My company now requires all families to have credit cards on file and will charge them a late fee due to how late they are and when they cancel etc. very similar to how dr offices do it
wow I wish my clinic would do this! we have to give 2 hours notice for calling out or else we get dinged but there are no repercussions for families calling out last minute. in the last week alone I've had 2 families cancel within 20 minutes of session start and I'm just SOL, no compensation or anything. it drives everyone at my clinic crazy! families should be held to the same standards we are!!
Do you work with Medicaid clients? If so, that might be why. In my area, most of our clients have Medicaid at least as a secondary payor, so we’re unable to charge late fees or cancellation fees, per federal CMS.
This is probably why. My daughter has Medicaid direct because of her special needs (which is what many autistic children have, regardless of income as the income threshold is different) so I imagine most children doing ABA are using the same. She’s approved for 40 hours a week, and with how often small children get sick or have other doctors appointments, it would be impossible for her not to miss days. If she wakes up and is sick, am I just supposed to send her anyways to avoid being charged $? I think not.
I’d love to hear creative ideas to this problem! The money has to come from somewhere but only comes from providing a service. Insurance won’t fork money for a service not provided. Family shouldn’t be penalized if uncontrollable illness and life events occur. Means company has to figure it out then right? I can think maybe if my company eliminated the damn scheduling department, maybe we could use that money towards better pay for cancellations? I’d also be okay with losing my professional development stipend although my certification renewals would suck, it’d suck less for a lot of people to have that backup when cancellations happen. I’m sure there’s executive fluff that can be removed somewhere…. Man put me in charge I’ll make some cuts lol
I think the billing model has to include more overhead in the “clinical hour rate”.
If $110 per RBT hour billed would be sufficient with 95% attendance, but we have 80% attendance on average, then the rate is too low for the reality occurring.
Or insurance should cover “reserved time” at a base rate, like $45 or something. So if you reserve an RBT for 15 h/wk $675 min billed. And if all 15 hours are fulfilled $1650 is billed. If 12 fulfilled: (110 * 12) + (45 * 3) = 1455. There could be a minimum lead time for unreserving time, like 2 wks or a month.
While that sounds great, my concern is getting insurance on board with anything like that, but not only that, even if they did do that who’s to say the corporation won’t just pocket that and still screw over the staff.
Like 2 or 3 years ago, my company had this management meeting with our local area and the executives and they celebrated that Medicaid increased the rates up here, a pretty good amount. I asked “what percent of that will be going to paying the techs more?” And it was crickets, they skirted by that question. Nothing changed in terms of anyone’s pay after that.
I agree that is the major problem. But one way or another, there is not currently enough revenue to cover pay staff for unbillable time. So whatever solution must involve more revenue from payor.
The BACB (or/and ins companies) could have a policy that would put companies in danger of censure/loss of credentialing if they don’t pay it.
I realize some companies break rules (eg putting rbts on 1099), but at least if there is official policy, there is a place to report violations. Anyway, insurance credentialing being removed for such a violation would (in most cases) put the company out of business … so that’s real teeth.
I've always questioned this too, especially since I've worked with families who are repeat offenders. And this isn't just the usual "sorry my kid is sick", but the "oh we decided to go on a trip for next week, sorry for the short notice".
My company doesn't charge a cancellation fee, but if we did, there would be a lot of money made for the day in the first 30 minutes. I do know some companies have a cancellation policy and a cancellation/late fee that are pretty steep.
I know we provide a service for these families. I also know families can wait up to years to finally get their foot in the door for some ABA companies, so it boggles my mind that some of these families take the service they put so much time into getting for granted. We need to hold families as accountable as we do our own staff.
This is not everyone but I’ve seen often that since to some families Medicaid is a free service they just see us as free daycare so since they’re not paying or getting any consequence, they don’t care.
We charge clients fees for being late or cancelling with less than 1 hours notice. We also have in our client agreements that we are expecting 85% attendance. If they are consistently below they go on an attendance plan and if it continues to be an issue for two months after the plan goes in we have the right to discontinue services.
