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.
General information for practice owners, not accounting, tax, legal, valuation or investment advice for your situation. MedPraxis CFO is not a CPA firm, a registered investment adviser, or a business broker. Talk to your own CPA, attorney or adviser before acting on anything here.