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You've already spent next quarter's revenue
A care plan collected today is cash in the account and work still owed. Practices that treat it as available cash discover the problem in the delivery months.
Why chiropractic cash flow is deceptive.
Chiropractic cash flow is unusual because a large share of collections arrive before the service is delivered. Prepaid care plans front-load cash into the month of sale while the cost of delivering that care, adjuster time, front desk, rent, and equipment, falls in the months that follow. The result is a practice that feels flush when it sells well and tight when it delivers.
Four things that distort chiropractic cash
- Prepaid plans spent in the sale monthThe most common cash mistake in the vertical. The money belongs to future visits that still cost money to deliver.
- PI receivables in the forecastCases that may settle in eighteen months should not appear in a thirteen-week cash plan at any value.
- Equipment financing on tables and decompressionMonthly obligations that hit cash while only depreciation shows on the P&L.
- Seasonal enrollment cyclesJanuary and September enrollment surges followed by delivery-heavy, sale-light months is a predictable pattern that still catches practices out.
Separate the bank balance from the earned balance
The single most useful report in a chiropractic practice is one that shows cash on hand next to the deferred revenue liability. The difference is what is actually yours. Practices that see those two numbers side by side every month stop making the classic mistake of hiring or buying against money that represents undelivered visits.
This is not conservatism for its own sake. A practice with $80,000 in the account and $55,000 of unearned care plan obligation has a different amount of room than one with $80,000 and no obligation, and the decisions available to each are genuinely different.
Build the forecast around delivery, not sales
A thirteen-week cash forecast in this vertical needs three inputs most practices don't track: expected insurance collections by payer, scheduled plan deliveries with their associated cost, and new plan sales estimated conservatively. Modeling delivery cost explicitly is what turns the forecast from an optimistic sales projection into something usable.
It also surfaces the growth trap. Aggressive plan selling raises cash today and raises delivery cost for six months. Growing quickly without forecasting the delivery tail is how profitable chiropractic practices end up short.
Building that forecast and updating it every week is part of our CFO advisory work.
Frequently asked
Why does my chiropractic practice feel tight after a strong month?
Usually because the strong month was a selling month rather than a delivering one. Prepaid care plans put cash in the account immediately while the cost of delivering those visits lands over the following months. If the sale-month cash was spent, the delivery months are funded out of whatever comes next.
Should prepaid care plans count as available cash?
No. The portion representing undelivered visits is an obligation. A practical habit is to report cash on hand alongside the deferred revenue balance every month so the genuinely available figure is always visible.
How should a chiropractic practice forecast cash?
With a rolling thirteen-week forecast that models three things separately: expected insurance collections by payer, the cost of delivering already-sold care plans, and conservatively estimated new plan sales. Personal injury receivables should be excluded entirely, since their timing is unknowable.
Chiropractic resource center
Or read the cross-practice version: cash flow in practice accounting →