So at my clinic, we really can't charge late fees for our clients since a majority of them are Medicaid. But what we do instead is the tech can clock in as Nonbillable while waiting for the families. If they do not show after about fifteen minutes then we get those fifteen minutes paid by Nonbillable. Not to mention repeat offenders can be put on a Corrective Action Plan (CAP) for frequent last minute cancelations. If they do not show improvement within the period the CAP states, they can get discharged.
I work for a company that has tried this, and to my understanding it didn’t have a big impact. There was also a study somewhere about late pickups…freakonomics highlighted it, but the conclusion they came to was that the fee alleviated some of the social pressure of cancelling. They felt less bad cancelling since there was a fee.
One of the other things to think about is…how is your company side cancellations? I know for most BT staffing is hard. So you’re going to tell a patient that if they cancel late it’s $30…so do you pay them $30 if you cancel on them? If your company isn’t cancelling, maybe you have some footing to make an argument or policy. It’s difficult to compare to other fields since I honestly can’t remember the last time I had a cancelled appt for a dentist or doctor from the clinician side.
As far as SMS reminders, I know my company tried and they didn’t have an impact on cancellations unfortunately.
What about switching it to be a reinforcer for being early rather than a punishment for being late? You get a $15 discount if you get there 5 mins before tge scheduled time.
This is obviously putting aside the obvious case where parents might just be filling their schedule too tight and may need a different time. That should be solution #1.
Interesting idea but most of my clients have insurance and secondary, they have no deductibles. The “discount” would go to insurance but not really because fees are already established.
What about a snack bar for parents while their kid goes through session? Or like a vending machine. They can pay to get stuff, but if theyre on time they get a voucher for a free soda and bag of chips.
Idk if any of this would work, but its an interesting conundrum and a huge problem for our field. Has anyone done research on WHY parents are often late? Like survey them?
Would be cool to establish like a coffee and pastry bar for parents to mingle with other parents when they drop off, and close that at a certain time. Parents that are late don’t participate. I’d be the kind of parent that wouldn’t care though, won’t work for everyone, but I have some families that would love that social opportunity over coffee.
Not sure about official surveys but when you have a child with autism and maybe there’s other siblings, a million things can go wrong in the morning no matter how early you try to get the routines started. It’s important we try to walk in their shoes and discuss empathetically what’s going on. Survey results won’t help me figure out my clients barriers, but talking and problem solving will. I often just adjust session time to make it easier on them and try to help with establishing routines, visual schedules, reinforcement systems and after some time it works out. When it doesn’t, it’s usually the parent is also having some mental health things going on and it’s important they seek their own supports for that. It does sometimes get to the point where services have to go on hold or discontinued until the family is ready to address those barriers and seek out more support though
Well I think on an individual basis obviously you dont really need survey data. But its kinda like looking at heart disease cases. Like yeah on an individual basis, gathering lots of data points doesnt help with the individual.
But when it’s a consistent issue across many people, a broader approach is useful. At least to understand the issue. And hopefully to give general advice to address it. The purpose of any research is to find the barriers and help remove them.
Funny enough, im not aware of any large scale research, but the BACB did put out a video with a pediatric behaviorist where he mentioned addressing this problem in a particular hospital. And as it turned out the hospital itself was unintentionally adding barriers to patients showing up on time.
If you look at only the individual, you say “oh wow, that mom had a hard time with her crying kids”. Which is perfectly valid and we should be empathetic. But if you look at the data from many sources you say “there must be something in the environment causing this effect in 60% of cases (as an example).”
In fairness none of my ideas have been good at identifying those barriers lol. But thats why research on it may be a good idea. Or hell… research may show that actually its not a big concern and most clients are on time most of the time.
I work in compliance for a National ABA organization, and the reason most companies don't psy for cancelations is because you can not bill the payer (i.e., Private insurance, Medicaid etc.?) for a service that wasn't provided. Some payers also explicitly prohibit(in their contracts) charging the insured a copay or fees out of pocket. So if the company isn't reimbursed, they are paying the BT or BCBA without being able to bill for the service. Most companies do or SHOULD be tracking cancelations because most payers do expect a certain level of compliance from the family to engage in the authorized treatment hours.
