On paper, Dr. Marcus ran a thriving practice. Two million dollars in annual revenue. A full patient schedule. A team of twelve. Every metric screamed success.
Except one: his bank account.
When we first connected, Marcus hadn't taken a full paycheck in three months. He was floating payroll on a line of credit. His vendors were sending past-due notices. And he couldn't figure out why a practice billing $2M couldn't cover its basic expenses.
The answer wasn't revenue. It was reimbursement timing: and the gap between what he earned and when he actually received it.
The Invisible Cash Flow Killer
Here's what most healthcare practice owners don't realize until it's too late: revenue is not cash.
Marcus billed $2M. His collections? Closer to $1.6M after write-offs, denials, and adjustments. And the average time from service to payment? 47 days.
That's 47 days of payroll, rent, supplies, and software subscriptions: all due now: while insurance companies held his money.
His practice wasn't failing. His financial systems for medical clinics were non-existent.
The Compounding Problem
When reimbursement delays stack up, the damage compounds:
- Week 1: A few claims get denied. No big deal.
- Week 4: AR aging creeps past 60 days. Collections slow.
- Week 8: Payroll gets tight. Owner stops paying themselves.
- Week 12: Credit lines max out. Vendor relationships strain.
- Week 16: The "successful" practice is one bad month from crisis.
Marcus hit week 16 without realizing how he got there. He assumed more patients would fix everything. But more patients just meant more delayed payments and higher operating costs.
Medical practice growth strategies that ignore cash flow timing aren't strategies: they're gambles.
The Turnaround: Systems Before Scale
We didn't start with marketing or patient volume. We started with visibility.
Step 1: Map the money
We built a 13-week cash flow forecast showing exactly when money came in versus when it went out. For the first time, Marcus could see the gaps before they became emergencies.
Step 2: Fix the leaks
His billing team was submitting claims correctly: but no one was following up on denials. Over $180,000 sat in "pending" status, untouched for 90+ days. We implemented a weekly AR review and recovered $94,000 in 60 days.
Step 3: Renegotiate timing
Some expenses could shift. We moved certain vendor payments to align with expected reimbursement cycles. We restructured his credit line to act as a bridge, not a crutch.
Step 4: Build the scoreboard
Marcus started tracking five numbers weekly: new patients, collections, AR over 60 days, cash on hand, and upcoming payroll obligations. Simple. Actionable. No more surprises.
Within 90 days, Marcus took his first full paycheck since the summer. Within six months, he paid off the credit line entirely.
The Real Lesson
A $2M practice isn't successful if the owner can't pay themselves.
Revenue without financial systems for medical clinics is just stress with better optics. The practices that thrive: especially between $500K and $4M: aren't the ones billing the most. They're the ones who collect consistently and spend strategically.
If your practice looks great on paper but feels fragile in reality, the problem isn't your clinical skills or your patient volume. It's the gap between billing and banking.
Business coaching for healthcare practices exists precisely to close that gap: before it closes the practice.
Get Clarity on Your Cash Flow
If Marcus's story sounds familiar, you're not alone. Most practice owners weren't trained to manage reimbursement cycles, AR aging, or cash flow forecasting. But these skills aren't optional anymore: they're survival tools.
Book a 15-Min Session and let's look at your numbers together. We'll identify your biggest cash flow risk and the first system to fix it.
No pressure. Just clarity.