Cadence is marked on every line — not everything here is monthly. Sections 1 through 5 apply to any practice. Section 6 is what makes this a dental review rather than a generic one.
Anything flagged twice in a row stops being a metric and becomes an agenda item.
1. Close integrity
Nothing below this line means anything if this section is not clean.
| What to check | When | How to read it | Flag if |
|---|---|---|---|
| All accounts reconciled | Monthly | Every bank, credit card, and merchant account, through period end. | Any account unreconciled, or a balance sitting in the reconciliation discrepancy account. |
| PM system ties to the books | Monthly | Production and collections from the practice system agree to the ledger. | Unexplained variance above 1%. |
| Undeposited funds cleared | Monthly | Should sit at or near zero once the month is closed. | A balance that carries from month to month. |
| Uncategorized transactions at zero | Monthly | Nothing parked in suspense or "ask my accountant". | Any balance at all. |
| Deferred revenue rolled forward | Monthly | Balance moves only with new enrollments and delivered care. | Movement that no roster change explains. |
| Loan balances agree to lender | Monthly | Principal and interest split correctly for the period. | Book balance differs from the statement. |
| Prior period locked | Monthly | Closed months cannot be edited after the read. | Prior-period totals changed since last month. |
2. Revenue and collections
| What to check | When | How to read it | Flag if |
|---|---|---|---|
| Collections vs. production | Monthly | Trailing 12 months, as a ratio, and by provider where possible. | Ratio declining two months running. |
| Net collection rate by payer | Quarterly | What each payer actually pays against your fee schedule. | Any payer moving more than a few points against its own history. |
| Days in A/R | Monthly | How long revenue sits before it is cash you can use. | Rising for two consecutive months. |
| A/R over 90 days | Monthly | As a share of total receivables. | Share growing while total A/R is flat or rising. |
| Refunds and adjustments | Monthly | As a percentage of gross revenue, by category. | Discretionary discounting growing without a decision behind it. |
3. Margin and cost structure
| What to check | When | How to read it | Flag if |
|---|---|---|---|
| Overhead percentage | Monthly | Total operating cost against collections, not production. | Two points above your own trailing average. |
| Staff payroll % of collections | Monthly | Excluding providers. The largest overhead component. | Rising while collections are flat. |
| Provider compensation % | Monthly | Against collections, and by provider. | A provider whose comp share is rising without production rising. |
| Occupancy % | Quarterly | Rent, utilities, and CAM against collections. | Above benchmark and volume is not growing into the space. |
| Supplies % | Monthly | Against collections, trailing 12. | Drift of more than a point without a price or mix explanation. |
| Marketing spend and cost per new patient | Quarterly | Judged against first-year value, never a single visit. | Cost per acquisition rising while new patient count is flat. |
4. Cash and balance sheet
| What to check | When | How to read it | Flag if |
|---|---|---|---|
| Operating cash, in months of expense | Monthly | How long the practice runs if collections paused. | Below your agreed floor. |
| Cash less deferred revenue | Monthly | What is genuinely yours to spend. | Gap narrowing while distributions continue. |
| Thirteen-week forecast updated | Monthly | Rebuilt every month against actual collections and payables. | Forecast has not moved since last month. |
| Debt service coverage | Quarterly | Cash available against scheduled principal and interest. | Coverage below the level your lender requires. |
| Tax reserve adequacy | Quarterly | Set aside against year-to-date earnings, not last year. | Reserve behind the pace of profit. |
| Owner distributions vs. plan | Monthly | Taken against what the practice actually earned. | Distributions exceeding earnings for two months. |
5. Forward view
| What to check | When | How to read it | Flag if |
|---|---|---|---|
| Trailing twelve-month earnings trend | Quarterly | Normalized, rolling. The number a lender or buyer would use. | Flat or declining across two quarters. |
| Capacity utilization | Quarterly | Chairs, lanes, rooms, hours actually used against available. | Falling while fixed cost is rising. |
| Decisions pending | Monthly | Anything to model before it is committed: a hire, equipment, a lease, a location. | A commitment was made without being modeled first. |
6. Dental operating metrics
The section a generic monthly review does not have.
| What to check | When | How to read it | Flag if |
|---|---|---|---|
| Collections to production, by provider | Monthly | Well-run practices sit high in the nineties against adjusted production. | Any provider trending down two months running. |
| Hygiene contribution margin | Monthly | Hygiene production against hygienist wages and allocated time. | Barely breaking even, or declining. |
| Hygiene reappointment rate | Monthly | Share of hygiene patients leaving with the next visit booked. | Falling — it shows up in collections two quarters later. |
| Case acceptance, in dollars | Monthly | Treatment presented against treatment scheduled. Not just the rate. | Dollar acceptance falling while presented dollars rise. |
| Unscheduled treatment balance | Monthly | Diagnosed and never booked. Appears on no financial statement. | Balance growing month over month. |
| Overhead percentage | Monthly | General practices commonly target the low-to-mid sixties of collections. | Two points above your own trailing twelve. |
| Lab as % of collections | Monthly | Tracks case mix as much as cost. | Drift without a corresponding shift in procedure mix. |
| Supplies as % of collections | Monthly | Small line, early indicator. | More than a point of drift. |
| New patients: count and first-year value | Monthly | Value matters more than count. | Count holding while value falls. |
| Revenue per operatory, per day in use | Quarterly | Whether the buildout is earning back its capital. | Idle operatories while overhead rises. |
| Associate contribution | Quarterly | Production against comp, assistant time, and chair cost. | Negative contribution after full loaded cost. |
| Deferred membership balance | Monthly | Unearned plan fees carried as a liability. | Balance rising faster than covered care is delivered. |
The monthly review
What we actually walk through on the call, in this order:
- What changed since last month, and why.
- Where the practice is leaking, in dollars.
- Which single number we are trying to move before next month.
- What decision is pending, and what the model says about it.
- Whether anything on this list has been flagged twice — those get escalated, not repeated.
Dental monthly review
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