The month-end discovery problem
Close happens on the tenth. Somebody reconciles delivered hours against billed charges and finds 340 sessions that never converted.
Some of those sessions are from the 2nd. Some are from the 29th of the previous month. The oldest ones are thirty-nine days old and the person who delivered them has worked about a hundred and eighty sessions since.
Everything about fixing them is now harder than it was on day two.
What the delay changes
The clinician cannot remember. A note written on day 39 is a reconstruction. It will be thin, it will be generic, and if it is ever audited it will not hold.
The cause is cold. On day two you can ask why a session did not convert and get a real answer — the client’s authorization had a question, the supervisor never signed, the session actually got cancelled and nobody updated it. On day 39 the answer is “I don’t know, I’ll look.”
The window has run. A third of a 90-day filing limit is gone before the problem is known. On a 60-day payer it is two-thirds.
The volume is unmanageable. Three hundred and forty sessions is a project. Eleven sessions is a morning. It is the same work either way; the only difference is whether it arrives in a pile.
Why it stays at month-end
Because close is when someone reconciles, and reconciliation is where the gap becomes visible. There is no other moment in the month when anyone compares delivered hours to billed charges.
That is the actual problem, and it is a cadence problem rather than an effort problem. The work is not hard. It is just scheduled once a month by accident, because that is when the other work that surfaces it happens.
What daily looks like
Illustrative arithmetic, not a client engagement.
Eleven rows. One person, ten minutes, mostly resolved by a message to the clinician who was there yesterday and remembers.
The report is the same report. The query is the same query. The only change is how often somebody looks, and the difference between the top row and the bottom row is the difference between a project and a habit.
The part that makes it stick
A daily report that nobody owns becomes a daily email that nobody opens, and that is worse than monthly, because it creates the appearance of a control.
So it needs three things. A name — one person, not a team. A target — the oldest row under four days, say. And an escalation — if the oldest row passes seven days, it goes to the clinical lead by name, not as a statistic.
That is a control. Everything short of it is a mailing list.
What close is still for
Moving the check to daily does not remove it from close. Close is where you confirm that the daily process worked, which is a different question from whether the sessions converted.
At close you want two numbers: delivered hours for the month, and billed charges for the month, reconciled with the difference explained. If the daily process has been running, the difference should be small and every item in it should have a reason next to it.
If the difference is large at close, the finding is not the sessions. The finding is that the daily process stopped running, probably three weeks ago, probably when the person who owns it was on holiday.
Five checks you can run this week
1. Run the unconverted report today and look at the age of the oldest row. That number is your current cadence, whatever the calendar says.
2. Count how many rows are under four days old. That proportion is what a daily process would leave you managing.
3. Name the owner. One person. Write it down somewhere other than in a conversation.
4. Set the escalation threshold and route it to a person, not a report.
5. At the next close, reconcile delivered to billed and require a reason per item. An unexplained difference at close means the daily process is not running, and that is a more useful finding than the sessions themselves.
The number to actually track
Age of the oldest unconverted session, checked daily, with an escalation threshold at seven days.
Pair it with the delivered-to-billed reconciliation at close, with a reason required against every item in the difference.
A monthly count tells you the size of a pile you can no longer work cheaply.
Where this sits
This is the fourth of eight stages where ABA revenue leaves, and the last one that sits entirely with the clinical side of the house. Everything above it is about whether the session should have happened. This one is about whether it turned into anything billable.
Everything in this stage is a cadence problem rather than an effort problem.
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.