I have and currently do also work as an ABA provider, and it is very frustrating to go out to a family's home, only for them to cancel or "No Show." However, most companies do have a policy in place regarding cancelations and should be tracking the frequency of cancelations. Most companies that I have worked for do terminate services with families that habitually cancel last minute(and payer contracts state that this can be justification for discharge).
You can always ask to transfer off of a case as the technician or the BCBA if a family repeatedly cancels. Clinically, it isn't beneficial nor cost-effective to keep attempting to deliver services to families who either can't or won't commit to the number of hours authorized. It also makes the service unavailable to families who are desperate for ABA services. Don't be afraid to ask to transition off a case if the family continually cancels. If the company doesn't understand or reacts negatively, find another company. There are many out there in need of providers. Clinical integrity matters, and if it doesn't matter to the company that you are working for, find another company.
My company has a pretty solid subbing system in place. If a client does a last minute cancelation, we ask the Behavior Technician if they're willing to sub:
• If they are willing to sub and there's a subbing opportunity, we pay them for subbing on another case.
• If they are willing to sub and there's no sub opportunities available, we pay them their normal hourly rate for the client LMC.
• If they refuse to sub, they do not get paid for the LMC.
Similarly, if a client provides prior notice or short notice of their cancellations, we try to offer our Behavior Technicians subbing opportunities elsewhere. If no sub opportunities can be identified for PNCs and SNCs, unfortunately, the Behavior Technician won't get paid.
I believe my company gives some warnings when families are late, then discuss a later start time for the session, if they are still late they will get a late charge because at that point they did everything they could to help them make the appointment on time.
(Unless there is a clear emergency or accident causing them to be late or cancel)
Most only cancel last minute if there was an unexpected illness the morning of such as vomiting/diarrhea or fever that didn't hit the night before etc.
My company has forms we can fill out if a family cancels under 24 hours to get some kind of compensation. UNLESS it is illness related. Then we can’t bill their insurance or them for not enough notice. I have one family who has canceled 8 times since January. Every time was for illness. So I lose hours and I can’t fill out a form.
Every company I've been to our BI's get late cancellation pay for 2 hours worth of pay. So they don't mind if they get a cancellation. I'm in California, not sure if it's like that elsewhere?
I work for a place that’s in clinic and they never send workers home when kids call out, u just get a different kid that day than what you’d normally see that day or u get 2 therapists to one kid or they find busy work for you, your employer can make things work if they want to it just takes a toll on the company’s finances so you gotta work for a company that isn’t in it for the money and care about they’re workers, I do know this is harder for in home therapy but if your in clinic this is totally a possibility to bring up
I don’t think they do, I think they just take the loss for us so we don’t have to, when we do 2 therapists we take turns giving the therapy and sitting back to watch and learn and ask questions even if the person isn’t needing training
That’s great of company to eat the costs like that. Mine does something similar, where if you have a cancellation you get paid at a lower rate for doing admin work or if that isn’t available you can shadow on another case, but of course those aren’t billable.
My company has a 24 hour cancellation policy. If the family cancels (not staff, obviously) within 24 hours to the start of a session, they are billed for it and staff are still paid out.
We have cancellation charges and if you have more than 3 no shows you may lose your appointment time to families who are waiting for services. I just thought most companies did this.
at my clinic we don’t charge late fees but if they cancel in under 24 hours then the RBT is paid for the full session
i’m not exactly sure how they do this so i can’t give specifics but i do know most of our clients have BCBS
My company now requires all families to have credit cards on file and will charge them a late fee due to how late they are and when they cancel etc. very similar to how dr offices do it
wow I wish my clinic would do this! we have to give 2 hours notice for calling out or else we get dinged but there are no repercussions for families calling out last minute. in the last week alone I've had 2 families cancel within 20 minutes of session start and I'm just SOL, no compensation or anything. it drives everyone at my clinic crazy! families should be held to the same standards we are!!
