Choosing ABA Software Your Team Will Actually Use (with Office Puzzle)

Picking your practice management software might be the highest-stakes decision nobody trained you for. Your whole team touches it every day. Switch, and you risk retraining everyone. Stay, and you may be settling for a tool that quietly slows you down. And every demo looks great, right up until you are the one clicking around inside it.

My guests today are Hailu Jardines, CEO of Office Puzzle, and Charlene Kurth, the COO. Office Puzzle is an all-in-one ABA practice management platform that brings scheduling, data collection, notes, and billing into one place, and it has grown to more than 800 ABA agencies since 2018. Charlene will be on the Hidden Cost of Bad Tech panel at ABA C.A.R.E.S. this August.

Here is what we get into:

• How to evaluate any platform on what actually matters: functionality, support, and cost, instead of what everyone else happens to be using.
• Why a demo is not enough, and why you should insist on using a product for a few weeks before you commit.
• How to weigh what you need today against where your practice will be in a few years, because the software has to scale with you.
• Who belongs in the room when you evaluate. Clinical, operations, billing, and compliance, and why you should invite your biggest skeptic in early.
• Why ease of use matters even more in a high-turnover field, since every new hire has to get up to speed fast.
• How to think about choosing a newer company. New is not automatically risky, but longevity matters when your data is on the line.
• The sales philosophy Charlene's team runs on. No quotas, and a willingness to tell you when they are not the right fit.

Office Puzzle handles the business and back-office side, and where they are not the right expert, like billing or accounting, they will point you to someone who is. Their throughline runs all the way through the conversation: you do not have to do it alone, and it is usually worse if you try.

Learn more about Office Puzzle at https://www.officepuzzle.com

Check out their How to Switch Guide: https://www.officepuzzle.com/how-to-switch-guide

Office Puzzle will have a booth right when you walk in at ABA C.A.R.E.S. in Boston this August, and Charlene will be on the Hidden Cost of Bad Tech panel. They are clear that you will not be sold to, so come say hi, ask your hardest questions, and grab some swag. Register here: https://behaviorlive.com/conferences/abacares2026/registration

We will see you in Boston August 4th through 7th, or live streaming from the other side of the screen.

Transcript

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SPEAKER_02 0:00

Hi, I'm Hallie Beth. Welcome to Inside ABA Cures, your behind-the-scenes space where we lay the foundation and set expectations for what to expect this August and who you'll meet. My guests today come from Office Puzzle, an all-in-one practice management that has been trusted by more than 700 ABA agencies since 2018. Charlene Kurth is the chief operating officer, and Hailu Hardnitas is the CEO and co-founder. We can't wait for Charlene to join us later this August. We're really excited about the panel she's going to be on called The Hidden Cost of Bad Tech. And today I'm just excited to learn and talk more about the product. So welcome to both of you. Appreciate you being here. Thank you. Happy to be here.

SPEAKER_00 0:48

Thank you, Holy. Thank you for having us.

SPEAKER_02 0:50

You're welcome. So before we get into it, Hailu, I would love to learn a little bit more about how the evolution of Office Puzzle came to be. If you could tell me about the story behind it.

SPEAKER_00 1:01

Office Puzzle was born from the need of an RBT to make her life and day-to-day more efficient and to improve the operation of an RBT, especially in the area of documentation. That's how it was born. One of her founders was an RBT. Today she's a BCPA. She went through the entire process. And the other founder is an engineer, which saw her struggling with the creation of the notes and the cumbersome process of recollecting data, documenting, all the therapy. And those were the first steps of the puzzle as a baby.

SPEAKER_02 1:37

Yeah, it's gotta work for the user. When the RBT was struggling with what she was using, what was the biggest complaint that she was running into? And do you know how it affected her job?

SPEAKER_00 1:48

This was 2018. Not every ABA clinic or provider back in the day had a software. A lot of RBTs were just rafting their notes in pen and paper. If anything, Google Sheets. There's a lot of room for mistakes and manual input, delays, et cetera. So there was there was an opportunity. Back then, that was the biggest improvement, the biggest change.

SPEAKER_02 2:09

I started in 2005 on pen and paper, and I know we like trials of fives and tens because it was easy to graph, but that's not always what you need.

SPEAKER_03 2:18

And Charlene, I'm curious what drew you into the space of my story behind this is that I actually I went to school for psychology, and I joke now that I wish I would have learned about ABA because I actually was not exposed to it. Went to school for psychology, wanted to go into social work, and I volunteered with Children's Home Society, went on a couple home visits, and very quickly realized that it's not something that I can do on a daily basis. And so I took a hard right turn, really leaned into my analytical, my business-minded side, and went into revenue management down just a completely different career path. At one point, I thought I'd be like a chief data officer. It just complete chance. I moved to LA with my husband and came across a practice management software in the mental health space. And so at that moment, it felt like this really weird culmination of events of I love technology, I love organization, and I have a background in psychology. So I felt like the customer base resonated. So I worked with them for nearly a decade and was ready to move on to my next challenge. And again, another just by chance, met Hilu and the team, and they were looking for someone to help them grow their company. We have amazing word of mouth in Florida, and they said, hey, we need someone who can help us move to the next level, help us be found outside of Florida and help us organize things. It was another chance for me to expand my impact. I like to say I help people who help people. It's what makes me feel better about what I do. I've taken what my strengths are, but found a way to apply it in a field that is doing really great work.

