Physical therapy clinics carry a payer mix that almost no other specialty deals with at the same complexity. Medicare with the 8-minute rule. Medicaid with state-by-state rules. Commercial plans with prior auth. Workers' comp with carrier-specific billing. Auto insurance with PIP and lien negotiations. Each one has its own reimbursement timeline, its own ERA file format, and its own quirks.

Most banks are built for businesses where revenue and deposits look the same. PT clinics are not those businesses. Banking that gets PT means banking that handles a four-or-five-payer mix without dropping the ball.

What a PT Clinic Actually Needs

ERA 835 matching across payer types. Medicare, Medicaid, BCBS, Aetna, Cigna, plus workers' comp carriers (Travelers, Liberty Mutual, Sedgwick, etc.). Manual matching across all of these is a half-time billing job for a multi-clinician practice.

Lockbox for the long-tail payers. Workers' comp and auto carriers still pay by paper check more than any other category. If you're seeing 30 to 100 paper checks a month, the lockbox isn't optional.

Multi-location consolidation. PT scaling typically goes 1 clinic, 3 clinics, 8 clinics, holding company. Your bank should keep up. Each location should be visible cleanly without 8 separate logins.

Cash flow tools. Reimbursement timelines for PT range from 14 days (commercial) to 60+ days (workers' comp lien cases). You need a banking layer that lets you see AR aging by payer type.

Yield on float. Multi-location PT groups often hold $300K to $1.5M in operating cash. At 0% APY that's $5K to $25K of opportunity cost per year.

How the Major Options Compare

Big banks (Chase, BofA, Wells Fargo): branches, scale, generic. No ERA matching, no PT-aware tooling. Default option for legacy reasons.

Fintech banks (Mercury, Bluevine, Relay): clean dashboards, free ACH, no healthcare-native features. Workable for cash-pay PT (concierge sports performance, wellness) but not for insurance-heavy clinics.

Lemma: ERA 835 matching across all major payers including workers' comp carriers, Medical Lockbox at $2.50 per check, multi-location/multi-entity onboarding in 5 to 10 days, 1.75% APY, $10M FDIC per entity.

What to Pick by Clinic Size

Solo PT, cash-pay, $200K to $500K. A fintech like Mercury or Relay covers the basics.

Single clinic, mixed payer, $500K to $1.5M. Lemma starts paying off here. ERA matching saves billing hours, lockbox handles workers' comp paper checks.

Multi-clinic group, $1.5M+. Lemma is built for this. Multi-entity, multi-location, consolidated dashboard.

Multi-state PT group with workers' comp focus. Lemma plus a specialty workers' comp billing partner. The bank handles deposits and reconciliation; the partner handles the negotiation work.

The Math for a 3-Clinic PT Group

Three locations, $2.5M annual collections, $400K operating cash, 250 ERA files monthly across 4 payer types, 60 paper checks (mostly workers' comp).

On a generalist bank: ~30 hours/month of ERA matching ($12,600/year fully loaded), $3,600/year in lockbox vendor fees, ~$1,400/year in ACH fees, 0% on operating cash. Net friction: ~$17,600/year, plus the slow monthly close.

On Lemma: $0 ACH fees, automated ERA matching, included lockbox, 1.75% APY on $400K ($7,000/year). Annual swing: roughly $24,500 plus a much faster monthly close.

Questions to Ask Before Signing

Do you handle ERA 835 files from workers' comp carriers and auto insurance, not just commercial?

What's the lockbox cost per check? Any monthly minimums?

How do you separate Medicare/Medicaid float from commercial float in reporting?

How fast can I open a second clinic's account under our holding company?

What's the APY on the operating account, not just the swept savings?