For practice administrators and medical group CFOs
Financial Clarity™
for medical practices.
Episode-of-care revenue recognition, gross-to-net contractual adjustments, days-in-AR optimization, and audit-ready financials. One team. No rotating pod.
22+
Medical practices
Single → multi-state
$240M+
Annual gross charges
under management
87 → 42
Median days-in-AR
Improvement on engagement
Trusted by practice administrators at:
Healthcare operates under accounting conditions GAAP was not designed for.
01Episode-of-care revenue is recognized over time. Gross-to-net contractual adjustments compound across the payor mix. Bad debt timing diverges from cash. Payors remit in 90 to 180 days — days-in-AR drift exposes whether the practice will make payroll three months from now.
02Most medical practices hire bookkeepers who treat the business like any other small business. The result is books that pass at startup and fail during an audit, an acquisition, or a private-equity diligence call.
03Debit & Co treats healthcare accounting as its own discipline. Gross-to-net waterfalls, payor-mix-aware revenue recognition, contractual adjustment reserves, and diligence-grade financials — built for the way practices actually run.
When to engage Debit & Co.
Most engagements begin with three or more of these eight conditions.
- Days-in-AR is rising month over month without explanation.
Cash runway compresses; payroll risk by Q3. - Contractual adjustments are booked as flat percentages, not payor-specific.
Material misstatement at audit; restated revenue. - Bad debt reserves haven’t been re-assessed since the last fiscal year.
Reserves under or over by 30%+; income statement noise. - The practice closes months without a formal payor mix reconciliation.
Concentration risk invisible; pricing decisions unsupported.
- 340B drug pricing tracking is manual or skipped.
Compliance risk; potential clawback exposure. - Stark / Anti-Kickback compensation reviews haven’t been documented in 18+ months.
DOJ scrutiny risk; settlement exposure. - A practice acquisition or PE conversation is expected within 12 months.
Diligence-readiness uncertain; valuation cut at LOI. - The current bookkeeper rotates between practices without specialization.
Healthcare-specific knowledge debt; corrections cycle quarterly.
The Financial Clarity™ framework.
Three pillars. Every engagement maps to them.
01
Clean.
Books that reconcile to the dollar. Monthly close by the 8th business day. Deferred revenue, accruals, prepayments, and intercompany handled correctly the first time.
02
Compliant.
ASC 606 revenue recognition. R&D tax credits filed. Sales tax nexus tracked. Audit-ready by default — not as a sprint before a priced round.
03
Communicable.
Financial packages a board, an investor, or an acquirer can read. Monthly close packet. Quarterly board section. Investor data room maintained between rounds.
Staff Accountants and Comprehensive Bookkeepers deliver against each pillar in two distinct engagement models.
Six functions. Two delivery models.
Every healthcare engagement is composed of these six functions. The mix of Staff Accountants and Comprehensive Bookkeepers depends on practice size, payor complexity, and provider count.
Revenue Recognition (Episode-of-Care + ASC 606)
Episode-of-care revenue allocation. Payor-specific contractual adjustment waterfalls. Bad debt reserve roll-forwards. Audit-ready documentation.
Pillar: Compliant · Delivered by: Staff Accountants
Monthly Close & Practice Reporting
Six-day monthly close. Reconciled to the dollar. Practice productivity dashboard drafted ten business days before each board meeting.
Pillar: Clean · Delivered by: Comprehensive Bookkeepers
Days-in-AR & Cash Flow Modeling
Days-in-AR by aging bucket and by payor. Cash flow forecasting calibrated to payor remit cadence. Scenario layers for hiring, capacity, and expansion timing.
Pillar: Clean · Delivered by: Staff Accountants
Payor Mix & KPI Reporting
Payor mix concentration, RVU per provider, visit yield, net collection rate. Cohort views. Reported in the same packet, every month.
Pillar: Communicable · Delivered by: Comprehensive Bookkeepers + Staff Accountants
Contractual Adjustment Reserves & Bad Debt
Payor-specific contractual adjustment models. Bad debt reserve methodology. True-up cycle quarterly. Audit substantiation included.
