When the news broke that North Carolina will slash Medicaid rates by 3% across all providers starting October 1, 2025 , ABA business owners felt the familiar punch of financial uncertainty. It wasn’t just the across-the-board 3% cut that stung. For ABA therapy, autism services are being hit even harder with reductions of up to 10% — an amount that could tip already fragile practices over the edge.
At 3 Pie Squared , we hear the same story every week: providers are doing incredible clinical work, but the administrative and financial burdens are getting heavier. Now, with statewide Medicaid cuts,...
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ABA practices can’t afford to keep “business as usual” systems. Something has to change.
That’s where we believe ABA providers have an opportunity — not just to survive, but to adapt in ways that make their businesses stronger, leaner, and more sustainable. And yes, billing is one of the most powerful levers you can pull.
The Harsh Reality of Medicaid Cuts
North Carolina’s Department of Health and Human Services estimates these cuts will reduce Medicaid spending by $319 million in the coming year. The new budget fell short of what was needed by nearly the same amount. While state leaders are hoping for future appropriations, providers don’t have the luxury of waiting and hoping.
For ABA providers specifically, here’s what these cuts mean in plain terms:
- Reimbursement rates shrink while costs rise. Your staff salaries, rent, insurance, and training don’t go down 10% just because Medicaid says so.
- Margins get razor-thin. Many ABA practices already operate on margins of 5%–15%. A 10% cut could mean no margin at all.
- Risk of provider exits. When rates don’t cover the true cost of service, some providers will pull out of Medicaid altogether, leaving families stranded.
We know that’s not what you want. And if you’re reading this, chances are you’re one of the owners determined to find solutions instead of walking away . That’s the spirit that inspired us at 3 Pie Squared to build a billing service with a very different philosophy.
Why Billing Becomes the Survival Strategy
Billing may not be glamorous, but let’s be clear: it’s where practices either leak money or capture every dollar they’ve earned. A denied claim here, a missed eligibility check there, a payment posting delay — those add up to thousands of dollars lost each month.
The difference between thriving and struggling often comes down to billing accuracy and efficiency. And yet, too many providers are stuck between two bad options:
- Do billing in-house with overstretched admin staff. They may mean well but lack the specialized expertise to manage denials, payer policy quirks, and compliance risks.
- Outsource billing to a faceless company. You hand over your claims, wait weeks for reports, and cross your fingers that the money comes in.
We’ve seen both scenarios play out, and neither sets ABA providers up for long-term success. That’s why we decided to offer something different.
Billing, the 3 Pie Squared Way
When we say 3 Pie Squared is offering billing services , we don’t just mean we’ll process claims. We mean we’re stepping into this role as partners . That word matters to us.
Here’s what makes our approach different:
- 2.99% of processed claims. That’s it. No hidden fees, no nickel-and-diming. You know exactly what you’re paying.
- Full-service billing support. From insurance eligibility checks to denial management and reporting, we handle the entire cycle.
- Direct human support. No call centers. You get a real person you can reach when you need answers fast.
- Training built-in. We don’t just want to do billing for you. We want to train your future in-house team if that’s your long-term goal.
- Leadership involvement. I (Stephen) am personally working side-by-side with our customers and our billing team during this Early Adopter Program. You’re not just getting a vendor — you’re getting our best.
This isn’t “outsourced billing” in the traditional sense. It’s more like adding an in-house team without the overhead — one that’s transparent, accountable, and committed to your success.
What’s Included at 2.99%
To give you a clear picture, here’s what’s on the table if you join our Early Adopter Program:
- Insurance Eligibility & Benefits Verification — Confirm coverage, copays, deductibles, and out-of-pocket directly with insurers.
- Accurate Charge Entry — CPT codes (97151, 97153, 97155, 97156, etc.) based on ABA documentation.
- Claims Submission — Electronic and paper, including secondary claims.
- Payment Posting — Detailed posting for insurance and patient payments.
- A/R Follow-Up — Monitoring and resolving unpaid or denied claims.
- Denial Management — Identifying, fixing, and resubmitting quickly.
- Reporting & Analytics — Clear reports on collections, denials, and performance.
- Customer Support — A dedicated person you can contact when you need help.
Every piece is designed to protect your revenue and free you up to focus on what you actually care about — providing quality services to families.
Why Now Is the Time
Medicaid cuts in North Carolina are a signal of what’s happening nationally: tighter budgets, stricter requirements, and more pressure on providers. We can’t control those external forces, but we can control how we respond.
For ABA providers, the smartest move right now is to:
- Secure your revenue. Make sure every claim is submitted correctly, every denial is followed up, and nothing slips through the cracks.
- Streamline operations. Reduce the hidden costs of inefficiency by working with a billing partner who is invested in your success.
- Plan for sustainability. Build systems that can grow with you, not ones that collapse under the weight of every new policy change.
At 3 Pie Squared , we’ve been committed for years to helping ABA providers build ethical, scalable, sustainable businesses. Adding billing to our services is just another way we’re keeping that promise.
The Personal Touch
If you’ve worked with us before, you know we’re serious about feedback. Here’s the deal: if you join this program and think, “Yeah, they’re good — maybe a 9 out of 10,” I want to know what it takes to make us a 10.
That’s not just talk. We’ve built everything we do — from training platforms to handbooks — by listening to providers like you and making improvements based on your real needs. Billing will be no different.
Early Adopter Program
Because I’m personally involved in the rollout, we’re opening this Early Adopter Program to a focused group of providers so we can give each one the attention they deserve.
If you’re interested, the next step is simple: fill out our quick intake form at 3PieSquared.com/billing-intake .
Final Word
North Carolina’s Medicaid cuts are a painful reminder that ABA practices can’t afford inefficiency. Every denied claim, every late posting, every overlooked eligibility check now matters more than ever.
At 3 Pie Squared , we believe providers deserve more than a “billing service.” You deserve a partner who will stand next to you in the hard seasons, help you weather the financial storms, and even train your replacement if that’s where your journey takes you.
So let’s do this differently. Let’s secure your revenue, cut unnecessary costs, and give your practice the breathing room it needs to keep changing lives.
Fill out the intake form and let’s start this conversation.
