You run a 5-PC group. You have seven bank logins. Your CFO has a spreadsheet she refreshes by hand every Friday.

Treasury at scale shouldn't feel like this. Here's what centralized treasury actually looks like across multiple practice entities. And how to get there without breaking CPOM.

What "Centralized" Actually Means

Centralized doesn't mean one bank account. It can't, legally. CPOM keeps PCs separate by design.

What it means: one dashboard, one set of policies, one point of control. The money sits in many accounts. The decisions sit in one place.

The Hard Rule: Money Stays in Its Lane

Patient and payer dollars hit the PC first. Always. The PC then pays the MSO a management fee on a documented schedule. Cash moves down the contractual chain, never sideways.

Break this rule and you've got fee-splitting, which most state medical boards treat as a felony.

The Five Things to Centralize

You can centralize these without touching ownership:

• Sweep rules across all PCs and the MSO

• A single treasury policy (idle cash thresholds, max single-bank exposure, signing limits)

• One reconciliation feed for ERA 835s, payer EFTs, and check deposits

• Consolidated reporting (cash, AR, deposit insurance coverage)

• Vendor and payroll origination, run from the MSO and charged back to PCs via MSA

What to Keep Separate

Don't centralize these. Ever.

• PC ownership and signers

• Patient-facing account names and DBAs

• Clinical revenue accounts

• Tax reporting

The PC is its own legal entity. It needs to look and act like one in every audit.

Signs You Need This Now

You're past DIY when:

• A new PC opening took 4+ weeks

• You had to manually move cash to cover payroll last month

• Two banks called about minimum balances on the same day

• Your CFO can't tell you total deposit coverage in under 30 seconds

• You're carrying $1M+ in idle cash earning under 1%

If two of these hit, you're already paying for the wrong setup.

What It Costs to Wait

Decentralized treasury isn't free. It costs in three places:

• CFO time: 4-6 hours a week reconciling across portals

• Idle cash drag: $1M sitting at 0.5% leaves $12,500 a year on the table

• Audit risk: messy intercompany flows are the first thing PE diligence flags

A lean treasury team shouldn't be the team that loses its weekends.

The Setup That Works

A clean centralized treasury looks like this:

1. Each PC has its own operating account

2. The MSO has its own operating account

3. All accounts sit at one bank that supports multi-entity dashboards

4. Sweep rules push idle PC cash to interest-bearing or sweep-network accounts

5. ERA 835 matching runs across every PC, with deposits posting to the right entity automatically

6. Management fee transfers run on a schedule, papered to the MSA

For Lemma, that looks like $10M FDIC per entity through the IntraFi sweep network, virtual accounts per location for payer EFT routing, and a single dashboard your CFO actually checks on a Tuesday.

Centralized treasury isn't one account. It's one source of truth. Pick a bank built for multi-entity, and the work shrinks from a Friday spreadsheet to a Monday glance.