The Annual New Aba Practice Review Checklist

Running a new ABA (Applied Behavior Analysis) practice means juggling clinical care and business operations. An annual review is not optional; it is how you catch problems early, plan for taxes, and set yourself up for growth. This checklist walks you through the key areas to review each year, with specific actions you can take this week.

1. Financial Health Check

Start with your numbers. Pull your profit and loss statement, balance sheet, and cash flow statement for the last 12 months. Look for trends, not just totals.

• Revenue: Compare monthly revenue. Are there seasonal dips? For ABA, summer and school breaks often change caseloads. Plan for those dips.
• Expenses: List your top 10 expenses. Common ones include rent, salaries, software, and insurance. If any category grew more than 10% year over year, investigate why.
• Profit margin: Calculate your net profit margin. For a new ABA practice, a healthy margin is typically 10% to 20% before owner compensation. If you are below 5%, you need to adjust pricing or cut costs.
• Cash reserves: Aim to have at least 3 to 6 months of operating expenses in reserve. If you do not, set a monthly savings goal.

Action this week: Review your last 12 months of bank statements. Categorize every expense. You can use accounting software like QuickBooks ($30-$80/month) or Xero ($30-$70/month), or a spreadsheet if you are small.

2. Tax Planning and Compliance

Taxes are a major part of your annual review. The goal is to minimize your liability legally and avoid penalties.

• Entity type: Review your business structure (LLC, S-Corp, C-Corp). Each has different tax implications. For example, an S-Corp can save on self-employment taxes, but requires payroll. If you are unsure, consult a CPA.
• Estimated taxes: If you pay quarterly estimated taxes, check that your payments match your actual income. Underpaying can trigger penalties. The IRS expects you to pay at least 90% of your current year liability or 100% of last year’s (110% if your adjusted gross income is over $150,000).
• Deductions: List all business expenses you can deduct. For ABA practices, common deductions include:
  • Clinical supplies (e.g., assessment tools, reinforcers)
  • Software subscriptions (e.g., practice management, billing)
  • Professional liability insurance
  • Continuing education for staff
  • Mileage for home visits (use the standard rate, which is $0.70 per mile in 2026)
• Retirement plans: Consider a SEP IRA or Solo 401(k) if you are self-employed. Contributions reduce taxable income. For 2026, the SEP IRA contribution limit is up to 25% of compensation, capped at $70,000. A Solo 401(k) allows up to $23,500 in employee deferrals plus profit sharing.

Action this week: Schedule a meeting with a CPA who works with healthcare practices. Fees for a CPA range from $150 to $400 per hour, or a flat fee of $1,000 to $3,000 for annual tax preparation. Ask them to review your structure and deductions.

3. Billing and Payer Contracts

Your revenue depends on how well you bill and how your contracts are structured.

• Payer mix: List your top payers (insurance companies, school districts, private pay). If one payer is more than 40% of your revenue, you are at risk. Diversify.
• Contract rates: Review your reimbursement rates. Are they competitive? For ABA, commercial insurance rates vary widely, from $60 to $150 per hour for direct therapy. If your rates are below average, renegotiate.
• Denial rate: Track your claim denial rate. The industry average is around 10% to 15%. If yours is higher, identify the top reasons (e.g., missing authorization, incorrect coding) and fix them.
• Coding: Ensure you are using the correct CPT codes. For ABA, common codes include 97151 (assessment), 97153 (behavioral health treatment), and 97155 (adaptive behavior treatment with protocol modification). Incorrect coding leads to denials.

Action this week: Pull your last 6 months of claims data. Calculate your denial rate and list the top 3 denial reasons. If you do not have a billing specialist, consider hiring one part-time ($25-$45/hour) or using a billing service ($500-$1,500/month).

4. Compliance and Credentialing

ABA practices must meet regulatory and payer requirements.

