You bill one amount. The payer allows less, and the deposit lands weeks later as one lump for forty claims. Our healthcare accounting services match every remittance to the bank. We post contractual adjustments, the gap between billed and allowed. Your books close by the 10th, with collections shown for each provider.
Collections ยท March close
Net collections $305,550
Certified on the platforms your business already runs on
A revenue leak in a practice rarely shows up as an error. It shows up as a full schedule and a thin bank balance. Or a provider who doubts their pay, or a payer that has underpaid a contract all year. Each one starts in the revenue cycle, the path from visit to claim to payment.
Insurers pay many claims in a single deposit. The ERA, the payer's 835 file that explains it, sits in your billing system, not your books.
What it costs you
The deposit posts as one revenue line, and a short or missing claim goes unseen.
The gap between your charge and the payer's contracted rate is never booked. Charges get compared straight to collections.
What it costs you
Revenue looks bigger on paper, and receivables include money no payer will ever send.
Insurance and patient balances sit in the practice system with no one sorting them by age.
What it costs you
Claims pass the timely filing limit, 12 months from service for Medicare, and patient balances turn into write-offs.
Allowed amounts slip below your fee schedule by a few dollars a claim, and no one compares the two.
What it costs you
A steady leak across thousands of claims that stays hidden unless someone looks.
Pay rests on production, collections or work RVUs (relative value units), but the reports behind it never tie to the books.
What it costs you
Providers are paid too much or too little, disputes follow, and good clinicians leave.
Copays at the desk, portal payments, HSA cards and payment plans settle on different days through different processors.
What it costs you
Patient collections never tie to the ledger, and small gaps pile up unseen.
Imaging units, dental chairs and lasers are expensed on purchase, or financed without the loan being tracked.
What it costs you
Depreciation is missed, loan balances are wrong, and the balance sheet undersells the practice.
A second office or a new associate shares the first office's books, so costs and collections are never split.
What it costs you
You can't tell which office or clinician pays its way before you hire or expand.
Patient and payer overpayments pile up as credits that are never refunded or applied.
What it costs you
Medicare overpayments carry a 60-day return rule, and old patient credits can fall under state unclaimed property law.
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Everything below sits inside one flat monthly fee. The fee is set once from your offices and providers, and claim volume does not move it.
Each claim followed from what you billed, to what the payer allowed, to what reached the bank.
What each clinician produces and is paid, and what each office costs to run.
The month closed on schedule, with revenue cycle numbers reported beside the statements.
We read reports from the practice system your front desk already uses and keep the books in QuickBooks or Xero. There is no data migration, no new login for your billers, and no change at the desk.
Tell us how many providers and offices you run. We check how collections, adjustments and receivables are booked and show where they fall short. A flat monthly quote comes with it. There is no charge, and nothing to sign.
Covered from day one
Each of these shifts a real decision: which payer to renegotiate, how to pay providers, and when to open a second office. The root is the same in all three. The deposit got booked, and the claim behind it did not.
| The mistake | What it causes | How we handle it |
|---|---|---|
| 01Booking insurance deposits as revenue | What it causesOne deposit covering dozens of claims hides underpayments, denials and missing claims. Nothing in the books traces back to a visit. | How we handle itWe match each deposit to its ERA, so every lump payment maps to its claims and any shortfall is visible. |
| 02Skipping contractual adjustments | What it causesGross charges compared to collections make it look like you have a collection problem you don't. Receivables sit at amounts no payer will pay. | How we handle itWe post the billed-to-allowed gap as a contractual adjustment by payer, apart from bad debt. Net revenue and A/R become real numbers. |
| 03Paying providers from unchecked reports | What it causesProduction reports that never tie to the books make pay impossible to verify. A disputed paycheck costs far more to settle than to prevent. | How we handle itEach month we tie production and collections by provider to the ledger, so anyone can check the figures behind pay. |
Medical practice accounting built from deposits alone can't show an underpaid claim. We reconcile at the remittance level, and a second person reviews every close. The fee does not climb with patient volume.
Statements show the month. These figures show where the revenue cycle is losing money and what to fix first.
Every month
Part of every monthly close, so staffing and claim follow-up use current data.
Measures: Paid vs the contracted amount owed
Why it matters: The truest test of the revenue cycle. Many billing benchmarks treat 95 percent or higher as healthy.
Measures: Days of charges still unpaid
Why it matters: A rising number is the first sign of a billing problem, weeks before it shows up as a cash gap.
Measures: Net collections by clinician
Why it matters: The fair basis for pay, and the clearest view of where the practice's time goes.
Every year
Reviewed each year, and the first thing a buyer or partner will ask to see.
Measures: Commercial, government and self-pay
Why it matters: Shows which contracts carry the practice and which are worth renegotiating or dropping.
Measures: Costs as a share of collections
Why it matters: Separates an office that is costly to run from one that is simply under-booked.
Measures: Net collections divided by visits
Why it matters: Tracks whether coding, contracts and service mix raise what each appointment is worth.
The difference between general and medical practice bookkeeping starts at the deposit. One posts it. The other opens the ERA behind it. Five rows show what changes.
Setup starts with how your practice bills and collects, and we change none of it. From the first full month, the close runs on fixed dates.
Day 0
Half an hour on how you bill and collect, then a look inside the ledger. We check how deposits post, whether adjustments exist, and how provider reports tie in.
The next day
You get a written monthly fee for all offices and providers. Catch-up work on past months, if any, is priced as its own project.
Day 2
Read access to the ledger, bank and practice reports is set up. The chart of accounts gets office classes before a single deposit is posted.
Weeks 1 and 2
Past deposits are matched to remittances and adjustments are posted. A/R is reconciled and equipment loans are tied out, so month one starts clean.
