Authorized units in the denominator
Understates NCR; hides unit leakage.
FixContract value is delivered units times rate; track authorization utilization separately
Guide · ABA billing KPIs
ABA gross collection rate: how to calculate it, and why net on contract value is the number to manage
Short answer: GCR is payments over charges; NCR is payments over what you were owed. For ABA units paid off a fee schedule only a contract-value NCR shows the claims nobody answered.
97153 · 4 units
Indiana $15.39/unit · Apr 1, 2027
NCR on contract value · the one to manage
Edition
1 · 2026
Focus
ABA billing KPIs
Audience
ABA groups · CFO
Metric
NCR on contract value
Codes
97153 · 4 units
States
IN · NY · WA · MO
53.5% vs 100%
GCR vs NCR, one fully paid Indiana 97153 hour at a $30 charge (illustrative) [1]
$5.05M
Never answered in our multi-state ABA diagnostic [case study]
65.8%
True first-pass yield there once silent claims counted as failures
2.2pts vs 0
GCR and NCR movement at Indiana's April 2027 phase, fully paid hour [1]
Same hour, same payer, two numbers
One technician hour, four units of 97153, Indiana Medicaid FFS, $30 charge per unit [1].
GCR against NCR on contract value, one hour of 97153
DOS from April 1, 2026paid in full, $64.16
GCR 53.5%$64.16 of $120
NCR 100%all owed
DOS from April 1, 2027paid in full, $61.56
GCR 51.3%-2.2 pts
NCR 100%no move
April 2027, one unit deniedmodifier error, $46.17 paid
GCR 38.5%$46.17 of $120
NCR 75%$15.39 short
025%50%75%100%
Gross collection rate (payments / charges)Net collection on contract value (payments / units x dated rate)
NCR on contract value = payments÷delivered units × dated rate per payer and code
Gross, net on allowed, net on contract value
| Measure | Gross collection rate (GCR) | Net collection rate on allowed | Net collection on contract value |
|---|---|---|---|
| Formula | Payments received divided by gross charges, same period | Payments divided by (gross charges minus contractual adjustments) | Payments divided by (delivered units times the contract or fee-schedule rate for each payer) |
| What it answers | How far your charge master sits above what payers pay | How much of the contractually allowed amount you collected | How much of the money you earned by delivering units you actually collected |
| Where it misleads | Falls when you raise charges, rises when you lower them, with no change in cash | Only as good as the adjustment codes; silent claims never post an adjustment | Needs a contract table by payer, code and date of service |
From session note to NCR, and where each miscount enters
Top row: how contract value is built. Lanes: where each of five miscounts enters.
- 1Session recordDocumented start and stop times [3]
- 2Delivered unitsUnits rendered, not authorized
- 3Dated rateBy payer, code and date of service
- 4Contract valueUnits times rate: the denominator
- 5Payments by service monthMatched to month of service
- 6NCR on contract valueBy payer and cohort; silent claims stay open
Units billed, not documented
Over-billed units inflate charges and value
Authorized, not delivered
Understates NCR, hides unit leakage
One rate, all payers and dates
Wrong by the size of each cut
Month received, not service month
Ratio swings for months
Silent claim counted as resolved
No denial, no payment: $5.05M in one diagnostic
Build stepsWhere a miscount enters
Not arithmetic errors: denominator errors
No denial code read as collected
Overstates first-pass yield; unanswered claims look fine.
FixUnanswered claims stay open against contract value until paid; see the silent receivable diagnostic
Month received, not month of service
A cut or a slow payer swings the ratio for months.
FixReport by service month (cohort) and let each month mature
One rate across payers and dates
After Indiana's phased cut or New York's October 1, 2026 97153 change, the denominator is off by the cut [1] [2].
FixA dated contract table by payer and code
Units billed, not documented
Missouri: units match documented start and stop times, one line per code per day [3].
FixBuild contract value from the session record, then compare with the claim
GCR falls; NCR should not move
If NCR moves after a cut, something operational happened: remits below schedule, a late table load, or transition-month claims.
