Most owners we talk to can tell us how many clients they serve, how many BCBAs and RBTs they employ, and roughly what they billed last month. Far fewer can tell us what the agency actually keeps from each hour of therapy.
That’s not a criticism. Most ABA agencies were built by people who wanted to deliver great care, and growth came fast. But growth hides problems. New clients cover for leaks in the business, right up until growth slows or a payer changes the rules. Most ABA agencies have a growth problem on paper and a margin problem in reality.
In our experience, five numbers decide whether an agency makes money. None of them are exotic. The work is in knowing them, tracking them, and acting on them.
1. Gross margin per billed hour
Take what you collect for an hour of service, then subtract what it costs to deliver that hour: the RBT’s pay, the BCBA’s supervision time, payroll taxes, travel. What’s left is the margin that has to pay for everything else: rent, admin, leadership, growth.
Why it matters: if your margin per hour is thin, growth doesn’t fix it. More hours just means more work for the same thin slice.
What to look at: margin by payer, by service code and by clinic. The averages often hide one payer or one location that quietly loses money on every hour.
2. Utilization: authorized, delivered, billed
Every client comes with authorized hours. Some of those hours get scheduled, some of the scheduled hours get delivered, and some of the delivered hours get billed and paid. The gap between each step is revenue you planned for and never saw.
What to look at: the three numbers side by side, by client and by clinician, every week. We wrote more about this in Authorized, delivered, billed.
3. Caseload design
How many clients each BCBA carries, and how many RBT hours each BCBA supervises, shapes both your margin and your team’s staying power. Too light and the economics don’t work. Too heavy and your best people burn out and leave.
What to look at: caseload in hours, not just in clients, for every BCBA. More in Caseload design.
4. Collection rate
Of everything you bill, how much do you actually collect? Denials, underpayments, missed resubmissions and write-offs all chip away at it, often one claim at a time, so nobody notices.
What to look at: collections against billed charges by payer, plus your top denial reasons. A few fixable causes usually account for most of the gap.
5. Days to collect
Money you’ve earned but haven’t received is money you can’t use. The longer it takes to collect, the more cash you need just to make payroll, and the harder it is to fund your next clinic or your next hire.
What to look at: average days from date of service to payment, by payer, and the age of your open receivables. Watch for anything drifting older month over month.
Putting them on one page
None of these numbers is hard to understand on its own. The power is in seeing all five together, every month, in a form you can read in two minutes. That’s how we work with owners: we put the five numbers into simple visual dashboards, find the biggest gap, and work it together until it moves. Then we pick the next one.
A healthy agency knows these numbers and tracks them monthly. If you don’t know yours yet, that’s the place to start.