As ERAs post
Insurance deposits, patient payments, supply bills and payroll are coded as they land, not saved up for month end.
By the 5th
Deposits are tied to ERAs and adjustments posted by payer. Patient payments are traced from the practice system to the bank.
By the 8th
Someone other than the preparer reviews the close. A/R is aged, and production and collections by provider are tied to the ledger.
Close day, the 10th
The P&L, balance sheet and revenue cycle reports go out, with a note on which payers moved and why.
From here the cycle repeats each month, payer by payer.
We record these through the year as bills arrive, so nothing is rebuilt from bank statements in March. When your CPA starts the return, each item already has its invoice attached.
Clinical equipment listed with cost and in-service date, so your CPA can weigh Section 179 against bonus depreciation.
Gloves, dental materials, lab fees and other consumables used in care.
Professional liability, general liability and property coverage for each office.
Continuing medical education, board fees, DEA and state license renewals, and society dues.
Practice management, EHR, clearinghouse and patient portal subscriptions.
Rent, utilities, cleaning, medical waste pickup and upkeep for each location.
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Your entity type and how you practice decide which of these apply and by how much. We book each one correctly, and your CPA decides how it is claimed on the return.
Owners who moved their books to Twelix, on what changed afterward.
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Yes, it is the center of the work: every insurance deposit is matched to its ERA or EOB. An ERA is the payer's 835 file listing what it paid on each claim. Matching it to the deposit ties a lump payment back to the claims inside it. Anything short, denied or missing then shows up instead of vanishing into one revenue line.
Yes, access is limited to what the work needs, and Twelix is ISO 27001 certified, SOC 2 Type II audited and HIPAA compliant. Bank and ledger links use read-only feeds where the system allows. We work from deposit totals, remittance files and practice reports, not clinical charts. Ask on the review call how access would be set up for your practice.
Yes, we report production and collections per provider each month and tie them to the books. Direct costs such as an assistant or supplies can be assigned where your setup supports it. That gives you a checked basis for pay and a clear view of each clinician's share.
Yes, we work from reports in Tebra (formerly Kareo), athenahealth, AdvancedMD, eClinicalWorks, Dentrix and similar systems. Deposit, remittance and production reports become the source for revenue cycle data. The books stay in QuickBooks Online or Xero. Your front desk and billers change nothing.
Yes, dental practice accounting runs on the same monthly service. We tie production and collections from Dentrix, Eaglesoft or Open Dental to the books. Insurance adjustments post by payer, and patient payment plans are tracked. Doctor and hygiene production are split by provider. Groups with more than one office get a P&L for each office every month.
Healthcare accounting follows each dollar from charge to allowed amount to payment, which most businesses never deal with. That is why accounting for doctors and dentists needs its own process. Payers pay less than you bill, in lumps, weeks later. Adjustments, credit balances and provider pay all need their own treatment. A practice can look profitable on charges and still be short of cash.
A contractual adjustment is the gap between your charge and the amount a payer's contract allows. It reduces revenue and is not bad debt. On an ERA it usually carries reason code CO-45, charge exceeds the fee schedule. Without it, receivables sit at amounts no one will pay, and your collection rate looks worse than it is.
No, medical billing gets claims paid, and medical bookkeeping records what was paid and ties it to the bank. Your billing team or billing company codes and submits claims and works denials. We provide the healthcare bookkeeping support around it, and confirm that what they report as collected reached your account. The two fit together, and we do not replace your billers.
Our healthcare accounting services cost a flat monthly fee, set from your providers, offices, payer mix and entities. A heavy flu season does not raise it, and setup is free. Expect the number in writing within a day of the free review. Any catch-up on past months is priced as a separate project, and the service runs month to month.
We track each credit balance until it is refunded or applied, so none sit forgotten in A/R. Medicare overpayments must be reported and returned within 60 days of being identified. Since January 2025, CMS allows up to 180 days of good-faith investigation before that clock runs. Old patient credits may also fall under state unclaimed property law. We flag aging credits, and your compliance advisor makes the call.
Many small practices file taxes on the cash basis but manage on accrual, and we can keep both views. Cash basis records revenue when payment arrives. Accrual books it when care is given, less expected adjustments. Accrual shows A/R and true monthly results. Which basis your return uses is your CPA's call.
Yes, when the numbers show it: remittances reconciled claim by claim reveal allowed amounts drifting below your fee schedule. The pattern shows up in net collection rate by payer. We report it with claim detail attached. Your billing team or billing company then takes it up with the payer.
Some practices own a management company, a wellness line or a grant-funded clinic. These pages cover how each of those is kept.
Memberships and class packs, for practices that add a self-pay wellness or PT line.
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An MSO, a management services company that bills practices for admin work, keeps books like this.
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Grant-funded clinics need fund accounting and Form 990 support on top of patient revenue.
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Payouts from every sales channel and sales tax, reconciled.
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Job costs, work in progress and retainage, tracked by job.
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Insurance claims, deposits and job cost, tracked by roof.
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A P&L for each property, plus escrow and owner draws.
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Daily POS sales, tips owed and food cost as a share of sales.
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Cost per mile, IFTA fuel tax and driver pay, tracked.
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Deferred revenue, MRR and R&D tax credit support.
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Crop cycles, equipment depreciation and subsidy income.
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Client deposits, vendor prepayments and margin per event.
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Revenue for each cohort, refunds and instructor pay.
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280E cost allocation and seed-to-sale reconciliation.
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Choose a half hour outside clinic time. Together we look at collections, adjustments and A/R, then you get a written flat fee. There is no pressure to sign.
Month to month. No setup fee. Billing reports connected within 48 hours.