SPEAKER_02 3:49

What did you notice when you came into ABA?

SPEAKER_03 3:51

Was there anything that surprised you? I realized that given the shortages of BCVAs and the staffing issues, that it's a bit more competitive than I expected. I was really happy to find that once I started meeting people like you, Holly Beth, and just others in the field who are working really hard to build more community around it, it's just a step behind. In the mental health private practice space, there's so much demand that people are very collaborative in helping each other find what they need to run a business. So I love seeing that that's starting to happen in ABA. So maybe it wasn't historically as collaborative, but I'm finding more and more people as we build partnerships who want to do that, who want to bring resources to their colleagues just to up-level the field as a whole.

SPEAKER_02 4:34

You really do seek out subject matter experts. Is there anything that you guys lean towards reaching out to people to make sure that it is meeting the needs of the ABA company beyond just the clinical side?

SPEAKER_00 4:48

Running an ABA clinic is the most simple way, two components: the clinical components and the practice management, what we call the business component. Usually the clinical component is where we lean more towards this, the the users, the BCBAs, the RBD, what are the pain points, what are their needs. We're actively listening to them, we're actively listening to the market, to the industry, the changes in trends. This is a fairly new industry, so it keeps evolving very fast. And also the technology, it's it's evolving very fast, allowing us to do things that 10 years were inimaginable. We couldn't do it today. We have the technology. Now, on the other side, we also lean towards some other type of partners which are more business oriented, but the combination of the two is what makes this industry pretty interesting. Because being a BCBA, being a clinician, like Jalen says, people who help people, it's one side of the story. Now, when you go and you try to make that of a business and organization, then you have to bring in processes, you have to bring a different type of knowledge. And then as a business owner, which is probably leaning towards the clinical side, you have to wear multiple hats. You require, and we require, and we lean towards the experience of different types of people in different industries and how those come together.

SPEAKER_02 6:07

It seems like a core value for you guys, and I don't want to put words in your mouth, is listening and then applying. It's not it's not easy when you have a lot of different opinions. So, how do you decipher what is a pain point that you actually want to devote time solving in and what is somebody that is maybe it's not real but doesn't make sense for you?

SPEAKER_00 6:28

We listen to our customers because at the end of the day, they are the ones using our software, using our product. The challenging part, Holy, it's not taking their their needs straight from the customer. Because sometimes what they feel is the pain, but we try to listen beyond the pain and look for the cause. So you have one problem, but that's how the problem is manifesting. That's what's causing delays and bottlenecks in your operations or uh compliance issues. Okay, but what's the problem behind this? What is causing that? That's what we really try to focus, that's what we really try to tackle.

SPEAKER_03 7:03

But Holly, like you said, is truly a core value. It's what made the company what it is today. And so the trick has been how do we, as we move into new markets, how do we as we have more and more customers? Actually, just this week we crossed the 800 customer threshold. Um, but it's like, how do we do this at a larger scale without losing the heart of the whole point of like we built this for you? Um, and so part of it is like customer education. It's a balance of we want to give customers what they want, but sometimes they don't necessarily know what they want or what they think they want is not what they need. And so using our discretion as a software where we're a software company to really solve the heart of the problem versus just being a factory where we just we take requests and we deliver, because at the end of the day, that's not actually what's best for the customer either.

SPEAKER_02 7:52

And so oftentimes we know that when people need help, they can't pinpoint or articulate the why. And what's unique and where you sit with 800, congratulations, with 800 now ABA companies, is you can start to see the pattern as you're talking to your potential customers and listening to where they're still running into barriers with the tech that they currently have. How do you sit in that space as a partner to help them evaluate whether or not your tool or another tool is the right answer? What do you advise?

SPEAKER_00 8:26

We advise number one to research and don't take the decision of choosing your practice management. It's an important decision, okay? Don't take it too slightly. So it's an important decision, and they should research and ask questions. Not the needs of the present, but also the potential needs of the future. So we can ask questions, understand what they need today, but also what are the needs of the future. And we always encourage them: hey, give it a try, use it, see for yourself, ask questions, read documentation, look at videos, talk to other people in the field, refer to current customers, look at Google reviews. Charlie, what else?

SPEAKER_03 9:02

Yeah, I think the big thing is understanding what your core needs are for your business, not being short-sighted in that. So, like Hylu said, it's thinking about what you need today, but also what you anticipate you'll need down the line. And then understanding what your team needs are. I think the biggest thing, if you're asking how you can educate yourself, is the ability to try it. So often in ABA, there's not necessarily a free trial mentality. I think maybe because a lot of these companies are used to selling to much larger organizations or enterprise customers that they're forgetting those BCBA owners, the people who are saying, Hey, you know what, I really want to give a shot at running my own practice. I'm very passionate about this space. I need all the tools that I need to get in place. And they want to see whether something's gonna work for them. And just remember, us as well, anytime you see a demo, that's great. You get to see the product, but until you're touching it and you're clicking around in it, you don't know if it works for you. I've been in so many demos where I'm like, this is gonna transform everything. And then I get in there, I'm like, wait, I can't remember anything of what they've told me. So that opportunity to really actually use a product and see if it works for you. I think that's the best way to learn whether or not something works. Like use it for 30 days, use it for a period of time and see whether it's gonna work or not, versus trusting someone whose job is to sell you on the product to tell you all the great things about it. And I also think like ask those hard questions. Like we're very transparent. Our team doesn't have quotas. I tell them if if a product is not a good fit for someone, you need to tell them. Or we can say, hey, like here's where there are gonna be gaps for you, here's how we think it'll work for you in the meantime, but we never want to try and make someone feel like we're a good fit and then they are trying to run their business and find out that we're not a good solution. So I think just making sure that you like build relationship too with the people who are showing you the product is important.