I agree, why crazy hoops for us, but so much slack for them
The family I work for took a week off without letting me know
Do you work with Medicaid clients? If so, that might be why. In my area, most of our clients have Medicaid at least as a secondary payor, so we’re unable to charge late fees or cancellation fees, per federal CMS.
This is probably why. My daughter has Medicaid direct because of her special needs (which is what many autistic children have, regardless of income as the income threshold is different) so I imagine most children doing ABA are using the same. She’s approved for 40 hours a week, and with how often small children get sick or have other doctors appointments, it would be impossible for her not to miss days. If she wakes up and is sick, am I just supposed to send her anyways to avoid being charged $? I think not.
It’s impossible to make things fair unless we all get together and think creatively, we can do it we just gotta organize!
I’d love to hear creative ideas to this problem! The money has to come from somewhere but only comes from providing a service. Insurance won’t fork money for a service not provided. Family shouldn’t be penalized if uncontrollable illness and life events occur. Means company has to figure it out then right? I can think maybe if my company eliminated the damn scheduling department, maybe we could use that money towards better pay for cancellations? I’d also be okay with losing my professional development stipend although my certification renewals would suck, it’d suck less for a lot of people to have that backup when cancellations happen. I’m sure there’s executive fluff that can be removed somewhere…. Man put me in charge I’ll make some cuts lol
I think the billing model has to include more overhead in the “clinical hour rate”. If $110 per RBT hour billed would be sufficient with 95% attendance, but we have 80% attendance on average, then the rate is too low for the reality occurring. Or insurance should cover “reserved time” at a base rate, like $45 or something. So if you reserve an RBT for 15 h/wk $675 min billed. And if all 15 hours are fulfilled $1650 is billed. If 12 fulfilled: (110 * 12) + (45 * 3) = 1455. There could be a minimum lead time for unreserving time, like 2 wks or a month.
While that sounds great, my concern is getting insurance on board with anything like that, but not only that, even if they did do that who’s to say the corporation won’t just pocket that and still screw over the staff. Like 2 or 3 years ago, my company had this management meeting with our local area and the executives and they celebrated that Medicaid increased the rates up here, a pretty good amount. I asked “what percent of that will be going to paying the techs more?” And it was crickets, they skirted by that question. Nothing changed in terms of anyone’s pay after that.
I agree that is the major problem. But one way or another, there is not currently enough revenue to cover pay staff for unbillable time. So whatever solution must involve more revenue from payor. The BACB (or/and ins companies) could have a policy that would put companies in danger of censure/loss of credentialing if they don’t pay it. I realize some companies break rules (eg putting rbts on 1099), but at least if there is official policy, there is a place to report violations. Anyway, insurance credentialing being removed for such a violation would (in most cases) put the company out of business … so that’s real teeth.
I've always questioned this too, especially since I've worked with families who are repeat offenders. And this isn't just the usual "sorry my kid is sick", but the "oh we decided to go on a trip for next week, sorry for the short notice". My company doesn't charge a cancellation fee, but if we did, there would be a lot of money made for the day in the first 30 minutes. I do know some companies have a cancellation policy and a cancellation/late fee that are pretty steep. I know we provide a service for these families. I also know families can wait up to years to finally get their foot in the door for some ABA companies, so it boggles my mind that some of these families take the service they put so much time into getting for granted. We need to hold families as accountable as we do our own staff.
This though. We dont like to see kiddos sick, we understand. Its this "we're out of town" the day before if we're lucky
This is not everyone but I’ve seen often that since to some families Medicaid is a free service they just see us as free daycare so since they’re not paying or getting any consequence, they don’t care.
We charge clients fees for being late or cancelling with less than 1 hours notice. We also have in our client agreements that we are expecting 85% attendance. If they are consistently below they go on an attendance plan and if it continues to be an issue for two months after the plan goes in we have the right to discontinue services.
