Reservoir by client, not by payer
Your practice runs a 70 percent reservoir.
Useful sentence. Describes nobody.
The average is made of two piles
Take two clients. Both authorized for 20 hours a week of direct treatment. Same payer, same code, same span.
Client A is a four-year-old whose parent works from home, lives eleven minutes away, and has done four afternoons a week for eight months without a gap. Client A does 18 hours.
Client B is a nine-year-old in school until three, whose family drives forty minutes each way, and who has an older sibling with a competing schedule. Client B does 8 hours.
Average the two and you get 65 percent. Neither client is at 65 percent. Nobody is at 65 percent. You have produced a number that describes a family that does not exist.
That would be a harmless bit of statistics if you were not making decisions with it.
What the average hides
Three things, and each one costs money.
It hides which clients to re-authorize lower. Client B is authorized for 20 and doing 8. That authorization is going to expire with twelve hours a week of unused units on it, and the re-authorization request is going to ask for 20 again because that is what the last one said. Nobody notices, because in aggregate the book looks fine.
It hides which clients have room. Client A is at 18 of 20 and possibly needs more. In aggregate, the practice looks like it has slack. In reality the slack is all on the wrong client.
It hides the trend. A book drifting from 75 percent to 65 percent over six months is a real problem — it usually means either cancellations are climbing or new starts are not converting. But if the whole book moves together in the aggregate you cannot tell whether twenty clients slipped a little or four clients fell off a cliff. Those have completely different fixes.
The distribution is the report
Illustrative arithmetic, not a client engagement.
Six clients out of forty are carrying 142 authorized hours a week and using 68. That is the whole conversation. It is invisible in “the practice runs 70 percent.”
Those six clients are not one problem either. Some of them need a lower re-authorization so the payer relationship stays honest. Some need a schedule change. One or two are probably about to discharge and nobody has said so out loud.
The only hard part
Building this takes fifteen minutes once the realistic-hours column exists. The hard part is the conversation afterward, because the under-50 band is usually where the awkward clients live — the family everyone likes, the referral source’s nephew, the client who has been on the books since the practice opened.
The distribution does not tell you what to do about them. It tells you that six of them exist and that they are collectively 74 unused hours a week, which is about $290,000 a year of authorized capacity nobody is going to use.
Whether that becomes a discharge, a schedule change, a lower re-authorization or nothing at all is a clinical and relationship call. It just should not be an accident.
Five checks you can run this week
1. Build the distribution, not the average. Four bands is enough. The bands are the report.
2. Read the bottom band by name. Six clients is a list you can hold in your head. Somebody should own each one by Friday.
3. Check the top band for clients who need more hours, not fewer. Above 90 percent utilization against authorization usually means the authorization is too low for the clinical need.
4. Run the distribution twice, three months apart, and look at movement between bands. Clients sliding down a band are the early warning; the aggregate will not show it for another quarter.
5. Before the next re-authorization request goes out, check the client’s band. Asking for 20 hours on a client who used 8 is how you end up with a payer who scrutinises every request you make after that.
The number to actually track
The distribution of reservoir ratio across four bands, by client, refreshed quarterly.
Pair it with movement between bands. Clients sliding down a band are the early warning; the practice average will not show it for another quarter.
A single practice-level ratio describes no client you have and supports no decision you need to make.
Where this sits
This is the first of eight stages where ABA revenue leaves, and it is the one everything downstream is measured against. The reservoir is what a client will realistically receive. Every other stage is a gap between that and what was collected.
Everything downstream is measured against this number, so getting it wrong at the client level puts an error into every stage below.
A Leak Map Assessment measures all eight — the reservoir, authorization burn, cancellations, session conversion, conversion to billed, clean claims, rate integrity and recoupments. A claims audit is a different instrument. It starts once a session has been converted and billed, and reconciles the back half of the cycle to cash.
Aimline closes the books, oversees the revenue cycle, and sits in the CFO seat for ABA practices. We run claims audits scoped to a payer book, and Leak Map Assessments that measure the full cycle — three weeks, $7,500 fixed. Either one gives us a verified number to run oversight against, and the report is yours whether or not you engage us to fix what it finds.
