You treat patients. Someone else pays the bill.
Medical, dental, and veterinary practices. The work happens in one system, the money arrives in another, and almost never in the amount you billed.
You will recognise this if…
- Your PM or EHR system says one thing and your bank says another
- Insurer payments arrive weeks late, short, and bundled across dozens of claims
- Write-offs and adjustments are recorded somewhere, but nobody is sure where
- You cannot say which provider or which location is actually carrying the practice
- Patient balances and insurance balances sit in the same undifferentiated number
Why the close is hard here
These are the four things that most often make the monthly close wrong here — and what has to be true for it to be right.
Gross production is not revenue
You bill a fee schedule, the payer allows a different amount, and the difference is a contractual adjustment — not bad debt, not a discount. If those two are not separated, your revenue is overstated every single month.
Payments arrive bundled
One remittance covers many claims across many dates of service. Matching it back to the encounter that generated it is the reconciliation, and it is the part most bookkeepers skip.
Two receivables, one number
What a patient owes and what an insurer owes behave completely differently — different aging, different collectability, different follow-up. Held as one balance, neither is manageable.
Profitability lives below the P&L
The practice-level number rarely tells you anything. The decisions are per provider, per location, per service line — and that requires the chart of accounts to be built for it from the start.
What we do about it
- Monthly close reconciled to your practice-management system, not just the bank
- Contractual adjustments and write-offs separated from collections
- Patient AR and insurance AR aged separately
- Provider- and location-level margin reporting
- Chart of accounts rebuilt to support both
Covered here: Medical practices → · Dental practices → · Veterinary practices →
Questions we get asked
Do you work inside our practice-management system?
We reconcile to it. Your PM or EHR system stays the source of truth for clinical and billing activity; the accounting close is tied back to it each month so the two agree.
Can you separate profitability by provider?
Yes, provided the chart of accounts supports it. Where it does not, rebuilding that structure is usually the first thing we do.
Do you handle billing or collections?
No. We are not a revenue-cycle management company. We account for what your billing produces and make the results legible.
What about multiple locations?
Location-level reporting and consolidation are standard for practices running more than one site.
Not sure this is you?
Most owners sit across two of these. A short conversation sorts out which parts actually apply.
Talk to a finance pro →