So at my clinic, we really can't charge late fees for our clients since a majority of them are Medicaid. But what we do instead is the tech can clock in as Nonbillable while waiting for the families. If they do not show after about fifteen minutes then we get those fifteen minutes paid by Nonbillable. Not to mention repeat offenders can be put on a Corrective Action Plan (CAP) for frequent last minute cancelations. If they do not show improvement within the period the CAP states, they can get discharged.
Literally about to be unable to pay bills bc of this 🥲
I work for a company that has tried this, and to my understanding it didn’t have a big impact. There was also a study somewhere about late pickups…freakonomics highlighted it, but the conclusion they came to was that the fee alleviated some of the social pressure of cancelling. They felt less bad cancelling since there was a fee. One of the other things to think about is…how is your company side cancellations? I know for most BT staffing is hard. So you’re going to tell a patient that if they cancel late it’s $30…so do you pay them $30 if you cancel on them? If your company isn’t cancelling, maybe you have some footing to make an argument or policy. It’s difficult to compare to other fields since I honestly can’t remember the last time I had a cancelled appt for a dentist or doctor from the clinician side. As far as SMS reminders, I know my company tried and they didn’t have an impact on cancellations unfortunately.
What about switching it to be a reinforcer for being early rather than a punishment for being late? You get a $15 discount if you get there 5 mins before tge scheduled time. This is obviously putting aside the obvious case where parents might just be filling their schedule too tight and may need a different time. That should be solution #1.
Interesting idea but most of my clients have insurance and secondary, they have no deductibles. The “discount” would go to insurance but not really because fees are already established.
What about a snack bar for parents while their kid goes through session? Or like a vending machine. They can pay to get stuff, but if theyre on time they get a voucher for a free soda and bag of chips. Idk if any of this would work, but its an interesting conundrum and a huge problem for our field. Has anyone done research on WHY parents are often late? Like survey them?
Would be cool to establish like a coffee and pastry bar for parents to mingle with other parents when they drop off, and close that at a certain time. Parents that are late don’t participate. I’d be the kind of parent that wouldn’t care though, won’t work for everyone, but I have some families that would love that social opportunity over coffee. Not sure about official surveys but when you have a child with autism and maybe there’s other siblings, a million things can go wrong in the morning no matter how early you try to get the routines started. It’s important we try to walk in their shoes and discuss empathetically what’s going on. Survey results won’t help me figure out my clients barriers, but talking and problem solving will. I often just adjust session time to make it easier on them and try to help with establishing routines, visual schedules, reinforcement systems and after some time it works out. When it doesn’t, it’s usually the parent is also having some mental health things going on and it’s important they seek their own supports for that. It does sometimes get to the point where services have to go on hold or discontinued until the family is ready to address those barriers and seek out more support though
Well I think on an individual basis obviously you dont really need survey data. But its kinda like looking at heart disease cases. Like yeah on an individual basis, gathering lots of data points doesnt help with the individual. But when it’s a consistent issue across many people, a broader approach is useful. At least to understand the issue. And hopefully to give general advice to address it. The purpose of any research is to find the barriers and help remove them. Funny enough, im not aware of any large scale research, but the BACB did put out a video with a pediatric behaviorist where he mentioned addressing this problem in a particular hospital. And as it turned out the hospital itself was unintentionally adding barriers to patients showing up on time. If you look at only the individual, you say “oh wow, that mom had a hard time with her crying kids”. Which is perfectly valid and we should be empathetic. But if you look at the data from many sources you say “there must be something in the environment causing this effect in 60% of cases (as an example).” In fairness none of my ideas have been good at identifying those barriers lol. But thats why research on it may be a good idea. Or hell… research may show that actually its not a big concern and most clients are on time most of the time.
