By Lozelle Mathai, MBA, CFE, founder of Healthy Bodies of Finance, a team that brings a forensic accounting lens to fractional CFO work for health and wellness practice owners.
Your group therapy practice has hired more clinicians and opened a second location. The bookkeeper is spending more time on bank reconciliations and vendor payments, so another accounting hire seems reasonable. However, the owner is considering additional therapists while payroll rises faster than insurance collections. The accounting workload has increased, but does hiring another bookkeeper address the financial question behind the next payroll commitment?
A bookkeeper may keep accounting records current, while a controller determines whether the financial reports are trustworthy. When the owner needs to know whether new therapists will generate enough collections to cover their compensation, the practice may need fractional CFO leadership.
When Does a Group Therapy Practice Need Another Bookkeeper?
Another bookkeeper may be appropriate when the department cannot close the books on time. Unfinished reconciliations and delayed vendor payments suggest the existing staff cannot keep up with routine accounting transactions. If deposits remain unmatched to the bank, the owner cannot rely on the cash balance in the ledger for decisions. With two offices, patient receipts may arrive through separate payment accounts, increasing the monthly reconciliation work.
A group therapy practice may reconcile accounts and deliver monthly reports on schedule while its bank balance continues to decline despite increasing patient visits. Another bookkeeper would not explain why earned revenue isn’t converting to cash at the expected rate. The owner needs to determine whether unresolved insurance denials or longer collection times explain the difference.
When Does a Group Therapy Practice Need a Controller?
Consider a group therapy practice with two offices. Therapist compensation is sometimes charged to the wrong location, while shared expenses are divided without a documented allocation method. Consolidated financial statements may be accurate in total even when one office appears more profitable than it is. The allocation method also needs to account for therapists who work at both offices rather than assigning all their compensation to one location.
Even after payroll and shared costs are assigned to the appropriate offices, the owner needs to know whether the revenue figures belong to the same reporting periods. The billing department’s insurance payment and accounts receivable reports may not agree with the accounting records. Contractual adjustments can explain some differences; others warrant investigation. A controller should identify the causes of the discrepancies and review expense allocations each month before the owner uses location-level margins to make staffing decisions.
The owner is considering a third office as well. Its rent and clinician compensation would begin before the new location collects insurance payments. How much cash could the practice commit without putting payroll at its existing offices under pressure?
When Does a Group Therapy Practice Need a Fractional CFO?
At the existing offices, the clinical director wants to hire three therapists after seeing increased appointment demand. Insurance collections haven’t kept pace with payroll, and a full appointment schedule doesn’t show when the practice will be paid. Cancellations and no-shows also belong in the forecast rather than treating every available appointment slot as a paid session.
Contracted reimbursement rates help estimate collections, but payer enrollment effective dates can affect whether sessions qualify for the anticipated in-network payment. Even when enrollment is complete, denied or unpaid claims may remain in accounts receivable while clinician compensation comes due. Paying therapists before claims are collected draws cash from the practice’s operating cash.
Before approving the hires, I would compare the compensation owed while those therapists build their caseloads with expected insurance collections, accounting for payer mix and contracted reimbursement rates. If claims are taking longer to pay, I would test the timing assumptions against the accounts receivable aging report.
Cash flow forecasting should also show what happens if payer enrollment takes longer than planned or new therapists build their caseloads more slowly than expected. I would test an on-time enrollment date against a delayed effective date rather than combine both outcomes into one revenue projection. The lowest projected cash balance during the first few months deserves as much attention as the expected annual profit from those hires.
The revenue cycle team remains responsible for working claims. A fractional CFO needs those results to evaluate the hiring forecast, not to take over billing. Through Healthy Bodies of Finance’s fractional CFO services, we examine whether collection history supports the cash assumptions behind additional clinician payroll.
Which Financial Role Is Missing?
Before approving another accounting position, I would ask who owns the hiring forecast and whether that person has the authority to challenge reimbursement assumptions using the practice’s actual collection history. The answer should guide how to build a finance department for a growing group therapy practice—including whether the existing team can take on the responsibility or a different financial role is needed.
Why your expenses keep a stricter calendar than your revenue
Before approving another accounting position, I would ask who owns the hiring forecast and whether that person has the authority to challenge reimbursement assumptions using the practice’s actual collection history. The answer should guide how to build a finance department for a growing group therapy practice—including whether the existing team can take on the responsibility or a different financial role is needed.
About the Author
Lozelle Mathai, MBA, CFE is Founder and CEO of Healthy Bodies of Finance. A Certified Fraud Examiner with more than 20 years in accounting and financial leadership, she helps established health and wellness practice owners examine how revenue collections and operating costs affect profitability and growth decisions.
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This article is designed to provide information only and should not be considered legal or tax advice. Because of the complexity of the law and the variables in your own personal tax and accounting situation, you can’t rely on our advice specifically related to your unique circumstances. In order to get the best tax savings and legal advice available to you, you should consult with your own accountant, attorney or advisor regarding your particular facts and circumstances. Healthy Bodies of Finance is an accounting firm that specializes in working with health and wellness providers. We provide monthly accounting & bookkeeping services and financial education. For more information on our specialized services for health and wellness providers please contact us at info@healthybodiesoffinance.com
