What speech therapists need from their software, from sources outside FreshBooks and outside Nexa:
Disclosure first: this page is published by the maker of Nexa, and we have no third-party test of either product with a speech-language pathology practice. So this read rests on what each product lists and on what Medicare requires of SLPs, not on outside endorsements. FreshBooks does the billing side well for a solo practice: it is easy for non-accountants, has built-in time tracking, a strong mobile app, professional invoice templates and a client portal. The $43 plan covers 50 clients, but archived clients count toward that cap, so a caseload with steady turnover has to delete clients, and their records, to free slots. It also offers a 30-day free trial, a 30-day money-back guarantee and free phone and email support during the trial. What its feature list does not show is anything built around the Medicare rules SLPs work under. Private-practice SLPs who see Medicare patients must enroll and cannot use private-pay arrangements with those patients the way physicians can. The practice therefore needs to track enrollment status and which clients are beneficiaries. It also needs plan-of-care certification dates and physician (or, where state law allows, NP or PA) signatures, which are due within 30 days and periodically after that. Each visit needs a place-of-service value, and home-visit mileage and travel time cannot be billed to Medicare. License status also has to be tracked per clinician. FreshBooks lists no such fields.
Nexa covers general business needs: invoices, estimates and payment plans, a client pay portal through your own Stripe account, time tracking, expenses, bank reconciliation, profit and loss, receipt scanning, and a public booking page with intake forms and reschedule links. For home visits, its jobs feature has costing and profit per job, and each day's stops can be sent to Google Maps in time order. That could help keep travel cost separate from billable sessions in your own books. Its CRM has tags and notes, which you could use to flag Medicare clients by hand. That is a workaround, not a record of enrollment, certification dates or signatures. Nexa has no Medicare tracking, no plan-of-care records, no place-of-service field and no license tracking. A client record has no street-address field. It has no QuickBooks or Xero sync and no hosted support desk or vendor-run onboarding, because you own and run the software yourself. Its automated emails, including appointment reminders, send only while Nexa is open on one of your devices.
Over three years FreshBooks at $43 a month comes to $1,548 ($516 a year). Nexa is $279 once, or 3 payments of $99, and $458.64 over three years if you add Cloud Sync at $4.99 a month to use more than one device. Nexa is much cheaper for general bookkeeping, but price is not the deciding issue for this trade. A practice that bills Medicare needs enrollment, certification and place-of-service records that neither tool provides. It should use practice-management software built for therapy billing and clinical records, and keep either tool, if any, for general bookkeeping. A cash-pay practice with no Medicare patients can reasonably stay with FreshBooks for its support and polish, or move to Nexa to cut cost if it can live without a support desk and accounting-software sync.
Our read for speech therapists: Neither FreshBooks nor Nexa tracks Medicare enrollment, plan-of-care certification, place of service or clinician licenses, so a Medicare-billing SLP practice needs therapy practice-management software, and a cash-only practice can simply stay with FreshBooks.
Read on each linked page in October 2026. Check them again before you decide; vendors change plans often.
FreshBooks costs speech therapists $516/year at today's list price. Nexa is $279 once for invoicing, scheduling, CRM, time tracking and accounting in one suite — so after 6.5 months it has cost less than FreshBooks, and you own it after that. What it is not: hosted-for-you software with a support desk and a roadmap you can lobby. That is the trade, and the rest of this page is the detail behind it.
Nexa is $279 once, about $23 a month over its first year. Its Drain Guard reads your expenses (from a linked bank, an imported statement, or ones you type in), finds the charges that repeat, and adds them up by the month. Keep or Cut then walks you through them one at a time. Cancel $23 a month of charges you'd forgotten about and Nexa has paid for itself inside the first year, before you count the FreshBooks bill you'd stop paying.
It depends on what you find and what you cancel, so we don't promise a number. In our demo data, Drain Guard finds 5 subscriptions adding up to $110.13 a month. That is sample data, not a customer's.
The verdict for speech therapists: Neither FreshBooks nor Nexa is the main system for this work; start with software built for it. Nexa only makes sense beside it, at $279 once against $1,548 for FreshBooks over three years.
Scheduling, client records, invoicing and time tracking are the pieces of that day. Some tools rent you each piece separately. A few — Nexa among them — bundle the lot and carry their own booking link, with no per-appointment cut. The sections below price both routes honestly.
None of that is a software problem you can buy your way out of in one click — it is why the tool you pick matters more than what it costs. FreshBooks solves some of it. So does Nexa. The difference is what you are left holding in three years.
Today's list price is $43/month — $516 a year, from FreshBooks's own pricing page. Every figure below is that price, multiplied. Nothing is projected.
Nexa: $279 once (or 3 × $99). Over the same three years, that is $1,269 less.
If FreshBooks raises its price, the three-year cost goes up; if it cuts it, the cost comes down. We don't guess which. Add-ons, extra seats and card-processing fees are not included, on either side.
| Feature | FreshBooks | Nexa |
|---|---|---|
| Invoicing | ✓ | ✓ |
| Scheduling | ✗ | ✓ |
| CRM | ✗ | ✓ |
| Time Tracking | ✓ | ✓ |
| Full Accounting | ✓ | ✓ (SIMPL) |
| Task Management | — | ✓ |
| Works offline | — | ✓ |
| Price | $43/mo | $279 once or 3 × $99 |
| 3-Year Total | $1,548 | $279 |
| You own it? | No — stop paying, lose access | Yes — forever |
✓ and ✗ for FreshBooks come from its own published feature list. — means the feature isn't in that list, which is not the same as FreshBooks lacking it: check with them. Three years is at today's price.