Pillar: Compliant · Delivered by: Staff Accountants
Acquisition / PE Diligence Readiness
Diligence data room maintained continuously. Three-statement model. Payor concentration memo. Reserve methodology substantiation. Buyer-readable financials.
Pillar: Communicable · Delivered by: Staff Accountants
A sample monthly practice financial package, delivered to your inbox.
Representative page from a multi-location specialty practice engagement. Identifiers redacted. Includes payor mix reconciliation, days-in-AR by aging bucket, contractual adjustment waterfall. Delivered by the 6th business day.
Single email. No newsletter signup.
✓ On its way.
Check your inbox in the next 2 minutes — sample sent from team@debitandco.com.
If you don’t see it, check spam or reply to this thread.
Featured case · Gayoso Plastic Surgery · Multi-specialty practice
“Working with Debit & Co gave us clarity we didn’t realise we were missing. We finally understand our numbers and feel in control of the business.”
Gayoso Plastic Surgery leadership · St. Petersburg, FL
< 7 days
Monthly close, from several weeks
24+ mo
Ongoing engagement
Monthly
On-schedule statements
Leadership
The leadership behind your Financial Clarity™.
Founding Partner & Senior Controller
Aaron Ressel
20 years building high-performing accounting teams. Reviews every client deliverable for accuracy, GAAP compliance, and strategic value.
Founding Partner & CFO
Kevin Cahill
Brings seasoned CFO-level strategic insight to every engagement. Helps clients shift from reactive accounting to proactive financial management.
Where Debit & Co fits.
Specificity is a service. The list below is honest.
Engages well with:
- Multi-provider practices, $5M to $80M in annual gross charges
- Single-location or multi-location specialty practices
- Practices with mixed payor (Medicare + Medicaid + commercial)
- Founders or COOs who want one team, not a rotating pod
- Practices expecting PE conversation or audit within 18 months
- Practices that need audit-ready 340B or cost-report compliance
Not the right fit:
- Solo practitioners on pure cash-basis accounting
- Cash-only practices outside insurance billing
- Operations needing same-day chat support more than monthly precision
- Practices requiring full outsourced revenue cycle management (Debit & Co partners with specialist RCM firms; coordination included)
Frequently asked.
We already have a bookkeeper. Why switch mid-year?
Most healthcare engagements begin between Q2 and Q3 — far enough from year-end to migrate cleanly, far enough before audit to fix contractual adjustment reserves and payor mix reconciliation. Migration takes 14 business days. The prior bookkeeper hands off; Debit & Co reconciles every account back to opening balance.
How is Debit & Co different from RCM-only firms or generalist accounting firms?
Three differences. First: a single team per engagement, not a pod with rotating leads. Second: Staff Accountants who can defend payor-specific contractual adjustment reserves to auditors. Third: a published monthly cadence — close by day six, payor mix reconciliation delivered the same day.
Will Debit & Co handle HIPAA-sensitive data?
All client data is handled under a Business Associate Agreement. Debit & Co maintains HIPAA security policies including encryption-in-transit and encryption-at-rest. Access logs are reviewable on request.
How fast is onboarding?
Fourteen business days from signed engagement to first close delivered. Onboarding includes prior-period reconciliation, payor mix baseline, contractual adjustment reserve reconstruction, and integration with athenaCollector, Epic, NextGen, AdvancedMD, or QuickBooks.
What’s included in the monthly close packet?
Reconciled P&L, balance sheet, cash flow. Payor mix dashboard. Days-in-AR by aging bucket and by payor. Contractual adjustment waterfall. Bad debt reserve roll-forward. Practice productivity dashboard (RVU per provider, visit yield).
Does Debit & Co file taxes?
No. Debit & Co prepares the financial statements; a partner CPA firm files the federal and state returns. Coordination is included in the engagement.
How is pricing structured?
Pricing depends on transaction volume, provider count, payor complexity, and which of the two service models applies. Ranges and structure are discussed in the discovery call.
Ready for Financial Clarity™?
Book a 30-minute discovery call. Tell us your situation, we’ll be honest about fit, and you get a custom proposal in 48 hours.