Dermatology is two businesses in one practice. Medical derm bills insurance like the rest of healthcare. Cosmetic derm operates more like retail with cash pay, package pricing, financing platforms, and product sales. The financial layer that supports both at the same time has to keep them visible separately or your P&L is just a soup.

Most banking platforms collapse them. The right one keeps them clean.

What a Dermatology Practice Needs

Cosmetic vs medical revenue separation. Virtual accounts that isolate cosmetic procedure revenue, retail product sales, and financing platform settlements from insurance billing.

ERA 835 reconciliation. Medical derm carries standard insurance billing (BCBS, Aetna, Cigna, Medicare, Medicaid). ERA matching across these should be automated.

Financing platform integration. Cherry, CareCredit, and similar platforms settle on different cadences than insurance. The dashboard should show those settlements separately for margin tracking.

Multi-entity for MSO-PC structures. Many derm groups operate as MSO-PC, especially with cosmetic-only PCs separated from medical-only PCs.

Yield on float. Cosmetic-heavy derm practices commonly hold $300K to $2M in operating cash thanks to favorable cash-pay timing.

How the Major Options Compare

Big banks: branches, generic, no derm-aware tooling.

Fintech banks: clean dashboards, free ACH, no ERA matching, no MSO-PC structure support.

Lemma: ERA 835 matching, virtual accounts for cosmetic vs medical revenue separation, financing platform settlement visibility, multi-entity onboarding in 5 to 10 days, 1.75% APY, $10M FDIC per entity.

The Math for a Mixed-Practice Derm Group

3-derm group, $4M annual collections (60% medical, 40% cosmetic), $700K operating cash, MSO-PC structure with separate cosmetic PC, 200 ERA files monthly, 50 paper checks (insurance + product vendor refunds).

On a generalist bank: 30 hours/month manual ERA matching ($12,600/year), $4,800/year lockbox vendor, $2,000/year ACH, 0% APY. Plus the cost of manually separating cosmetic vs medical revenue in QuickBooks (5 hours/month, $2,100/year). Net friction: $21,500/year.

On Lemma: $0 ACH, automated ERA, included lockbox, 1.75% APY on $700K ($12,250/year), automatic cosmetic vs medical separation. Annual swing: roughly $33,750.