SPEAKER_00 10:56

Yeah, that try before you buy approach, it's not new. It does have been in every single industry for decades now, and probably in software too, because almost in every other industry, softwares offer a free trial five days, sometimes with a limited features. We don't see that in the industry. We don't find it very common.

SPEAKER_02 11:16

And using a certain software, even if it's not functioning right, there is that fear of trying something new and then having that also not work out because it is a big expense to sometimes switch depending on how large you are. Um, it's a big investment in your time. And so the fact that you can try it before you buy it allows for there to be not only understanding how the tool works, but how is the customer service, how is the support there? Support is always more valuable than having all the features that could potentially be there. I'd love to hear more about what your take is on the level of support that's needed.

SPEAKER_03 11:54

We have a variety of ways that we tackle that because it is also such a personal preference. We find that the people who want to skip the demo and sign up for a free trial and get in there, sometimes those are more tech savvy or not necessarily looking to talk to someone. They don't want to be handheld, they want a product that works, that they can figure out, and they want resources available to them. So we have the full range. If someone is a little bit more requires hands-on or or wants someone to walk them through it, every single customer of ours who starts with a free trial, they're assigned one of our teammates that helps them through that onboarding period. So for 30 days, they can get on phone calls and and they'll actually go through and show them how to configure. We'll offer training. And then from there, we offer a live chat support, email support, and robust help center library. So you always have access to someone. But we really want to make sure in those first 30 days that they have the support they need. But for our teammates or for our customers who are saying, hey, like, I don't want to talk to anyone, we work really hard to ensure that we've got videos. We also think about all the different ways that people learn. So we have videos, we have clickable walkthroughs. I'm someone who give me the reins. I need the mouse myself, and I have to click it to remember. So we have clickable walkthroughs and then we have articles. So we're we're really thinking about yes, our focus is going into new, new states, but we need to ensure that the customers that we have are loving our software, are able to learn our software. And we know that in ABA, there unfortunately tends to be high turnover, or you're constantly adding new staff. Every single time you add a new staff member, they need to be able to learn that software easily. If every time you add someone, it's a whole new chore, that's a problem. So we're also thinking about how can we support your ongoing learning and maintenance of the product, not just in those first 30 days get you set up and then you're on your own.

SPEAKER_00 13:41

Biggest impact we might have when it comes to training is that fear from the business owner that now considering changing their tool, but they also need to take into consideration the implementation and the learning curve of their staff and how their staff is gonna feel and how they're gonna react to change. And that could go both ways: either really bad or it's really good. We have some client that said, I'm I want to switch to Office Puzzle because all the all the users are asking me why don't I use this? Because I'm using it somewhere else and it's easy. And then we have some other customers that are considering Office Puzzle because they've seen us online, they've had some interaction with us, but they're very afraid of making the switch because it's they will probably have to train or retrain their entire task force or their entire team in a new tool. So we try to make it as easy as possible. We try to focus on having a UI and a UX that it's a user interface and user experience that is very easy for them, very appealing, very modern.

SPEAKER_02 14:46

If you are aware that there is a high turnover industry, you can take steps. And it sounds like you have taken steps to at least make it easier when somebody leaves to have somebody else come in and have the same support that can get them up to speed. Um and let's talk about the uncomfortable and skepticism. And we're having coffee and I'm an owner and I'm a little skeptical about trying something new. How do you advise that I think through it so that I can get with the right partners?

SPEAKER_03 15:16

New can be scary. And sometimes people will stick with the familiar regardless of whether they're satisfied with it, because it's just a name that they know and they've seen for a long time. And let's not forget Office Puzzle specifically, we're not that new. We weren't flashy and you didn't know about us because we weren't putting ourselves out there and we were just kind of growing naturally where people would love us and find us and talk about us on our behalf. You want to be knowledgeable about if there's a new software, whether it's practice management or a new practice management or a different software in the ABA space. If it's brand new, you want to consider the viability of that company and the longevity of it. So that's something to be mindful of. We won't ignore that part. New can be scary because if it doesn't last, you've put all your eggs, all your data into this basket that might not last. So you do want to make sure that it's not just like shiny and new, but will disappear tomorrow. But I think that removing this expectation of just because I haven't heard of you before doesn't mean that you aren't a good fit for what my needs are. So if you start to break it down to functionality, support, and cost, what am I spending on this? Assessing each platform on those things without getting distracted by just like what everyone else is doing and really understanding what your practices' needs are and whether this is going to be a good fit for you.

SPEAKER_02 16:32

I think that's great advice. And I'm curious, if I am in a room where I'm assessing whether it's a demo or a conversation, who on my team do you think needs to be in the room?

