Want to invest in your team and your clients? Having rates that cover your operating expenses is necessary for a viable and sustainable practice.
It is important that the rates you accept from funders are based on thoughtful budgeting and projections. Accepting funder rates without reference to operating expenses is like accepting a salary for a job without reference to your costs of living and your personal monthly bills.
Be circumspect of commercial provider reimbursement rates below Medicaid rates. Outside of ABA, commercial healthcare reimbursement rates are often much higher than Medicaid rates.
Leverage and timing are important aspects of successful negotiations. Understanding network adequacy for the funders with which you are negotiating, and in your specific region, is an important part of the process.
Get your agreed-upon insurance reimbursement rates in writing. Not only is this an important business practice, but it is your responsibility as a behavior analyst (see 3.05 of BACB Ethics Code).
Do not assume that a funder will increase your reimbursement rates commensurate with operating costs, or at all in a given time frame.
Brandon Herscovitch, Ph.D., LABA, BCBA-D
Partners Behavioral Health can help with your clinical and business standards, compliance, and outcomes. We can help you scale an ethical ABA practice you’re proud about.