GCR, Indiana 97153 hour
Fully paid, across the April 1, 2027 phase [1]
53.5%Apr 2026 rate$16.04 per unit
51.3%Apr 2027 rate$15.39 per unit
NCR on contract value
Same hour, rate loaded on the right date of service
100%Apr 2026 rate$64.16 owed
100%Apr 2027 rate$61.56 owed
Four steps, in order
1
2
Report NCR by service month and payer3 months either side
A transition-month dip that recovers is a loading issue; one that persists is a payment issue.
3
Reconcile remits line by linefirst 60 days
Underpayments against the new rate are the one thing a rate cut should never add.
4
Rebase budgets on delivered units at the new ratethen margin
Levers in the 2027 margin playbook; unit yield decides margin after a cut.
Six monthly KPIs that make the rate readable
| KPI | Definition | Why it pairs with NCR |
|---|---|---|
| Authorization utilization | Delivered units divided by authorized units in the period | Separates units never delivered from units delivered and not paid |
| Unit-to-claim lag | Days from date of service to claim submission | Late claims depress cohort NCR early and inflate it later |
| First-pass yield on contract value | Contract value paid on first submission divided by contract value billed | Counts silent claims as failures, which a denial rate does not |
| Denial rate by root cause | Denied units by reason over billed units | Tells you which control to fix: authorization, modifier, enrollment, documentation |
| Remit-to-schedule variance | Paid amount minus dated schedule or contract amount, by payer | Catches underpayment after a rate change |
| Days in AR on current book | Open contract value over average daily contract value, excluding legacy balances | Legacy balances make the whole book look slow |
Takeaway
A denial is a payer talking to you. A silent claim is worse, and only a contract-value denominator makes it visible.
Six checks
Ask which rate the board slide usesGCR: which charge master? NCR: which contract table and date of service?
Count delivered units from the session recordNot authorized or billed units; Missouri's start-and-stop rule [3].
List every claim with no payment and no denialAge it against contract value: the silent receivable.
Re-cut the last six months by service monthLet each cohort mature; rate changes are in the Q4 2026 rate tracker.
Add the six paired KPIs to the monthly packQuestions per KPI: evaluating ABA billing services; templates: ABA RCM toolkit; or let the ABA billing team run it.
Frequently asked questions
What is the formula for ABA gross collection rate?
Gross collection rate is payments received divided by gross charges for the same period. In ABA it mainly measures how far your charge master sits above fee-schedule and contract rates, so it falls when a state cuts rates or when you raise charges, without any change in how well you collect.
What is the difference between ABA gross and net collection rate?
Gross collection rate uses gross charges as the denominator. Net collection rate uses the amount you were contractually allowed, either gross charges minus contractual adjustments or, the version we recommend for ABA, delivered units times the dated contract or fee-schedule rate for each payer. Net collection on contract value is the one that shows whether you collected the money you earned.
Why does our ABA collection rate look fine when cash is short?
Usually because claims that were never answered are being counted as resolved. A claim with no denial code and no payment has contract value and no cash. Report net collection on contract value by service month and treat unanswered claims as open until paid.
How should an ABA group read its collection rate after a Medicaid rate cut?
Expect gross collection rate to fall by about the size of the cut and stay there. Net collection on contract value should not move if the new rate was loaded with the correct date of service. If it falls, look for remits below the new schedule, a late table load, or transition-month claims billed against the old expectation.
- Indiana IHCP bulletin BT202627, IHCP announces changes to applied behavior analysis (ABA) therapy services (February 26, 2026)
- New York State Medicaid Update, August 2026, Volume 42 Number 9: Reimbursement Change for Unlicensed Individuals Providing Applied Behavior Analysis Services
- MO HealthNet hot tip, Important Information for Documenting and Billing for Applied Behavior Analysis Services (September 9, 2026)
- Washington State Health Care Authority, Apple Health ABA fee schedule effective July 1, 2026
Checked October 27, 2026. Confirm against the source; proposed rules are marked proposed.
Want your collection rate rebuilt on contract value?
We load your dated payer rates, rebuild net collection by service month and payer, and show the units never delivered and claims never answered.