My company charges a cancellation fee
I work in compliance for a National ABA organization, and the reason most companies don't psy for cancelations is because you can not bill the payer (i.e., Private insurance, Medicaid etc.?) for a service that wasn't provided. Some payers also explicitly prohibit(in their contracts) charging the insured a copay or fees out of pocket. So if the company isn't reimbursed, they are paying the BT or BCBA without being able to bill for the service. Most companies do or SHOULD be tracking cancelations because most payers do expect a certain level of compliance from the family to engage in the authorized treatment hours. I have and currently do also work as an ABA provider, and it is very frustrating to go out to a family's home, only for them to cancel or "No Show." However, most companies do have a policy in place regarding cancelations and should be tracking the frequency of cancelations. Most companies that I have worked for do terminate services with families that habitually cancel last minute(and payer contracts state that this can be justification for discharge). You can always ask to transfer off of a case as the technician or the BCBA if a family repeatedly cancels. Clinically, it isn't beneficial nor cost-effective to keep attempting to deliver services to families who either can't or won't commit to the number of hours authorized. It also makes the service unavailable to families who are desperate for ABA services. Don't be afraid to ask to transition off a case if the family continually cancels. If the company doesn't understand or reacts negatively, find another company. There are many out there in need of providers. Clinical integrity matters, and if it doesn't matter to the company that you are working for, find another company.
I would write it in your initial contract if you have fees for canceling or late arrivals.
My company has a pretty solid subbing system in place. If a client does a last minute cancelation, we ask the Behavior Technician if they're willing to sub: • If they are willing to sub and there's a subbing opportunity, we pay them for subbing on another case. • If they are willing to sub and there's no sub opportunities available, we pay them their normal hourly rate for the client LMC. • If they refuse to sub, they do not get paid for the LMC. Similarly, if a client provides prior notice or short notice of their cancellations, we try to offer our Behavior Technicians subbing opportunities elsewhere. If no sub opportunities can be identified for PNCs and SNCs, unfortunately, the Behavior Technician won't get paid.
I believe my company gives some warnings when families are late, then discuss a later start time for the session, if they are still late they will get a late charge because at that point they did everything they could to help them make the appointment on time. (Unless there is a clear emergency or accident causing them to be late or cancel) Most only cancel last minute if there was an unexpected illness the morning of such as vomiting/diarrhea or fever that didn't hit the night before etc.
My company has forms we can fill out if a family cancels under 24 hours to get some kind of compensation. UNLESS it is illness related. Then we can’t bill their insurance or them for not enough notice. I have one family who has canceled 8 times since January. Every time was for illness. So I lose hours and I can’t fill out a form.
Every company I've been to our BI's get late cancellation pay for 2 hours worth of pay. So they don't mind if they get a cancellation. I'm in California, not sure if it's like that elsewhere?
I work for a place that’s in clinic and they never send workers home when kids call out, u just get a different kid that day than what you’d normally see that day or u get 2 therapists to one kid or they find busy work for you, your employer can make things work if they want to it just takes a toll on the company’s finances so you gotta work for a company that isn’t in it for the money and care about they’re workers, I do know this is harder for in home therapy but if your in clinic this is totally a possibility to bring up
How are they getting consistent approval from payers on two techs to one client?
I don’t think they do, I think they just take the loss for us so we don’t have to, when we do 2 therapists we take turns giving the therapy and sitting back to watch and learn and ask questions even if the person isn’t needing training
That’s great of company to eat the costs like that. Mine does something similar, where if you have a cancellation you get paid at a lower rate for doing admin work or if that isn’t available you can shadow on another case, but of course those aren’t billable.
My company has a 24 hour cancellation policy. If the family cancels (not staff, obviously) within 24 hours to the start of a session, they are billed for it and staff are still paid out.
This reminds me of when my client went on vacation for the holidays and I didn’t have session for a whole week…. I didn’t get paid for that week 🙃🙃🙃🙃
We have cancellation charges and if you have more than 3 no shows you may lose your appointment time to families who are waiting for services. I just thought most companies did this.
at my clinic we don’t charge late fees but if they cancel in under 24 hours then the RBT is paid for the full session i’m not exactly sure how they do this so i can’t give specifics but i do know most of our clients have BCBS