The question I ask every clinic owner
This post is about why accountants alone miss billing-side leaks. If you want the specific places those leaks hide, see billing-collections-gap.
In the first meeting with a new client, I always ask the same question: "Does your accountant pull your billing data, or just your bank deposits?"
About 9 out of 10 times, the answer is the same. The accountant sees bank deposits. That is it.
They are good at what they do. Your books balance. Your taxes get filed. But they are working with half the picture, and neither of you realizes what that costs you.
What you miss when accounting only sees deposits
Your bank account shows money that arrived. It does not show money that should have arrived.
Here is a simple example. Your billing company submits $500,000 in claims this month. Insurance companies pay $380,000 of that. The $380,000 shows up in your bank account. Your accountant records it as revenue and moves on.
But what happened to the other $120,000?
Some of it was written off correctly. Contractual adjustments, patient responsibility, that sort of thing. But some of it was denied and never appealed. Some of it is sitting in accounts receivable aging past 90 days. Some of it was underpaid based on your contract, and nobody caught it.
Your accountant cannot tell you any of this because they never see the billing data.
I worked with a dental group last year (anonymized Sorso client, Southeast, three locations, $2.3M in annual revenue). When we pulled their billing data and compared it to their bank deposits, we found $187,000 in claims that had been denied and never reworked. Their billing company had just written them off. The accountant had no way to know this because denied claims never become bank deposits.
That $187,000 was not a rounding error. It was 8% of their total revenue, gone.
Underpayments nobody catches. When a payer reimburses you $85 instead of the $110 your contract specifies, that $25 difference does not show up in your accounting. The $85 hits your bank account, gets recorded, and life goes on. Multiply that by hundreds of claims per month and you have a real problem that is completely invisible to your accountant.
Location-level performance you cannot see. If you have two or more locations, your bank deposits typically land in one or two accounts. Your accountant can allocate expenses by location (rent, staff, supplies), but they cannot accurately allocate revenue by location without billing data. So you cannot tell which location is actually profitable and which one is being subsidized by the others.
Payer performance that goes unmonitored. Which of your insurance payers pays the fastest? Which one denies the most? Which one consistently underpays? Your billing data can answer all of these questions. Your bank deposits cannot.
Two systems that never talk to each other
The billing company lives in one world. They track claims submitted, claims paid, denials, appeals, and collection rates. They have a practice management system with detailed data on every patient visit and every dollar billed.
The accountant lives in a different world. They track revenue, expenses, payroll, taxes, and cash flow. They work in QuickBooks or Xero or whatever accounting software you use.
These two systems run in parallel. They cover the same money. But they almost never intersect.
The billing company sends you a monthly report. Maybe you read it, maybe you do not. Your accountant sends you a P&L and balance sheet. You probably glance at the bottom line. Nobody is sitting down and asking: "Does the revenue on the P&L match what the billing company says we collected? And if not, where is the gap?"
This is not a technology problem. Your billing software and your accounting software can be connected. The problem is that nobody has set it up, and nobody has a reason to. Your accountant gets paid to do accounting. Your billing company gets paid to bill. The gap between them is nobody's job.
Until it is.
What integrated accounting looks like
At Sorso, we pull billing data, bank deposits, and claims data into one view. Every dollar is traced from the patient appointment to the bank deposit. That means we can see where money leaks at each step.
Here is the path a dollar takes through your practice:
- Patient visits the clinic. A charge is created.
- The charge gets coded and submitted as a claim to the payer.
- The payer processes the claim and sends a payment (or a denial).
- The payment posts to your billing system.
- The payment deposits into your bank account.
- Your accountant records the deposit.
Most accounting only covers step 6. Most billing only covers steps 2 through 4. Nobody watches the full chain.
When we reconcile both data sources, we can answer questions that neither system can answer alone:
- How much of what you bill actually gets collected? (Your net collection rate, and most clinics overestimate this by 5-10 points.)
- Which payers have the highest denial rates, and what are the denial reasons?
- How long does it take each payer to pay you, and is that getting better or worse?
- Are there CPT codes where you are consistently being underpaid versus your contracted rate?
- Which location generates the most revenue per provider, and which one is underperforming?
This is not reporting for the sake of reporting. Each of these answers leads to a specific action. High denial rate on a specific payer? Renegotiate or drop them. Slow payment from another? Adjust your cash flow forecasting. Underpayment on a specific code? File appeals or renegotiate the contract.
The moment that usually surprises people
There is a moment in nearly every new client engagement when the owner sees their data reconciled for the first time. The reaction is almost always the same.
One urgent care operator with four locations (anonymized Sorso client, Mountain West) said it plainly: "We had no idea our billing company was sitting on $180K in unworked claims." Those claims were past 90 days. Many were past 120. The billing company's internal reports showed them as "in process." But when we matched them against what had actually been deposited, the gap was obvious.
Another one, a physical therapy group doing $4M in revenue (anonymized Sorso client, Northeast, three locations), discovered that one of their three locations had a net collection rate of 78%. The other two were at 94%. Same billing company, same payer mix, same fee schedule. The difference was that the underperforming location had higher coding errors and more untimely filings. Nobody had caught it because the revenue from all three locations flowed into the same bank account. The aggregate numbers looked fine. The location-level numbers told a different story.
A dermatology practice (anonymized Sorso client, Sun Belt, single location ~$3M revenue) found that one payer was consistently reimbursing $30-$50 below their contracted rates on three high-volume codes. The billing company was not checking reimbursement against contracted rates because that is not what most billing companies do. They check that a payment was received, not that the payment was correct. Over a year, the underpayment was $67,000.
These are not unusual findings. This is what we see in the majority of practices we review. The money is there. It is just invisible when your accounting and billing data never meet.
What to do about it
If you have never asked your accountant whether they pull your billing data, ask them tomorrow. Not as a test or a gotcha, but as a genuine question about what data they work with.
If the answer is "just bank deposits and credit card statements," that is normal. It is what 90% of practice accountants do. But it means you have blind spots.
You have three options:
Ask your billing company for better reporting. Some billing companies can provide detailed reconciliation reports if you ask. Most will not do it proactively. You need to request specific metrics: net collection rate by payer, denial rate by reason code, days in AR by aging bucket, and underpayment analysis against contracted rates. If they cannot produce these reports, that tells you something about their operation.
Ask your accountant to integrate billing data. Some accountants will do this. Most will not because it is outside their scope and expertise. Healthcare billing data is complex, and reading it correctly requires understanding CPT codes, payer contracts, and claims processing. A general practice accountant is not set up for this.
Work with someone who does both. This is what we built Sorso to do. We handle the accounting and we pull the billing data, so there is no gap. One team watching the full revenue cycle from claim to deposit.
If you are not sure where you stand, schedule a free assessment. We will look at what your current accounting captures, what it misses, and how much that gap might be costing you. No charge, no commitment, and you will walk away with a clearer picture of your practice's financial health either way.
