Authorization burn rate

Lock the authorization cohort first

An authorization is a scoped record. Capture the member, payer and product, service or code, provider constraints, approved units, effective dates, frequency limits, location or modality rules, and current status. Amendments and extensions need their own dates and evidence.

The HealthCare.gov preauthorization glossary explains that preauthorization can be required before care and does not promise that a plan will cover the cost. Operational teams should keep authorization, benefit, claim, adjudication, and payment states separate.

Use a reproducible formula

A basic delivered-unit burn rate is:

delivered authorized units through the measurement date ÷ total authorized units

An elapsed-period rate is:

elapsed eligible days through the measurement date ÷ total eligible days in the authorization period

Compare the two only after applying the same date convention. State whether the first and last dates are included and whether planned closure days affect the elapsed denominator.

Convert time and units before comparing

Payers may authorize hours, 15-minute units, visits, or another measure. Store the source unit and conversion rule. Sixty minutes equals four 15-minute units, but the claimable result can still depend on code, service date, aggregation, rounding, and payer instructions.

Keep scheduled, delivered, documented, released, submitted, and adjudicated units in separate fields. A scheduled hour has yet to become a delivered hour.

Forecast remaining capacity

Start with authorized units minus valid delivered units. Divide that remainder by eligible weeks or days left to produce a neutral pace indicator. Then test the forecast against client availability, clinical recommendations, staffing, setting access, supervision, holidays, and expected absences.

Avoid changing clinical dosage solely to make the graph land at zero. A qualified clinician decides whether the care plan should change, while operations surfaces the evidence and scheduling options.

Explain variance instead of chasing a target

A lower-than-planned burn rate may reflect a delayed start, illness, cancellations, staffing gaps, family availability, school closures, authorization errors, or changed clinical need. A higher rate may reflect a front-loaded plan, calendar pattern, unit conversion error, duplicate count, or added clinical need.

Assign each variance a reason, owner, next action, and review date. Route clinical questions to the qualified clinician and payer-rule questions to current payer evidence.

A fictional authorization example

Milo has a fictional authorization for 480 fifteen-minute units across 12 weeks. At the end of week four, 144 units are validly delivered. Unit burn is 144 ÷ 480 = 30%. Elapsed-period rate is 4 ÷ 12 = 33.3%.

The difference is 3.3 percentage points. That figure describes pace rather than under-service. The remaining 336 units over eight weeks equal a neutral planning pace of 42 units per week, or 10.5 hours, before the team considers Milo’s plan, availability, staff, holidays, and payer rules.

Use cohort measures carefully

For a dashboard, report authorizations whose burn forecast was calculated divided by authorizations due for review. Keep missing and held records in the denominator. Segment by service, unit type, payer, effective-period stage, and variance reason.

Useful companion measures include authorization days remaining, units remaining, scheduled-unit coverage, delivered-unit pace, cancellation units, and unresolved discrepancies. Counts beside percentages make small cohorts visible.

Handle amendments and partial periods

When a payer changes approved units or dates, keep the earlier authorization version and its effective period. Recalculate the forecast from the amendment’s actual scope rather than overwriting history. Identify any units transferred, replaced, or left under the prior version.

For a midperiod start, use the first eligible service date only when the governing authorization and workflow support that convention. A late first visit does not necessarily change the payer’s effective date. Display calendar elapsed rate and active-service elapsed rate as distinct measures when both help the team.

Open documentation or correction work can make delivered units provisional. Publish the amount awaiting review beside the locked amount and state when the cohort matures. Never allow a late record to vanish from the worklist because the reporting period closed.

Questions owners should ask

Ask which event moves a unit into the numerator, which authorization version governs, how voided sessions are removed, and when documentation changes the count. Confirm the timezone and inclusive-date rule.

Review who receives an alert, who can alter a schedule, and who can make a clinical recommendation. Set alerts early enough for payer follow-up and family discussion.

Before acting on an alert, sample the underlying service dates and authorization version. A forecast built from duplicated units, an expired period, or unresolved documentation should stay provisional and carry a named reconciliation owner.