Who owns the authorization calendar
Ask an ABA practice who owns authorizations and you will usually get a list of four people, each of whom owns part of it.
Intake obtains them. The BCBA writes the request. The biller notices when one has run out, generally because a claim denied. The office manager tracks the renewals, sometimes, in a spreadsheet that lives on one laptop.
Four people own part of it. Nobody owns whether it worked.
The difference between doing it and owning it
This distinction is worth being precise about, because “we have someone on authorizations” is technically true in every practice that has ever had a denial.
Doing it means completing the tasks: submitting requests, filing approvals, entering units into the system.
Owning it means being accountable for a number — that no session is delivered outside a valid authorization, and that no authorization expires with unused units on it. Those are two different failures and they are the whole stage.
You can have all four tasks performed diligently and still fail both numbers, because the tasks are sequential and nobody is looking at the sequence.
The two failures
Delivering outside the authorization. The session happens. The cost is fully incurred — clinician wages, drive time, supervision. The revenue was never available, because there were no units, or they were the wrong units, or the span had ended. There is nothing to appeal. You worked for free and paid for the privilege.
Letting units expire unused. The authorization covered 20 hours a week for six months. You delivered 13. Those seven hours a week did not roll over, are not recoverable, and quietly told the payer that your clinical request was larger than your clinical need — which makes the next request harder.
The first failure costs you money now. The second costs you money now and credibility later.
What ownership involves
Four things, and only four.
Knowing every active authorization’s span, code set and unit allowance, in one place. Knowing burn rate against each — units used over units available, against time elapsed. Triggering the renewal early enough that there is no gap. Escalating a mismatch between authorized and delivered before the span ends, not after.
That is it. It is not a full-time job for a practice of forty clients. It is about ten minutes a week if the data is in one place, and about six hours a week if it is not, which is why it usually is not being done.
The one report
Every active authorization, one row each, with seven columns: client, code, span end date, units authorized, units used, percentage of span elapsed, percentage of units used.
Then one derived column: the difference between those last two percentages.
Illustrative arithmetic, not a client engagement.
Anything near zero is fine. That client is burning units at the rate the span assumed.
A large positive number is a client who will run out early. C-117 has used 94 percent of the units with 26 percent of the span left — that is three weeks of sessions with nothing to bill them against, and the renewal needs to go in this week.
A large negative number is a client whose authorization is going to expire with units on it. C-131 is the one flagged, and by a distance: 252 unused units with three weeks left. Some of that is a schedule problem, some of it is a clinical question, and all of it is going to be in the next re-authorization request whether anyone thinks about it or not.
Why this report and not a renewal calendar
Because a renewal calendar only catches one of the two failures, and it catches it late.
A calendar tells you a span is ending. It does not tell you the client blew through the units in month two, which is the expensive one. And it does not tell you that a client is at 37 percent, which is the one that damages your standing with the payer.
The gap column catches both, in the same glance, weeks before either becomes urgent.
Five checks you can run this week
1. Ask four people who owns authorizations. If you get four answers, you have found the problem and you do not need to read further.
2. Build the seven-column report. If it takes longer than an afternoon, the data is not in one place, and that is the real finding.
3. Sort by the gap column, both directions. Positive means running out early. Negative means expiring unused. Both need a name against them this week.
4. Check every authorization ending in the next 30 days for whether a renewal has actually been submitted, not planned.
5. Count sessions delivered in the last quarter with no valid authorization on the date of service. Multiply by your blended rate. That is the number that makes this a ten-minute weekly job instead of an idea.
The number to actually track
For every active authorization, the gap between percentage of span elapsed and percentage of units used.
Large positive means the client runs out early. Large negative means the authorization expires with units on it. Both need a name against them.
A renewal calendar catches one of these, late. The gap column catches both, early.
Where this sits
This is the second of eight stages where ABA revenue leaves. Stage 01 is the reservoir — what a client will realistically receive. Authorization burn is what happens when delivery and authorization stop lining up.
Ownership is what separates a practice that has an authorization problem from one that had one.
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.
