The Hidden Costs of Running an ABA Practice Most Owners Don’t Calculate
Running an ABA practice often looks profitable on paper. Payroll is covered. Schedules are full. Claims are going out the door.
But many ABA owners eventually reach a confusing, frustrating realization:
“We’re busy… so why does it still feel tight?”
The answer usually isn’t a single catastrophic mistake. It’s a collection of hidden costs—expenses that don’t show up clearly on a P&L, aren’t billed by vendors, and rarely get calculated in advance.
These costs quietly erode margin, strain teams, and stall growth. Let’s unpack the ones most ABA practice owners underestimate.
- Staff turnover: the cost that never stops billing you
Turnover is one of the most expensive realities in ABA, and not just because recruiting is hard.
When an RBT or BCBA leaves, the cost isn’t limited to replacing their salary. You’re paying for:
- Recruiting and hiring time
- Background checks and onboarding
- Training and supervision hours
- Weeks (or months) of reduced productivity
- Increased cancellations and service disruptions
- Higher risk of client dissatisfaction or attrition
Even well-run practices experience turnover. The hidden cost comes from treating it as an exception instead of a predictable operating expense.
If turnover isn’t modeled into your financial planning, it will always show up as “unexpected stress.”
- Administrative overload disguised as clinical work
ABA practices rely on highly trained clinicians—but many spend a surprising amount of time doing non-clinical work:
- Tracking authorizations manually
- Fixing documentation issues
- Following up on missing notes or signatures
- Responding to billing questions
- Managing schedules outside formal systems
This is one of the most invisible costs in an ABA practice: highly paid clinical time consumed by administrative friction.
The result is lower billable utilization, burnout, and leadership spending their days putting out fires instead of building systems.
- Claim denials and rework: revenue friction you can’t ignore
Most owners track how much they bill. Fewer track how hard it is to actually collect.
Denials don’t just delay payment. They create a cascade of hidden expenses:
- Billing team rework
- Clinicians pulled back into documentation fixes
- Appeals and resubmissions
- Cash-flow pressure that still has to meet payroll
Even claims that are eventually paid still cost money in time, labor, and attention. Multiply that across payers, months, and growing volume, and the drag becomes significant.
If you’re not tracking denial rates, reasons, and rework time, you’re underestimating your true cost of revenue.
- Compliance and security: “optional” until they’re not
HIPAA, payer audits, documentation standards, credentialing rules—compliance often feels like overhead that doesn’t directly produce revenue.
Until something goes wrong.
Hidden compliance costs include:
- Staff training and retraining
- Policy development and audits
- IT security measures and access controls
- Vendor risk management
- Legal and remediation costs after an incident
The most dangerous assumption is thinking compliance costs are rare. In reality, they’re inevitable—the only question is whether you budget for them intentionally or pay for them reactively.
- Cancellations and no-shows: predictable losses treated as surprises
Every ABA practice experiences cancellations. The mistake is treating them as random instead of statistically predictable.
This falls into non-billable time. Non-billable time is brutal to a company. It is what hangs up most of the practices. There is an overly generous compensation for holidays, sick days, PTO, admin tasks, and others. “Overly generous” can be defined as >15% of payroll or if it’s placing the company in a fiscally irresponsible position.
Cancellations cost more than lost revenue:
- Paid staff downtime
- Administrative rescheduling work
- Disrupted treatment continuity
- Increased frustration for families and staff
When cancellation rates aren’t built into forecasting, practices overestimate revenue and underestimate staffing inefficiencies—especially in in-home models.
- Technology sprawl and “death by subscriptions”
Many ABA practices evolve their tech stack organically:
- One system for EMR
- Another for billing
- Another for scheduling
- Spreadsheets to fill the gaps
Over time, hidden costs pile up:
- Overlapping software licenses
- Per-user fees that quietly grow
- Manual work to bridge systems
- Reporting limitations that force extra admin labor
The real cost of technology isn’t just what you pay vendors—it’s how much inefficiency the stack creates or eliminates.
- Payer mix and rate pressure
Not all revenue is equal.
Two cases with the same authorized hours can have very different profitability once you factor in:
- Reimbursement rates
- Supervision requirements
- Denial frequency
- Administrative burden
- Cancellation patterns
Accepting “any case to stay full” can quietly lower margins, especially when rate pressure rises and operating costs don’t slow down.
Without contribution margin analysis by payer, many practices grow volume while shrinking profitability.
- Marketing and intake costs beyond the ad spend
Marketing costs are easy to see. Intake costs are not.
Hidden acquisition expenses include:
- Intake coordinator labor
- Benefits verification time
- Assessment scheduling and follow-up
- Authorization delays
- Leads that never convert but still consume resources
Intake can include eligibility checks, sometimes with multiple payers and gathering the coordination of benefits. These factors can take hours to confirm, depending on payers. Sometimes they are on portals. Sometimes you have to call to verify. Coordination of benefits also takes time to verify what is the primary payer vs secondary payer. Many services that offer eligibility don’t necessarily check coordination of benefits
If you only calculate cost per lead—and not cost per started client—you’re underestimating how expensive growth really is.
The core problem: visibility, not effort
Most ABA owners are working incredibly hard. The issue isn’t motivation—it’s measurement.
Hidden costs thrive in areas that feel operational, messy, or “just part of the business.” But when they aren’t measured, they quietly dictate profitability.
Practices that last don’t just grow caseloads. They:
- Model turnover as a real expense
- Measure administrative drag
- Track revenue friction, not just revenue
- Budget for compliance and risk
- Design systems to absorb cancellations and variability
Busy practices can still be fragile.
Durable practices understand where the money leaks—and fix it before it becomes a crisis.
