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 mental health 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. Mental Health operating metrics
The section a generic monthly review does not have.
| What to check | When | How to read it | Flag if |
|---|---|---|---|
| Contribution margin per clinician | Monthly | Collected revenue against full loaded cost, including supervision. | Any clinician negative after full cost. |
| Utilization by clinician | Monthly | Sessions delivered against sessions available. | Below your target range, or falling. The gap between 65% and 85% decides the practice. |
| No-show and late-cancel rate | Monthly | Fixed clinician cost against no revenue. | Above your trailing average, or rising for one clinician specifically. |
| Revenue per session by payer | Quarterly | What each panel actually pays after adjustment. | A payer consuming caseload at a rate you would not sign today. |
| Days to payment by payer | Monthly | Determines whether payroll is comfortable or tight. | Any payer slowing by more than a week against its own history. |
| Credentialing pipeline | Monthly | Clinicians hired but not yet billable, and what they have cost so far. | Cost accumulating with no approval date in sight. |
| Payer mix shift | Quarterly | Commercial, Medicaid, EAP, private pay, superbill. | Mix moving toward slower or lower-paying panels. |
| Clinician retention | Monthly | Turnover is the most expensive event in this vertical. | Any unplanned departure, or a second in a quarter. |
| Caseload and waitlist | Monthly | Demand against delivered capacity. | A waitlist alongside clinicians under 70% utilization. |
| Prepaid and program deferred balance | Monthly | Session packages, IOP and PHP enrollment collected ahead of delivery. | Balance rising faster than care is delivered. |
| Contractor vs. W2 cost and control | Annual | Reviewed against the actual working relationship, not the paperwork. | A contractor whose schedule, rates, and protocols you set. |
| Denial rate by payer | Monthly | Denials arrive weeks after the sessions were delivered. | Rising, or concentrated in one payer or one clinician. |
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.
Mental Health monthly review
The formatted Word version, ready to use or edit. Nothing to fill in first.