SPEAKER_03 16:43

It depends on how large your organization is at the time. Like the smaller organizations, if you're say you're a BCBA owner and so you're you're kind of wearing multiple hats, you don't need to have a ton of people in the room. But if you're a bit larger and you know that you've got key stakeholders, I would suggest thinking about the different functions of the business. We kind of break it out into clinical, operational, billing, and compliance. And so if you've got people who are owners in those roles, because we're an all-in-one fully integrated platform, it's important to have buy-in from all of those roles. Another thing which I think people may not think to do is if you have someone who is really skeptical or they're resistant, bring them in early. Let them come in and challenge during the demo, during the trial, find all the things wrong with it, allow the company to support you and address their concerns versus finding something without them and then trying to shove it down their throat later. So I'd say it's just it's not just roles. So you have to think about the roles that you need in the room, but also the people who are going to be your champions and the ones who are gonna be your naysayers and having them involved early on to drive adoption because buying software and actually getting people to adopt software are completely different things.

SPEAKER_00 17:55

To add on what Charlene was saying, so I think there's probably a step before that. It's a very internal step for every clinic, which is assessing their own capabilities. So if you are a BCBA and you're going into this, you probably don't have all that business experience. So you probably need to bring somebody that is compliments you on that. If on the other side you're more business oriented, for sure have your clinical director in that room. Okay. If you are concerned, if maybe your struggles in the past are related to the compliance of the documentation, how efficient are your BDs or your RBDs in that process of creating the documentation? Have a couple of RBTs that want to pitch in and collaborate and participate in the decision-making process.

SPEAKER_02 18:39

It makes sense onboarding new clients. Do you recommend that they do have super users or champions of the people that are using it? How do you normally onboard or does it look different for different companies?

SPEAKER_03 18:51

The typical, like what is consistent across all the companies is that there's usually someone or a small handful of people who are administrative, whether that's like operational, clinical, but they're administrators of the product and they're getting the initial configuration in place. So what makes Office Puzzle really unique is not just that you've got the all-in-one product, like the platform across scheduling, data collection, notes, billing, all of that, but that it's configured where the data flows seamlessly. And then you also have checks in place. So we're actually configuring the product to your practices specific needs so that you can ensure that from the point that you get a new client and you schedule with them, that you're avoiding issues that will cause billing concerns down the line. So it's important that you've got someone to start with our team to understand what are your organization specific rules that you want to have configured. We help them get that in place. From there, it is somewhat company specific where they decide, I want to go and train everyone. So I'm gonna be the super user and I'm gonna drive adoption, or I want these handful of people to work with Office Puzzle to do that. And so that's why we want to build out this is not something we have yet, but we're working on building this very role-specific training so that if they wanted to do it on their own, there's a course that an RBT could take and you can assign it to that particular person. So we've got really robust training right now, but it's not necessarily broken out by role. We have our perspective of what works, but we also want to be very dynamic to what the specifics of that company are and how they want to drive their training.

SPEAKER_00 20:27

Yeah, we've seen holy that also the size of the practice, sometimes it matters on their internal capabilities also. There's also some industry-specific compliance and operational challenges. Like as we probably all know, the assessment cycle of a client is usually six months. So migrating a client from one platform to another in the middle of an assessment cycle could be a challenge. So some clients they prefer to do what we call a migration as the clients start to reassess. And there are some other clients that they do prefer to rip the band-aid off, say, okay, this is gonna be your last day, and that's when we're gonna change. And each approach has its own pros and cons, like everything. It depends also on the manpower they have and their you know their qualification and their experiences doing this. We say, okay, we're here to help. What is gonna work best for you right now in this process? You have the majority of your clients here, you have the majority there, what's your preference? Where do you feel you're gonna be successful? And then we'll we'll adapt. We get small clients, five, ten providers, those will usually migrate really fast. But now when you start talking about 50, 100, 200, 500 clients, then ribbing that bande is not as easy as it could be when you're smaller.

SPEAKER_02 21:50

I've been on the other side as a consultant helping migrate things over. And it's a big undertaking. That being said, you can't stay with. Bad tech if it's not working for you. And so it is an investment. But if you find the right partner who's able to walk through it with you and help rip the band-aid off, but then be able to also console you when the band-aid hurts when it's being ripped off, makes it better, right? I appreciate that because bad tech, we know, does not just waste time. It wastes a lot of money too. Money that you might not be seeing directly go out just your bank account, but also people leave because of bad tech. They get frustrated. I can't tell you how many times there have been companies when you look under the hood and they can't figure out what their RBTs are frustrated about, and you start talking to them and they say, Well, you know, I have to resubmit all of my notes. I have to do that, and I don't get paid for that time. It's frustrating to me because it's time that I'm not getting paid for and it adds up. And I also just feel really confused by this tech and I'm not able to do the work that I need to. And so I'm just looking elsewhere because this is one frustration I can, you know, get rid of. And companies don't necessarily hear that, but it is something I hear in interviews as well. I'm wondering from your own customer base, any stories you want to share that you've heard about the friction that can be caused by bad tech and lead to potentially staff turnover.

