Three things actually differ, and the rest is naming
Vendors sell specialty editions, which implies the underlying system is different for each one. Mostly it is not. What genuinely differs, and what you should check on any platform, comes down to three axes.
How time becomes units. This is the biggest divide. Physical, occupational and speech therapy bill timed codes, so minutes convert to units under Medicare’s 8-minute rule or the AMA rule of eights, and getting the remainder wrong is a claim-level error repeated across every visit. ABA counts differently again, in session time against an authorization. A system that treats a unit as a flat quantity you type in will be wrong in both directions, quietly.
What a defensible note contains. A SOAP note, a DAP note and a trial-by-trial data sheet are not formatting preferences; they are different evidentiary artifacts, and the one your payer expects is the one an audit asks for. Note structure travelling with the specialty rather than being a text box is the difference between an audit that takes an afternoon and one that takes a quarter.
Whether authorizations gate the work. In ABA and early intervention an authorization is the thing that makes a session billable, and running out of authorized hours mid-month is a revenue event rather than an admin one. In cash-pay massage or acupuncture there is frequently no authorization at all, and the equivalent question is whether the patient gets a superbill they can submit themselves.
Everything else (scheduling, client records, invoicing) is broadly the same work with different vocabulary. Where a vendor’s specialty edition is only different vocabulary, that is worth knowing before you pay for it.
The thing that is true of all of them
No specialty on this list gets claims sent to payers from inside the product. What leaves is charge data, one row per session with the fields a claim form needs, and your biller takes it from there; the CMS-1500 field guide shows what each of those fields is. A practice that files its own claims electronically should weigh that before anything else here.
Set it up for your specialty
14 days, no card required. Use made-up patients while you evaluate: real patient information waits until a business associate agreement is in place.