The cancellation you can make up, and the one that is already gone
A tech is scheduled at four. At 3:40 the family calls off. Across town, a different tech calls off on a client who was ready.
Same hour gone. Same line in the cancellation report. Completely different economics, and only one of them is yours.
Two cancellations, two owners
Client cancellations are demand. Illness, transport, a sibling's schedule, a family that quietly decided three days a week was enough. You manage them. You do not control them.
Provider cancellations are supply. A tech called off, a BCBA double-booked, a session nobody staffed. Those are yours, start to finish.
Most practices count one number. The number that matters is the split, because only one half responds to anything you do internally.
The part nobody separates
Before the split, there is a harder line: does the hour roll forward or not.
Where an authorization is written for a period — a block of units over six months — a cancelled session is capacity that still exists. The units are sitting there. If you put a make-up on the calendar inside the period, you bill it. The revenue was delayed, not lost.
Where an authorization is written week to week, the units do not roll. A session cancelled Tuesday cannot be made up next Tuesday, because next Tuesday has its own units and they are already spoken for. That hour is gone the moment it is cancelled.
Counting the second kind as recoverable is how a practice ends up planning against money that was never coming.
What the arithmetic looks like
Round numbers, so the shape is visible. Forty active clients, a blended rate of $75 an hour.
Illustrative arithmetic, not a client engagement.
That is a 14 percent cancellation rate, which is ordinary in ABA and nowhere near a target.
No practice runs at zero. Families get sick. Five percent is a working floor. On 700 scheduled hours that is 35 hours a week you should expect to lose.
You are losing 100. The excess is 65 hours a week, or $4,875. Across 48 working weeks, $234,000.
That is the number at stake in stage 02. Not the full cancellation line — the part above a floor you could realistically hold.
Now split it
Say 45 percent of the book sits under week-to-week authorizations.
29 of those 65 hours are gone on contact. $104,400 a year that no process fixes, because there is nothing left to bill against.
36 hours sit under period authorizations. $129,600 a year that is still sitting in units, waiting on a make-up nobody scheduled.
The second number is the one to chase. It does not require a payer, an appeal, or a conversation with anyone outside your building. It requires someone to look at the units and put the hour back on a calendar.
Most practices do not have that person, which is why make-up capture in the field runs closer to 20 percent than 60.
Provider cancellations are the ones you own
Thirty hours a week of provider cancellations is $108,000 a year of capacity you staffed and did not sell.
Take that to 10 hours and you have recovered 20 hours a week — $72,000 a year — without adding a client, a payer, or an authorization.
There is a second cost that never shows up in a revenue report. A tech whose hours keep getting cut stops being a tech. A client whose sessions keep getting dropped stops being a client. Provider cancellations are the leading indicator for both turnover and attrition, and by the time they show up as either, the cancellation report is months of history.
Summer is the worst of it. June through August, cancellations run well above the rest of the year in most practices, and they fall off the week school resumes. If you are looking at a single quarter, look at which quarter.
Five checks you can run this week
You do not need anybody's help for these. One month of schedule data is enough.
1. Split the report. One column for client-initiated, one for provider-initiated. If your system cannot do it, the reason codes are not set up, and that is the first fix.
2. Rank providers by cancellation rate, not by cancelled hours. A part-timer with six cancellations on 20 scheduled hours is a bigger problem than a full-timer with eight on 120.
3. Rank clients the same way. The top five will usually be the same five every month, and they are a family conversation, not a billing problem.
4. Tag every active authorization week-to-week or period. Now your cancellation report has a recoverable column. It probably never has before.
5. Count make-ups. Cancelled hours under period authorizations that were rescheduled and delivered inside the period, divided by cancelled hours under period authorizations. That is your capture rate. Under 40 percent means the units are expiring quietly.
Check four is the one that changes how you read every other number here.
The number to actually track
Cancellation rate, split by provider and by client, against a target under 5 percent.
Paired with make-up capture rate on the period-authorization half. One tells you how much capacity you are losing. The other tells you how much of it you are going back for.
Tracking total cancelled hours alone is a vanity metric in the other direction — it looks alarming, it moves with census, and it never tells you what to do on Monday.
Where this sits
This is the second of seven stages where ABA revenue leaves. Stage 01 is the reservoir — what a client will actually receive. Cancellations are the gap between that and what landed.
You cannot read stage 02 cleanly without stage 01 underneath it. A cancellation against an authorization nobody was going to deliver is not a loss. A cancellation against the reservoir is.
A Leak Map Assessment measures all seven — reservoir, cancellations, session conversion, biller lag, clean claims, rate integrity and recoupments. A claims audit is a different instrument and starts at stage four, after a session has been converted and billed.
In most practices the larger number is upstream, before a claim exists to audit.
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.