SPEAKER_03 23:21

Yeah, I love that you're sharing that, Holly, because we I I've had that theory for a while. We've gone to some sessions where they talk about staff turnover and burnout, and they link it to supervision, they link it to the field, all of these different things, which I think are the primary drivers. But then it's almost like the icing on the cake when you're dealing with these challenges in the field. And then at the end of the day, your software is a pain in the butt and you feel like you have two jobs because you have to actually do the session, and then you have to figure out how to remember how to do it all in the technology. You weren't hired to do that piece. So we actually did a session with one of the school programs and we did a walkthrough of what to look for when you're finding an organization to join. And we said, listen, you're not gonna hear this from anyone else, but think about the software that they're using. Are they using anything at all? Or do they expect you to figure this out with pen and paper? Is it easy to learn? Are they gonna help you train? Are they investing in it? That's a sign of what that company values. And if they're not giving you the tools that you need, like if Hilu was like, go grow this business, but you have no tools, figure it out. Like that's a sign of what the company is, right? So we were making the case that the technology that a company decides to implement is a sign of how they will value you in your role and what resources they'll offer to you. What we have seen at Office Puzzle is the opposite. Like I said, in Florida, grew completely word of mouth. We went to Fava, we did some things, but for the most part, it was an RBT saying, Will you use Office Puzzle? I want to work there. Or a BCBA joining a company and saying, I'll join you, but you need to implement Office Puzzle. So it was almost like the clinical staff word of mouth of like, you want me to work here? This is the technology that I want to have in place that was actually driving growth. I mean, think about how powerful that is if you've got technology that attracts talent. That's massive shortage right now.

SPEAKER_02 25:11

Wouldn't it be nice to see it on marketing where you can see the tech stack or in a job description? Because quite honestly, I do think that if that is a strength of yours and you have a really strong tech stack, it would help you if people are looking at different positions. There's nothing more frustrating than to get into an interview and then hear we're using Excel sheets.

SPEAKER_03 25:33

In other fields that it works that way. Like if you're hiring for a marketer and you interview a marketer, they're gonna ask you, oh, what tools are you using? And everybody's like, oh, well, you know, we have a hodgepodge of tools. They're not gonna want to work for us. Technology makes a difference.

SPEAKER_02 25:47

Yeah. That's a good point. Especially when we are short staffed all the time, adds up. There's some industries like UPS, for example, they'll look at down to the second. How long does it take for the driver to do this part of their job? And even if it's 30 seconds, they multiply it and then they fix the problem because they know even though it looks like a 30-second problem, multiply it is actually a very expensive problem, especially if it's causing frustration and turnovers.

SPEAKER_00 26:14

In ABA, we just need to add compliance on top of that. So it's not only operational inefficiencies, it's always the risk of compliance that the software could help.

SPEAKER_02 26:25

Let's talk about that. So I sat in a conversation with the OIG that was talking about looking at audits. And we know in this industry, audits are not going to decrease. Um, in fact, we expect them to increase. And there's not a lot of auditors that are full-time with a company, even though you have quality assurance, you typically it's on the clinical side and not necessarily looking at some of the requirements for insurance. And even if it is, I'm curious when you guys are looking at your tech and how it helps support that. What responsibility do you guys feel like taking on with your tech, if at all?

SPEAKER_00 27:06

There are some compliance, issues wholly that are very basic. I was in the OIG meeting in Vegas last month, and they gave a full presentation of what we found, where were the problems, the real problems, the potential ones. There are some of those problems that are very easy to solve with technology. Like one individual billing using a billing code that is not related to their credential. That's very easy for us to solve. We already have that, we've had it for years. It's it doesn't necessarily mean it's bulletproof. If somebody wants to do harm, they will, but the software can help you. One BCBA, it's tied to a specific set of billing codes that they can use, and that virtually removes the potential of mistake in that area. There are some other areas where you need professional judgment from the BCBA, even from the RBT at a lesser degree, but mainly from the BCBA. The software can help, technology can help, but it's that line where the professional is exercising the professional judgment. We help with formatting the notes, uh, you know, revising the grammar and and that is properly written, that the note is complete, that you're not missing a signature, you're not missing the participants, you're not missing the billing codes, you have the data, that the data is tied to the session. That's that's the easy part. The other component is where the clinical knowledge steps in, where we can also help, but then that's where the that's where the the beauty of the combination of a very powerful software with a very powerful professional that can leverage the technology to their advantage. So they don't have to be worried about the clerical stuff. They only need to be worried about the clinical component, which is basically what they were trained for. That's what they sign up for.

SPEAKER_02 28:48

What do you feel about overriding? So you use the word judgment. Um I'll throw out an example and don't feel like you you have to answer this if you don't want authorization codes, right? And authorization usage. In some platforms, you can override and say, Yes, I know we might be out of authorization, but I'm here. I'm gonna override it, done. And oftentimes those are the claims that don't get paid because they're overriding it because they're out, right? And there's a misjudgment in terms of how much time was allotted with that client, with that insurance for an assessment. Do you feel like it is a judgment call to override whether or not they have used their time, or do you feel like that's not a clinical judgment?

