The Guide.
Everything we know about where ABA revenue goes, organized by the stage it goes missing. Written from the inside of real practices, not from a podcast.
Eight chapters, not a stream.
A blog decays — the best piece scrolls off the front page and dies. The Guide has eight chapters, matching the eight leaks exactly. Every new piece slots into the stage it belongs to instead of landing on a pile.
The Leak Map is the table of contents. Each leak links into its chapter.
See the Leak Map
The reservoir
What a client will actually receive.
The Guide · Chapter 01 of 08 · Four piecesThe number in your system is not the number you can bill
An approval for 100 hours a week is permission, not a forecast. Here is the number that is.
Read more →What your schedulers already know that your forecast does not
The front desk knows who shows up next month. The forecast never asked.
Read more →Staffing to the authorization is how you end up overstaffed in March
Hiring to approved hours puts people on payroll for work that was never coming.
Read more →Reservoir by client, not by payer
A practice-wide average describes exactly none of the families you serve.
Read more →
Authorization burn
Units authorized, scheduled, delivered.
The Guide · Chapter 02 of 08 · Four piecesThe units were gone before anyone looked
Sessions against a spent authorization cost full price and pay nothing. There is no appeal.
Read more →Who owns the authorization calendar
In most practices the answer is nobody. That is the whole problem.
Read more →Re-authorization is a revenue event, not an admin task
The gap between approvals is unpaid work or undelivered care. Choose one on purpose.
Read more →The three authorization errors that survive every audit
Wrong code, wrong span, wrong units. All three look fine on the approval letter.
Read more →
Cancellations
Capacity you staffed and did not sell.
The Guide · Chapter 03 of 08 · Four piecesA 5 percent cancellation floor, and what the gap above it is worth
Some cancellation is structural. The gap above the floor is the part with a price tag.
Read more →Your provider cancellation rate is a hiring metric
Client cancellations are demand. Provider cancellations are supply, and supply is yours.
Read more →Make-up sessions that never get made up
The offer to reschedule ends the phone call and never reaches the calendar.
Read more →The cancellation you can make up, and the one that is already gone
Two sessions cancel in the same hour. Only one of them is still money.
Read more →
Session conversion
Work the billing system never heard of.
The Guide · Chapter 04 of 08 · Four piecesThe sessions your billing system has never heard of
The session happened, the clinician got paid, and no claim exists.
Read more →Completed and unconverted, aged by day
The report your practice management system does not have, and should.
Read more →Why conversion lag is a clinical workflow problem, not a billing one
Friday notes for Monday sessions are a scheduling decision, not a character flaw.
Read more →The month-end discovery problem
Finding unconverted sessions at close means finding them after the cheap fix expired.
Read more →
Conversion to billed
The filing clock.
The Guide · Chapter 05 of 08 · Four piecesThe last stage you can fix without a payer on the phone
Everything after this needs a payer to act. This one only needs you.
Read more →What a percentage-of-collections contract actually incentivises
Your biller is paid on what comes in, not how fast. Usually that is fine. Usually.
Read more →Biller lag, measured properly
Converted and unbilled, aged by day. The report nobody hands you.
Read more →Your biller’s real number is not the collection rate
A collection rate grades the claims that went out. It ignores the ones still sitting.
Read more →
Clean claims
The rework tax.
The Guide · Chapter 06 of 08 · Four piecesThe rework tax nobody books
First-pass failures cost staff hours and delayed cash. Neither shows up on the P&L.
Read more →Denials do not originate in billing
A denial is where the error surfaces, not where it happened.
Read more →First-pass clean claim rate, and the mid-nineties floor
What good looks like, and two innocent ways the number gets flattered.
Read more →A claim that eventually pays still cost you twice
A 97 percent collection rate can sit on top of a rework problem and never show it.
Read more →
Rate integrity
Contracted, loaded, paid.
The Guide · Chapter 07 of 08 · Four piecesAgreed rates, not billed rates
Two CentralReach fields look like the same number and are not. Every revenue report picks one.
Read more →Credentialing level is where the money goes
One service mapped to the wrong level bills wrong on every claim, forever.
Read more →What happens to your rate table when a contract renews
The amendment gets read, gets agreed, and never gets loaded.
Read more →Three numbers should match, and nobody checks
When contracted, loaded and paid drift apart, every claim still looks paid in full.
Read more →
Recoupments and write-offs
Money that arrived and left.
The Guide · Chapter 08 of 08 · Four piecesWhy your collections report looks fine while cash is tight
Your A/R report says one number and the bank says another. The bank is usually right.
Read more →A write-off is a decision, not an outcome
Letting A/R age past timely filing is a choice to overstate the balance sheet.
Read more →Overpayments belong in liabilities
A payer credit balance sitting in revenue is a recoupment you already spent.
Read more →The A/R number a buyer will not accept
Diligence treats unreconciled receivables as worth nothing. Plan accordingly.
Read more →