Orthopedic practices have one revenue profile that almost no other specialty matches: surgical procedures with high reimbursement, ambulatory surgery center (ASC) ownership stakes, durable medical equipment (DME) revenue, and physical therapy ancillary services. Plus workers' comp. Plus auto. Plus a meaningful surgical implant cost line.

The banking that handles all of this without dropping the ball is rare. Most providers can't.

What an Orthopedic Practice Needs

High-value ERA reconciliation. Surgical claims pay $5,000 to $50,000 per case. A misreconciled claim is a real number, not a rounding error.

ASC and DME revenue separation. If your group owns an ASC or runs DME, the float should be cleanly visible per entity, not collapsed into the operating account.

Workers' comp and auto-aware lockbox. A meaningful share of orthopedic revenue still pays by paper check, especially in lien states.

Multi-entity for MSO-PC structures. Most orthopedic groups today operate as MSO-PC with separate ASC ownership. Banking should onboard each entity in days, not quarters.

FDIC for $1M+ balances. Surgical practices routinely hold $500K to $5M in operating cash. Standard $250K coverage isn't enough.

How the Major Options Compare

Big banks: established, generic, no orthopedic-aware tooling.

Fintech banks: don't handle ASC ownership structures, ERA, or workers' comp paper.

Lemma: ERA 835 matching including workers' comp, Medical Lockbox at $2.50 per check, multi-entity onboarding for MSO-PC plus ASC structures, 1.75% APY across the structure, $10M FDIC per entity.

The Math for an 8-Surgeon Group

8 surgeons, $12M annual collections, $1.2M operating cash, ASC entity attached, 400 ERA files monthly, 80 paper checks (workers' comp + auto + ASC distributions).

On a generalist bank: 50 hours/month manual ERA matching ($21K/year), $4,800/year lockbox vendor, $2,500/year ACH, 0% APY on operating. Net friction: $28K+ per year.

On Lemma: $0 ACH, automated ERA, included lockbox, 1.75% APY on $1.2M ($21K/year). Annual swing: roughly $50K plus faster monthly close and clean ASC distribution accounting.