SPEAKER_00 29:33

That's an interesting question. In office puzzle, we have the guardrail, so you can input your prior authorization with the corresponding units for each billing code and potentially with all the requirements from number of hours per week, number of hours per day. It could be very, very detailed. Okay, if the prior authorization is entered correctly and all the sessions are recorded in the system the way it's supposed to be, the need for an individual to override, especially considering that we're talking about a six-month process, thousands of units across multiple building codes. Now, another component which is okay, what if the person that is driving the clinical process understands that the system it's not 100% what it should be because you just went through a transition from one software to the other because you have staff in training that they're not properly putting their units in the system or they're not doing it timely, that's where it becomes a little bit of a gray area. We say, okay, can you overwrite? Maybe it's ideal. I don't think it's ideal. I think that's one of those clerical components where the where the software, if we use it properly, can help. But at the same time, we're not gonna say, okay, you cannot ever override because that's very absolute. And then at the end of the day, what that translates into it's an individual that requires a therapy that doesn't receive the service because the software decided that you were over the units. And you and that might not be the case, it might just be that somebody put 44 units instead of putting four, and that's just one keystroke. So it's a very gray area. We push for the software because we know the software we test it and we run scenarios and we know the software is going to do the math correctly. Now the inputs are the ones that might, in some cases, justify the overriding. In this specific case, you know, in the case we're talking about prior authorization and number of units, and then the consequence of recoups or claims not being paid.

SPEAKER_03 31:34

There's responsibility shared all around. So there's the clinical responsibility of ensuring that you're staying compliant. There's the technology, there's a certain threshold of responsibility. It can't always be black and white, but we try and stay in our lane. We know what our expertise are. We are not clinical, we're not delivering the care. And so, as a technology, we don't want to veer over that. We want to put enough guardrails in place where we can alert you. Like you're gonna know that you're overriding it. It's not gonna happen accidentally. You're gonna say, Are you sure? And so we we don't want to be rigid to where we are saying we know that better than you, because we're here to support you. But we want to put enough guardrails in place. So we do try and and it's a constant debate internally too. Like our team is like, we should have this. And we're like, well, is that our choice or is that the clinician's choice? So we're it's a constant debate to make sure that we have that line. And then, like you said, the final step of that responsibility is like clear requirements from payers so that we know what needs to be built. Like we can build things to help solve these problems that we're running into. But if the requirements are not clear, then there's nothing you can build. You can only build the guardrails that we have in place.

SPEAKER_00 32:45

In in this particular case, Holly, that that you mentioned, which is very specific to the overriding of the number of units. I personally haven't seen a lot of overrides. And I think the reason for that, it's it's something that that we've been trying to do, which is when when you are on your last week of your prior authorization and you have a lot of units left that you have not used, that's too late. What we've tried is to be proactive, say, okay, you get 2,000 units for an X amount of time. It's very simple math, especially with the technology they'll have to considering that you cannot do more than six hours a day or more than 20 hours a week. All the different restrictions from the Medicaid, from the MCO, from the clinic's own internal policies that they don't want to so we can lay that out, and that's part of what we actually do. So it's probably why this question was a little bit off for us because we don't see a lot of that. But maybe the reason why we don't see a lot of that is because our customers they can see from day one, the minute you enter your PA, you plan your entire six-month cycle and you can monitor in real time this is how am I doing, this is my pace, and you can adjust the client is out for a couple of weeks because he was sick, wasn't the hospital. Maybe you need to play a little bit of a catch-up if the insurance allows for it, or maybe you just know that you're gonna just lose those two weeks, or the RBT was out. It could be both ways. The solution for that is just to be proactive.

SPEAKER_02 34:08

Sounds like there's a warning, like if you're running out of gas, it's up to you to pull over and make sure you don't actually run out of gas, right?

SPEAKER_03 34:16

Or so yeah, I know there are a lot of people who love data in ABA. When I was on another podcast, they're like, Oh, what's your favorite feature? And I brought this out because it shows the actual pace and then it shows your predicted pace. And anything that's showing predictions with red light, red, yellow, green, I'm like, oh my god, this is it's my favorite part.

SPEAKER_02 34:36

Yeah. A lot of color coding is something else that BCBA is like. And the classic, like, teach model of red, yellow, green is perfect. Yes, I could see that definitely being a solution. All right, we're gonna pivot a little bit. I want to talk about how software reflects choices. When you design a feature, you're making decisions about what is easier, what's easier, or what's harder for somebody to use. What choices do you deliberately make harder because you thought, let's just put a little extra layer, a barrier, not restrictive, but a barrier when you're making or helping them with decision making in the something that is repetitive in nature, that involves basic math with very clear rules, that's the perfect candidate for technology.

SPEAKER_00 35:23

They need to run this report every week. Why are we gonna make them go and click 20 times in a screen to do the same thing over and over? That's not good use of a BCBA or an admin or even an RBT time. That's that's not okay. So let's try to solve that with technology. I can give you an example: the workflow process of reviewing documentation. Okay. Uh there are certain areas of an appointment or progress note that need to be completed. You have the time in, the timeout, the building code, the data, the summary has to be completed, it has to be signed. We put a workflow process inside of that. So if your note is not signed, the software is not going to allow you to submit for revision because we know it's not complete. We don't need a BCB8, read the entire document, then realize it's not signed, so you wasted 10-15 minutes of your time at best. And then you have to reject the document and send it back to the RBT so they can fix it. That's technology 100%. If you're submitting something that is incomplete, we can catch it. We can say, hey, just complete it here. It's gonna take the two seconds, save them a lot of time. That's perfect sample. Now, if it's incorrect, if if the the the summary section is incorrect, then that's where we lean more on the BCBA because that's more clinical. But if it's incomplete, that's easy. You're not putting anybody in goods, you're not putting the notes, you're not putting the the dates, you're not putting the participants, you're not putting environmental changes, you're not signing, or even the summary section, it's incomplete because you wrote it and then accidentally you deleted and you didn't realize. So you click somewhere. No, that's not.

