The Leak Map

Where ABA revenue actually goes.

A claim denial is the last event in a chain, not the first. By the time it happens the money has usually been gone for weeks. These are the seven stages where it leaves, in the order it leaves them, and the number that tells you whether it is happening to you.

Authorization burn

Sessions get delivered against authorizations that are exhausted, expired, or were never right. The clinician did the work, the family got the service, and none of it can be billed. This is the most expensive leak in ABA because the cost is fully incurred before anyone discovers the revenue is not there.

We measure it as a reservoir, and the reservoir is almost always smaller than the authorization. If a client is authorized for 100 hours a week and the guardian will only agree to 20, the reservoir is 20. That is the water you actually have. The other 80 hours are a number in the system that nobody is going to deliver.

Owners already staff to what the client actually needs, not to the authorization. The reservoir is that number, written down. It is the real ceiling on what a client can produce, which makes it the only honest basis for a revenue forecast — and the gap between the authorization and the reservoir is the one leak on this list you close by delivering more care instead of by recovering money.

The reservoir — authorized hours narrowed to guardian-agreed and analyst-approved, vs scheduled and delivered

Cancellations

Every cancelled session is capacity you staffed and did not sell. Provider cancellations are worse than client cancellations because they are yours to fix, and they are usually the ones nobody is counting separately.

Not all of it is recoverable. Where authorizations run week to week, the units do not roll forward — a session cancelled this week cannot be made up next week, and that revenue is simply gone. Counting it as recoverable is how practices end up planning against money that was never coming.

Cancellation rate by provider and by client · target under 5%

Session conversion

A session happens. Nobody converts it into a billable entry. It sits in the schedule as completed work that the billing system has never heard of. Practices routinely carry weeks of this and only find it at month end, if at all.

Completed and unconverted, aged by day · target 1–2 days

Conversion to billed

The entry exists and is correct, and still has not gone out the door. Every day it waits is a day of the timely filing window spent, and some payers are unforgiving enough that a slow week becomes a permanent write-off.

This is biller lag, and it is the one number that tells you whether the person doing your billing is keeping up. It is also the last stage a practice can fix on its own, without a payer on the phone.

Biller lag — converted and unbilled, aged by day · target 1–2 days

Clean claims

The percentage that pays on first submission. Anything below the mid-nineties is a rework tax you are paying twice — once in staff hours, once in the delay. Rework also hides the real problem, because a claim that eventually pays looks fine in a collections report.

First-pass clean claim rate · target 95%

Rate integrity

Three numbers should match: the rate in your contract, the rate loaded in your system, and the rate the payer actually pays. When they drift apart, you underbill quietly and forever, and no report flags it because every individual claim looks like it paid in full.

Contracted vs loaded vs paid, by payer and code

Recoupments and write-offs

Money that arrived and then left again, and money written off as uncollectible that was never actually chased. Both distort every other number on this list, which is why the books have to be right before any of the rest of it can be trusted.

Recoupments, overpayments and bad debt as a % of collections

You cannot fix what you have not measured.

The Leak Map Assessment puts a dollar figure on each of the seven stages using your own trailing twelve months. Three weeks, a fixed fee of $7,500, and a report with a fix list ranked by what each fix is worth.

It is not a claims audit. A claims audit starts after the session is converted and reconciles claims to cash. That is real work and we do it, but it is the back half of the cycle. The Leak Map runs the whole thing, and the three stages ahead of billing — the reservoir, cancellations and biller lag — are usually where the larger number is hiding.

It also separates what you can still recover from what is already gone. Capacity lost to week-to-week authorizations does not roll forward, and anything past the timely filing window is a write-off, not a receivable. You should know which is which before you plan around it.

The report is yours either way. If you decide to fix it with us, we start from the fix list instead of re-scoping.

Book a 20-minute fit call

Twenty minutes to find out whether this is a fit. Not a strategy session — we will not have your numbers yet.

Leak Map — trailing twelve monthsSample

Annualized value at stake

01 · Authorization burn118,400

02 · Cancellations74,900

03 · Session conversion41,200

04 · Conversion to billed22,650

05 · Clean claims — 88.4%63,180

06 · Rate integrity29,470

07 · Recoupments17,900

Total identified367,700

Of that total

Not recoverable — week-to-week authorizations(59,000)

Gone — timely filing lapsed(67,400)

Actually recoverable$241,300

Sample figures, illustrative only. Not every leaked dollar comes back — the assessment separates what you can still recover from what is already gone.