Straight from FreshBooks's own feature set. If one of these is the reason you pay them, that reason does not disappear because Nexa is cheaper.
FreshBooks is the better call if you need very user-friendly for non-accountants specifically, or if your team is large enough that per-seat pricing still beats buying software outright.
FreshBooks says it is "perfect for everyone from self-employed professionals to growing business owners." It lists four audiences: freelancers, solopreneurs, businesses with employees, and businesses with contractors. (freshbooks.com)
What people outside FreshBooks and outside Nexa say:
Read on each linked page in October 2026. Check them again before you decide; vendors change plans often.
Software doesn't do the actual work — it automates the business around it. And that part is the same for every speech therapist: find the work, manage it, bill for it, get paid. Each step has a tool — and the right single tool runs the whole loop, so the handoffs are automatic and you get back to the actual work. Tap a step to see what gets automated.
An inquiry becomes a proposal becomes a signed engagement — the terms and the retainer set.
The work you're paid for — with the hours, tasks, and expenses tracked against the engagement instead of reconstructed at month-end.
The work becomes the invoice — the hours, the add-ons, the materials, the deposit credited — totaled and sent, instead of re-typed at 9pm.
Paid by card or link, the deposit credited, and what's overdue chased — without you doing it by hand.
You can stitch four separate subscriptions across these four steps, or run one tool that does the whole flow so a booking becomes a job becomes an invoice becomes a payment without re-typing. Either way the goal is the same: less time on the business of the business, more on the actual work. (Nexa is built to be the one — but the honest options for each step are above and below.)
This is the connection that makes the rest worth it. A speech therapist's job already holds the services, the hours, the add-ons, and the materials — so the invoice builds itself from the work instead of you re-typing it at 9pm. Toggle an add-on or nudge the hours and watch it recompute.
You didn't write this invoice — the job did.
FreshBooks plus whatever else you're paying for:
Email yourself this comparison?
The median speech therapist earns $55,000/year. At $516/year, FreshBooks is a recurring slice of that — paid again every year, whether the year was good or not. Owning the same jobs outright is $279 once, and the slice stops.
Nexa is $279 once. Invoicing, scheduling, CRM, time tracking, accounting — all connected, built for speech therapists. You own it like you own your Assessment tools and materials.
An honest fit check — because the wrong tool is worse than no tool.
The honest fit: if you're a solo or small speech therapists business that owns its tools and is sick of renting software, Nexa replaces your whole stack for $279 once. If you're scaling into a large team with dedicated admin staff, a bigger platform may fit better — and we'd rather tell you that now than sell you the wrong thing.
Your people are already online — swapping real numbers, tool picks, and war stories. Here's where to find them.
Active community — tool picks, pricing, and day-to-day questions.
Open on Reddit →Active community — tool picks, pricing, and day-to-day questions.
Open on Reddit →Active community — tool picks, pricing, and day-to-day questions.
Open on Reddit →Scheduling, client records, invoicing and time tracking are the pieces of that day. Some tools rent you each piece separately. A few — Nexa among them — bundle the lot and carry their own booking link, with no per-appointment cut. The sections below price both routes honestly.
Most of my caseload is children, with some adults recovering from strokes or working on voice and fluency. A new client starts with an evaluation: standardised tests, observation and a conversation with parents or family about what they're seeing, which takes an hour and a written report. From that I set goals, specific and measurable, like producing a sound correctly in words or following two-step directions, and plan therapy around them. Sessions are usually thirty to forty-five minutes, and with young children therapy looks like play, because a game keeps them practising far longer than drills. I take data every session on how often they get it right, because progress has to be shown, not assumed. Families get home practice after each session, since what happens between visits matters as much as the session itself. Documentation is heavy: session notes, progress reports and plan updates, especially where insurance pays. Billing means checking coverage, submitting claims and handling denials, or private pay. I keep my licence and certification current with continuing education.
Real speech therapists near you who run their business on Nexa — book directly, no platform fee. Are you a speech therapist? Post your business and get found in your area — $2.99 one-time. Or browse every speech therapist on Nexa →
The tools of the trade — each a one-time buy that earns its keep for years.
You paid for these once because good tools last. That's the bar your software should clear too — priced like a tool you own, $279 once, not a subscription that costs more than your kit every year.
We build a speech therapist's guide the same way every time, and we'd rather you trust it than take it on faith. Nexa is our product, so the test we hold ourselves to is simple: a tool only "wins" a job here when it genuinely does that job better for a speech therapist — and where something free, open-source, or buy-once does it better, we say so and link you to it. Where Nexa falls short (payroll is the honest example), we name the alternative outright.
Found something out of date? Prices change and we don't catch every move the day it happens. This guide is published and maintained by the Nexa team; if a figure here is wrong, tell us and we'll fix it — getting it right matters more to us than the sale.
For solo speech therapists and small teams, yes. invoicing, scheduling, CRM, time tracking, task management, and full accounting — all for $279 once. FreshBooks may be better if you have a large team (10+) or need enterprise-specific features.
FreshBooks has features like Very user-friendly for non-accountants and Built-in time tracking that some businesses rely on. For most solo speech therapists, these aren't dealbreakers.
At $43/month, Nexa pays for itself in 6.5 months. After that: $516 saved every year.
Yes. Nexa is $279 as a one-time payment, or 3 payments of $99 ($297 total). Either way it's a one-time purchase — no subscription, no recurring fees ever.
Own your tools. Stop renting your software.
Get Nexa — $279 Once