SPEAKER_02 36:51

Yeah, and so documentation's a a great example. I think um we've all heard it said in HR. If it's not documented, it didn't happen. We know that's the case here in ABA as well. Is AI going to change documentation and billing? Do you think in the next two years, what do you think is gonna happen?

SPEAKER_00 37:12

We're going we're going a little bit of in into the magic bowl here because we we don't know. Okay. AI has been doubling their capacity the last time I checked every six, eight months. So and the the the prior time that I checked was doubling like every year. So probably now it's doubling capacity every five months. There are gonna be many things that are gonna change. We already see they're changing, and we can use AI for many things. Anything that is repetitive in the documentation, you could you could basically look for specific words going back to that OIG and all the compliance, everything that it's not that it's like recreational activities, AI could find those type of words, everything that could resemble or could be misinterpreted as a group activity when you are in a session, AI could also pinpoint and detect that. Then on the you also asked on the billing side, right?

SPEAKER_01 38:09

Yeah.

SPEAKER_00 38:10

The billing is also one of those, the CMS 1500 or EDI electronic version. There is a lot of information in there. A lot of information that not necessarily changes over the the life cycle of the client, the customer inside the platform. It's this is what I personally call like pass-through information, like your diagnosis, your referring physician, that that type of information, it has to be included in a claim, but you don't necessarily work with that type of information every single day. So AI can help you, and technology in general, just AI makes it easier, can help you to separate those and say, okay, this is information that has to be there, but it's kind of static. So when you're day to day, that becomes a little bit of a noise that you don't need. So you can use technology and specifically AI to carve out that information, say, okay, let's place this directly into the claim. We know that's not changed. We're working with this BA, this authorization, this diagnosis since day one. And that happened like three months ago. Let's focus on the session. Time in, time out is all the documentation or we have for ABCs or all the good stuff, the one that is actually changing, right? And I think AI is gonna, it's it's already doing. I know I'm not I'm not gonna say it's gonna do, it's already doing a great job.

SPEAKER_03 39:23

People are using AI for all different things right now, and people are using it outside of products. There is individual preference, like individual users can leverage AI to do the work that needs to be done. We don't want to replace the clinician. So we're not looking to say, hey, like instead of using the clinician's brain to decide what the service plan and the note summary should be, the clinicians do the job that they want to do. But how can we minimize your need to learn software? In a perfect world, the clinician can say, I want to create this thing. They don't need to know where to click, they don't need to know what to do, they don't need to know our tool. They just need to know what they're trying to accomplish and then allow AI to act as that software expert is the feature of AI. Whereas right now, I think it's being used in this really small way of like, just make me the perfect note. Do that part of the work. Don't learn the software. Why do you need to spend your time learning how to use clicks? And that also allows us to quickly evolve the software without having to worry about people remembering where things are. Like one of the challenges when you're building software is if you you want to improve it, but if you change where a button is, people go crazy, right? Why did they do this? Why is it on this side instead of that side? So we can evolve and improve software so much quicker if we didn't have to worry about people having to learn it. I think that that's how we are trying to be innovative with it is let AI do the work that we don't want or need clinicians to do, but let them continue to do the work that matters.

SPEAKER_00 40:49

I see how AI is evolving, and it it kind of reminds me a little bit when we had to put the address on the GPS, this is where I want to go, and you have to type everything. And now you say, Hey Siri, give me directions to A, B, and C. And Siri will say, Okay, like you didn't give me a zip code. So I have two options A or B. In the future, you probably have AI agents inside of every single server. Say, hey, this is what I want to do. And and they say, this software is not capable of doing that, or say, okay, this is how you do it. You want to create an appointment, okay. Tell me which day, tell me what time. So you don't have to click, you're gonna replace the clicking for instructions. That's what I'm envisioning.

SPEAKER_02 41:27

Yeah. No, we just have to go do it. That's a world sign me up because if I don't have to be an expert in all things, and not only do I not be an expert, but I can rely that the software knows I'm not an expert and will say, Do you mean this or do you mean that? Because I I think it also opens the door. I talk about being autistic quite often. A large piece of being autistic is a communication barrier. And what I love TAC and AI offers is there are times when we don't know that we're not being clear. It makes sense on our side of the conversation. But when you have an AI say, well, let me just clarify, it is helpful because you just don't push forward then assuming you know when you don't. So I like that. You guys mentioned earlier this kind of checks and balances. I could see where this is an exciting time to be in tech and uh you can really do some cool things.

SPEAKER_00 42:19

It's an exciting time to be a less, I think. Yeah.

SPEAKER_02 42:23

It's exciting to be more human in a weird way, right? I don't want to ignore the fact that that now 800 practices that you're working with is no small number. My favorite question that has that kind of data is to dig into it a little bit. I would love to hear what you've learned about ABA practices when you lift the hood and looking into their businesses and what's important.

