company that works well with your website builder.)
Get business cards. (I used vista print. Using the business card design from Fiverr, I literally checked off a few buttons and ordered the cards.)
Unlucky number 13.

Insurance Credentialing. This is the part that no one tells you about. This is the shit that will keep you up at night for months and years to come. Credentialing.

Here's the thing, you're probably already credentialed with some major players in your area - if your current employer is billing for your services. I thought that would help out, make the process quicker. No, not really. Credentialing takes 60-120 days, and that's if you don't make any mistakes or if the insurance company doesn't "lose" your application. And yes, they will "lose" your applications and you will make mistakes. I cannot give too much advice on this topic. I will say, if you are able to afford outsourcing this work, then do it. It will save some of the headache, and the company handling it is better equipped than you are. I went with an online company that I found through google searches, who were vetted through some facebook groups that I joined. It's not cheap. You're going to be looking at at least $400-600 per company that you credential with. I did 7 companies. But here's the mistake that I made - I didn't start credentialing until my last day as an employee. You can start this now! And you can do it quietly without getting into trouble with your employer. Do it, time and money are your enemies. Some quick bits about my experience:

80 days was the fasted amount of time that I waited
100 days was the average amount of time it took to become credentialed
140 days was the longest amount of time that I waited
No one answers the phone
You need a fax machine - they are in the stone age
You need a good scanner - so you can fax stuff
Some big companies will audit you. This tool kit should prepare you for that. If you fail an audit, it will put you back weeks or months.

The Break Up

The time has come for you to leave. You've done you due diligence - planned, prepared and saved. Manifest destiny.

Put in a more than 2 weeks notice. You're not an hourly employee. You oversee large caseloads of clients who now require adequate transition planning. You're leaving them as a provider, and your employer will need to replace you. I gave 60 days notice. It may seem excessive, but I wanted to make sure that I could provide an ethical transition for my clients and my staff.

But you are breaking up. And sometimes it's not pretty. Your employer is going to ask where you're going. They secretly hope you're moving out of state because your significant other got offered a promotion elsewhere. There's a bad taste in their mouth that your going to work for a competitor. But when you tell them you're opening your own business.. who knows what reaction you will get. You're now a competitor. The thoughts going through their mind: are you going to steal my clients? what about my therapists? are you going to report my behavior to the BACB? what will you say about this center behind closed doors? But hey, maybe you're leaving on good terms. It's a small field, ABA. My suggestions before you break up:

Don't burn any bridges
Write a letter of resignation with a date of intended resignation with your signature on it and with the date that you submitted it.
Have a written record of when you submitted your notice (so that it's not your word against hers)
Request to make copies of all contracts with RBTs / BCBA candidates, as well as copies of supervision hours, and anything that you may need for the board later on.
Write letters to parents or have individual exit meetings to explain their child's transition plan.

Leave contact information for your families and for the company to reach you

Ask about COBRA if you do not have a plan for health insurance going forward.
Review your contract to see if you will be compensate for vacation/sick days not used.
Consult with a labor lawyer if necessary
Leave on good terms!

Everything Else That You Need to Know

Grind and shine.

There's a ton of shit to do. Hopefully you're neck deep in credentialing at this point. Hopefully you've found a location that is suitable. I pray you saved some money because you're about to be really broke for a little while. Did you look into loans? Business loans are not gonna work - they have a ton of rules that you don't fit into because your business isn't open yet. A home equity loan could work. Talk to a loan officer. In the meantime, here's some more stuff you need to do:

Create intake forms for clients. (I made mine from scratch using templates available online)
Write your policies and procedures (employee, company and client)
Get a professional email and connect it to your website / domain
Purchase online storage for your electronic documents or look into a software management company (i.e. catalyst, accupoint, central reach)
Get personal liability insurance for the center
Get general liability insurance
Sign up for workers compensation insurance
Sign up for a clearing house
Consider a payroll company
Establish an accounting and record keeping system or outsource
Establish an organizational structure or hierarchy
Write an employee and parent handbook
Make job descriptions for all current and future positions
Set up an indeed account if you're struggling to find employees
Utilize facebook and social media to find employees and clients

Refine your intake process

Make an initial intake form / questionnaire and have it available on your website
Create the following forms and policies: client's rights agreement, financial responsibility agreements, confidential exchange of information policy, welcome letter, standard operating procedures, ABA treatment contract, caregiver participation and parent interaction agreement, fee agreement, payment policy, sick and absentee policy, notice of privacy practices for clients, HIPAA compliance statement, sentinel events policy, fire safety policy, control of hazardous materials policy, emergency safety plan.

Refine your organizational and clinical processes

Create an assessment report template
Create a behavior reduction plan template
Create and FBA / FA template
Create a progress report template
Create a BCBA supervision note template
Create a daily data / RBT case note template
Decide on a data collection system
Standardize the assessment process when evaluating clients
Streamline as many processes as possible
Choose a curriculum / assessment for clients and purchase the needed materials
Create a transition plan and or discharge plan, as well as a fade-out policy
Have a new hire process in place (i.e. background checks, interview process, vetting system, desired hours, pay rate, benefits, salary, schedule, calendar)
Consider caseload (i.e. how many children per BCBA?)

Miscellaneous

Occupational license. Get one as soon as possible, it's cheaper if you haven't made any money yet!
Fire inspection. Get one through your local fire department first, it's usually free. You NEED this for your audits (Optum). Pro tip 1: you need at least one fire extinguisher 75ft away from each exit, and if you're strategic, you can possibly get away with having only one. Pro tip 2: make sure you commercial locks on your doors and panic hardware on your second exit. Pro tip 3: don't have any doors locked when the fire department comes. Pro tip 4: have drinks and snacks available for the fire department when they arrive - if you can develop a good relationship with them, they may come to your center for some reverse field trips!
You don't need a receptionist until you do. Trust me, you'll know what I mean.
I hope you like hats, because you're going to be wearing all of them.
If you outsourced credentialing, there's a good chance that same company could do your billing too. As I stated before, your two number one enemies early on are going to be time and money. Outsource the billing if you can. You probably don't know how to do it anyway. The last thing you need is your screwing up and not getting paid for months. Look, they're going to want a pretty penny, typically a percentage of your profit (4-10%). Early on, this is cost effective for you. You're not going to be making enough money for it to matter. Later on, as your profits increase, they're going to take more money. When that happens, consider hiring in house or learning billing yourself.
Signs are expensive. Hold off on getting a big sign outside and instead get vinyl for the door. Time and money..
Furniture is expensive. Finance as much furniture as you can. Everything else, buy it used. I went to Rooms-to-go, picked out $5000 in furniture and I'm paying like $70 a month for the next 36 months. Sure beats losing 5k.
Toys are expensive. Thriftstores, goodwill, consignment shops, boutiques, flea markets, garage sales. People are giving away lightly used toys. There's no need to buy everything brand new, not when you're strapped for cash.