Every ABA agency plans around authorized hours. Very few get paid for all of them. The gap rarely shows up as one big problem. It shows up as a cancelled session here, an unfilled schedule slot there, a note that never got signed. Added up over a year, it’s often the biggest leak in the business.
Three numbers, one funnel
Think of utilization as a funnel with three levels:
- Authorized: the hours the payer has approved for each client.
- Delivered: the hours that actually happened.
- Billed and paid: the hours that turned into revenue.
Most agencies track one of these well. The money is in tracking all three, side by side, and asking why each step is smaller than the one above it.
To be clear, this isn’t about second-guessing clinical recommendations. That’s your clinical team’s call. It’s about making sure the hours your clinicians recommended and the payer approved actually happen, and actually get paid.
Leak 1: hours that never get scheduled
Some authorized hours never make it onto the calendar. Usually it’s staffing: not enough RBTs in the right area at the right times. Sometimes it’s a schedule that fits the family once and never gets revisited, or a new authorization that sits for weeks before services start.
What helps: a weekly view of scheduled hours against authorized hours for every client, so the gaps are visible while you can still fill them, plus hiring plans built around where the unfilled hours actually are.
Leak 2: cancellations
Cancellations are part of ABA. But they’re not random. They cluster by family, by clinician, by day of the week and by season. Agencies that treat them as bad luck tend to have more of them.
What helps: track every cancellation with who cancelled and why. A clear, kindly-worded attendance policy that families understand from day one. A simple process for offering make-up sessions where the authorization allows. And a look at staff-side cancellations, which are often a sign of a scheduling or retention problem rather than a one-off.
Leak 3: delivered but never billed
This one hurts the most, because the work was done. A session note isn’t finished, a signature is missing, the authorization lapsed a week before the session, the service code doesn’t match what was approved. The hour happened, and nobody gets paid for it.
What helps: a short daily or weekly check for sessions that were delivered but haven’t been billed, with a named owner for clearing them. Most of these are fixable if they’re caught in days rather than months.
Leak 4: authorizations that run out unused
Authorizations have start and end dates. When reauthorization paperwork starts late, there can be a gap in coverage, and hours in that gap are either not delivered or delivered at risk. When an authorization ends with hours left on it, that capacity is simply gone.
What helps: a calendar of upcoming authorization end dates, reviewed well ahead of time, and a running view of hours used against hours remaining for each client.
Making it visible
The fix for all four leaks starts the same way: seeing them. When an owner can look at one screen and see authorized, delivered and billed hours by client, by clinician and by clinic, the conversations change. Problems that used to surface months later in the bank account show up the same week.
That’s the work we do with owners. We build the view, find the biggest leak, and work it with your team until the numbers move. A healthy agency knows its utilization and reviews it every week.