SPEAKER_00 42:49

The combination of and the business component. I think that's the most interesting, amazing, and at the same time challenging component of an ABA clinic. I'm gonna talk based on my experience, but a lot of our customers are clinicians first. Passionate people that want to help others, they want to truly make a difference in the world for for their professional vocation, for sometimes for exposure to family members or other people close to them that require this type of service, and they end up being amazing clinical professionals. But that's not a business owner. Sometimes they do not have the training and the experience. So that's very interesting because you're basically stepping into a different world, and then all of a sudden you find yourself wearing different hats, playing clinician in the morning, playing business owner in the afternoon, and two very different worlds. It doesn't mean that they cannot coexist, they do. There are thousands of successful practices of ABA in the US of all different sizes, and we see them popping up all the time. There's a real need for this service, so I'm sure they're gonna succeed and thrive. But that doesn't remove the challenge. That's the big one. Then the other one, it's especially when you grow and you start going into multi-payer or multi-state practices, different payers operate with slightly different rules. Compliance is so important here that you have to be mindful of that. You have the compliance layer related to the clinical component, but do you also have the compliance layer related to the payer component? Then you have the compliance related to the business. Because the minute you have employees, you have employment loss and you have taxes and you have financial management, you have human resources management, and you have cash flow management, and you have billing practices, and then you have on top of that all of this very good stuff that we love, and we play with them day in, day out, but they're complicated in nature and you require training. For example, my background is not clinical, so I struggle in the clinical component. That's why we have clinical people. And my ground is more in business and operation. That's where I bring some value and have different types of conversation with our clients. Those are the big ones.

SPEAKER_03 45:05

I want to add to that just in case Hylo scared away a bunch of people from starting their own practice, is that's where we see ourselves as being able to support you and your partner. It could be a very lonely thing to go off and start your own business. And if you're coming from a clinical background, you're not necessarily expected to know how to do all of that. But we've seen now 800 of these businesses going. We've seen some that work and some that don't. Hilo is an experienced business professional. We view our team as that back office support. So if you're going off in business on your own as a clinician, you need all of this other support. And where we don't have the expertise, we find partners that we can refer you out to. We had someone who called and said, Oh my gosh, I need a biller. And right away I texted like three people in the team. Hilo's like, hold on, I'm literally standing next to someone right now. We got them connected, and within an hour, he had a biller. We have partners who are accountants and finance, and we try and bring those resources. So we've got the technology, but we also are thinking about what content can we help create? What kind of guide can we build? One of the things we built was if you are gonna switch technology, and and our own customers could use this. We gave them a whole guide on how to think about switching, assessing technology, how to drive adoption, the communication templates to send to your team for training. At the end of the day, it's like we want to give resources to people. We look at it, we're your back office support. We're not gonna pretend to be clinical. Hylo and I are not clinicians in ABA. Neither of us like we're like, oh, wait, we're gonna be in ABA. Like we're here by pure luck. But we bring certain expertise to this field so that we can then learning from our customers and learning from being in general, how can we bring those skills, the customers that we serve?

SPEAKER_02 46:42

I'd love to get that, first of all, so I can link it in somewhere for listeners to have it. I'd love to get that resource. But what I'm hearing from both Hilu and you, Charlene, throughout this is you don't have to do it alone. And quite frankly, it's worse if you do. I like the message of you're not saying don't do it. You're just saying do it mindfully. And it's something that people who really care and are passionate need that reminder of you don't have to do it alone, and there are people who want to take care of you too. Yeah. Um, and that's okay.

SPEAKER_00 47:13

There are tools out there. Some people don't know that there are tools. We have this conversation like, are you a data collection system? Yes and no. We are a data collection system, but we're way more than that.

SPEAKER_02 47:25

So I appreciate that. And I appreciate the fact that something I really value about ABA Cures and the speakers who are coming, the sponsors who are coming, and also the attendees, is this idea of if it's not me and we're not the right person, I'll connect you to the right person. I'm so happy to have you in the sponsorship family because that is something that that we really value is putting out good in the world, making sure it's not self-motivated. I feel like we talked about a lot, and I'm sure there's more that's going to be discussed on your panel, the hidden cost of bad tech. And I'm excited to be in that room and and hear more, um, peel back the onion more than what you guys have already peeled today. And if there's anybody listening to this who's going to the conference or who just wants to reach out on LinkedIn, what advice do you have for them when they're prepping to talk to you?

SPEAKER_03 48:16

Well, you don't have to prep to talk to us. We're we're super nice. So people who'll be there, come say hi. I love, I love talking to people and meeting people. Prep yourself in the sense that you're not going to be sold to. When we're at these events, we want to hear, learn from you, hear what your needs are. And if you ask us questions, we're going to answer, give you all the information. But I would say get to know people at these events and don't be afraid that you'll be sold to it. We'll probably have some fun swag to give away.

SPEAKER_00 48:45

Don't be afraid to ask. The worst thing that could happen is the answer it's no, we cannot do that. But with the technology we have today, chances are that almost everything is possible. And if it's not possible now, it's probably possible in the near future.

SPEAKER_02 48:58

So it's always good to talk to people who are willing to listen. And so thank you for both sharing and and talking. The thing about tech in ABA is that it's either the reason your team can do their best work, or sometimes it's why there's sometimes a resume like we spoke about earlier. Thank you, everybody. Find Office Puzzle at the summit in Boston August 4th through 7th. They'll be on the panel like we discussed, and they'll also have a booth right when you walk in. So go meet them, say hi, and we'll see you in Boston or on the other side of the live stream. Thanks for listening.

SPEAKER_00 49:32

Thank you, Holy.

SPEAKER_02 49:33

Thank you.