5 min read
2025-03-27
Most derm groups treat clinic two as a copy-paste of clinic one, then spend a year unwinding co-mingled deposits and broken reconciliation. Here is the banking checklist worth running before opening day.
You signed the lease. You ordered the chairs. You hired a second front-desk lead. Now you need to figure out the banking. Most derm groups treat clinic number two as a copy-paste of clinic number one, then spend the next year cleaning up co-mingled deposits, broken reconciliation, and a P&L that cannot tell you which clinic is actually profitable. Here is the banking checklist worth running before opening day.
Decide the entity structure first
Before you touch a bank, decide whether clinic number two is a new PC under your MSO or a new location under the existing PC. The distinction shapes everything downstream.
If clinic number two is a new PC, you need a fresh entity, a fresh EIN, fresh bank accounts, and clean intercompany transfer rules. The MSO management agreement and shared-services flows have to be documented before the first deposit.
If clinic number two is a new location under your existing PC, you keep the entity, the tax filings, and the payer enrollments. But you still need a clean way to separate the two locations on the books, or you will spend the next quarter trying to figure out which clinic is breaking even.
Either path is fine. Mixing the two is what causes pain.
Set up per-location virtual accounts on day one
Whichever entity structure you pick, set up per-location virtual accounts before clinic number two opens its doors. The structure most multi-location derm groups land on:
Root operating account, per PC.
Virtual account: clinic 1 medical revenue.
Virtual account: clinic 1 aesthetic revenue.
Virtual account: clinic 2 medical revenue.
Virtual account: clinic 2 aesthetic revenue.
Virtual account: shared services and overhead.
Virtual account: payroll reserve.
Per-location splits matter because clinic profitability is the most important number for a multi-site group. If you cannot answer "is clinic two carrying its weight?" cleanly, you cannot decide whether to open clinic three, when to renegotiate the lease, or how to bonus the medical director.
Start payer enrollments the day you sign the lease
Payer EFT and ERA enrollments are the slowest external dependency. Most commercial payers take 2 to 6 weeks. Medicaid varies by state and can stretch longer. CareCredit and patient financing partners need their own routing setup.
Use the new account number from clinic two's virtual account so deposits land where they should from the first claim onward. If the enrollments are not done by opening day, you will collect cash through the wrong account and spend a quarter unwinding it.
If you operate as MSO-PC, Lemma onboards the new PC entity in 5 to 10 days, which keeps banking off the critical path while you focus on hiring and buildout.
Decide how money moves between clinics
You will move cash between clinics. Shared services need to be funded. Quarterly distributions need to be processed. The MSO management fee, if you have one, has to flow on a schedule. Decide the rules before you need them:
Daily sweeps from clinic operating accounts to a shared reserve.
Monthly transfer of MSO management fee, documented to support the management agreement.
Quarterly distributions from each PC to its owners.
Emergency-fund threshold per clinic, with automated top-ups.
ACH transfers between accounts are $0 inside Lemma, so policy decisions are not constrained by per-transfer fees. Wires are a flat $15 if you ever need one. Operating cash earns 1.75% APY while it sits, with FDIC coverage up to $10M per entity through the IntraFi sweep network.
Lock down access from the start
Clinic two means new staff. Front-desk leads, an office manager, possibly a second medical director. Everyone needs the right level of access and nothing more. Set role-based access before opening day:
Front desk: payment posting and deposit visibility, no transfers.
Office manager: full clinic visibility, transfers up to a daily cap.
Medical director and owners: full visibility, full transfer rights.
PIN plus password, RFID badge, mobile MFA, and audit logging cover most healthcare operating requirements. The audit log gives you the trail you need if anything ever needs review.
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