• Licensure: Verify that your practice and all clinicians have current state licenses. For BCBAs, this includes maintaining certification through the BACB, which requires continuing education and a renewal fee of $150 every 2 years.
• Insurance: Review your professional liability insurance. Coverage limits of $1 million per claim and $3 million aggregate are common. Premiums for a small ABA practice range from $1,500 to $5,000 per year.
• HIPAA: Ensure your practice is HIPAA compliant. This includes having a Notice of Privacy Practices, secure communication systems, and staff training. Use a HIPAA-compliant email and telehealth platform (e.g., SimplePractice, TheraNest, or Doxy.me, which range from $30 to $150/month).
• Payer credentialing: Confirm that all clinicians are credentialed with your major payers. Lapsed credentials can cause claim denials.

Action this week: Create a compliance calendar. List all renewal deadlines for licenses, insurance, and credentials. Set reminders 60 days in advance.

5. Staffing and Training

Your team is your biggest asset and your biggest expense.

• Turnover: Calculate your staff turnover rate. If it is above 30% per year, that is high for ABA. High turnover increases training costs and reduces continuity for clients.
• Training: Ensure all staff have completed required training, including HIPAA, CPR, and behavior technician certification (RBT). RBT certification costs $50 to $100 for the exam, plus training.
• Payroll: Review your pay rates. For RBTs, the average hourly rate is $18 to $25. For BCBAs, it is $70 to $100 per hour. If you are below market, you will lose staff.

Action this week: Survey your staff anonymously about job satisfaction. Use the results to address burnout and retention.

6. Operations and Technology

Efficient operations save time and money.

• Practice management software: Evaluate your current system. Does it handle scheduling, billing, and telehealth? Popular options include CentralReach ($100-$300/month), Catalyst ($150-$400/month), and AccuPoint ($100-$250/month). If you are paying more than $300/month and not using all features, switch.
• Client satisfaction: Send a satisfaction survey to families. Net Promoter Score (NPS) is a simple metric. A score above 50 is good for healthcare.
• Marketing: Review your referral sources. Are you getting referrals from pediatricians, schools, or word of mouth? If not, invest in a simple website and Google Business profile. A basic website costs $500 to $2,500 to build, plus $20 to $50/month for hosting.

Action this week: List all software subscriptions and cancel any you do not use. This can save you $50 to $200/month.

7. Planning for Next Year

Use your review to set goals.

• Budget: Create a budget for the next 12 months. Include projected revenue, expenses, and profit. Update it quarterly.
• Growth: Decide if you want to add services (e.g., school consultations, parent training) or expand to a new location. Each has costs and regulatory implications.
• Professional advice: Build a team of advisors: a CPA, a lawyer, and a business coach. Fees vary, but a business coach for healthcare practices ranges from $100 to $300 per hour.

Action this week: Write down 3 specific goals for the next year. For each, list the steps and a deadline.

FAQ

Q: How often should I do an annual review? A: At least once a year, ideally at the same time each year, such as after tax season or at your fiscal year end. Some practices do a mini-review quarterly.

Q: What if I cannot afford a CPA? A: You can use tax software like TurboTax Self-Employed ($120-$200) or H&R Block, but for a practice with employees and insurance billing, a CPA is worth the cost. Look for a CPA who offers a free consultation.

Q: What is the biggest tax mistake new ABA practices make? A: Not paying estimated taxes. Many new owners assume they will pay at the end of the year, but the IRS requires quarterly payments. Penalties can be 5% to 25% of the underpayment.

Q: How do I renegotiate payer contracts? A: Gather data on your costs and outcomes. Request a meeting with the payer’s network manager. Be prepared to show why a higher rate is justified, such as low turnover or high client satisfaction.

Related guides

• The Complete New Aba Practice Startup Checklist
• 7 Mistakes New Aba Practices Make in Their First Year
• 7 Questions to Ask Before Buying a New ABA Practice

The bottom line

An annual review is your chance to step back and run your practice like a business, not just a clinical service. Focus on the numbers, taxes, billing, compliance, staff, and technology. Take one action from each section this week. You will catch problems early, save money, and build a stronger foundation for growth. If you only have time for two things, do the financial health check and the tax planning meeting. Those two areas have the biggest impact on your bottom line.