Accounting for healthcare practices, reported by provider and location

Care was delivered, but the claim was denied.

The caregiver has already been paid. An authorization, EVV record, member ID, or date of service does not match, and the revenue that labor produced cannot be collected.

Denied visits are quantified every month against the payroll already spent on them, so the exposure is a dollar figure on a statement rather than a queue inside the billing system.

The claim was paid, then recouped.

A payer reverses a previously paid claim months later, and nobody can say quickly whether it can be corrected, rebilled, or has to be written off.

Recoupments are tracked against the original claim and service period, with a reserve carried against known exposure, so a takeback does not land as a surprise on a month you already closed.

Payroll, visits, billing, and collections do not reconcile.

Authorized hours, completed visits, EVV records, billed claims, reimbursements, and caregiver payroll sit in different systems, and no single view ties them together.

A monthly reconciliation runs the chain end to end, from authorized hours through EVV visits, billed claims, cash received, and payroll, with every break listed and quantified.

Deposits arrive without claim-level support.

Medicaid and managed care payments land in the bank in batches. The accounting records do not show which patients, claims, programs, or service dates produced them.

Deposits are applied from the remittance detail, so every batch traces back to the claims, the program, and the service period behind it.

Revenue is growing and nobody knows what is profitable.

The statements show total revenue and total payroll. They do not show margin by payer, service line, branch, or program once denials, recoupments, and direct labor are counted.

Margin is reported by payer, program, branch, and service line, calculated after direct caregiver cost and net of denials and recoupments.

Payroll is due before the reimbursement arrives.

Caregivers are paid weekly or biweekly while claims pay weeks later. The gap gets managed by watching the bank balance and hoping.

A thirteen-week forecast built on actual reimbursement lag by payer, run against your payroll calendar, so a tight week surfaces with time to do something about it.

• End-to-end visit reconciliationAuthorized hours, EVV visits, billed claims, paid claims, denied claims, and caregiver payroll tied together monthly, with the variances at each step named and quantified.
• Cash applied to the claim levelBatch Medicaid and managed care deposits traced through remittance detail to the patients, claims, programs, and service dates that generated them.
• Denial and recoupment reportingDenials and takebacks tracked by payer, reason, and service period, with a reserve carried against exposure so the write-off is anticipated rather than discovered.
• Unbilled visits and expiring authorizationsVisits delivered but not yet billed, and authorizations approaching expiry, reported as a dollar amount at risk while there is still time to act on them.
• Revenue recognized net of expected adjustmentsRevenue booked against realistic collection expectations rather than gross billed charges, so the top line reflects what the organization will keep.
• Direct labor cost per billed hourCaregiver wages, overtime, mileage, and non-billable time measured against billed and collected hours, which is where margin in this business is won or lost.
• Margin by payer, program, branch, and service lineContribution reported at the level where you make staffing and program decisions, after direct labor and after collection losses.
• Cash forecasting on reimbursement lagA thirteen-week forecast built on observed payment timing for each payer, run against a payroll calendar that does not move.
• Payroll liability mappingPayroll journal entries mapped to your QuickBooks setup and confirmed against what was remitted, including accrued payroll matched to unbilled visits.
• Audit and cost report supportBooks kept to a standard that holds up for a payer audit, a lender review, a cost report, or a transaction.

We do not submit claims, correct authorizations, or work denials. That is your billing team or your RCM vendor, and they are better placed to do it than an accounting firm.

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What we build is the financial layer above that work: the reconciliation that shows whether the claims went out correctly, the reporting that shows what was collected against what was delivered, and the margin analysis that shows whether the program made money once the caregiver was paid. Where the billing function has a problem, our reporting is usually what makes it visible and puts a number on it.

Home care, home health, behavioral health, and Medicaid-funded service organizations doing $1M to $50M, including multi-branch and multi-program operators. We also work with medical, dental, and specialty practices where the same questions apply to payer mix and provider margin.

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We work inside the QuickBooks Online file you already use and take billing, EVV, and payroll data as it exports from your existing systems. You do not change how the operation runs.