3 min read
2026-01-28
Mohs surgery practices live with 60 to 90 day reimbursement cycles. Most fund the gap with a line of credit and tight nerves. A yield-bearing reserve plus virtual accounts changes the math without replacing the credit line.
A Mohs surgery practice is a high-volume, insurance-billed business with a specific cash flow problem. Each case involves multiple stages, costly fixed equipment, frozen-section pathology, and reconstruction. Reimbursement is heavy, but it lands 60 to 90 days after the case. Meanwhile, payroll, lab supplies, and the building lease all have to be paid this week. Most Mohs practices manage this gap with a line of credit and tight nerves. There is a better answer.
The Mohs cash flow problem in detail
A typical Mohs case is several thousand dollars of billed revenue. Volume practices run 10 to 30 cases a week. The economics work, but they only work if the cash arrives. Insurance reimbursement timing is the variable.
Commercial payers usually pay in 14 to 45 days. Medicare and Medicare Advantage land in 14 to 30 days. Medicaid varies wildly. Patient responsibility and HSA reimbursements drift longer. When average AR sits at 60 to 90 days, your practice carries roughly two months of revenue as a receivable at all times.
That AR has to be funded. Most practices fund it with a line of credit at 8 to 12% interest, plus annual fees. Better banking does not eliminate the AR cycle, but it changes the math.
How a yield-bearing reserve changes the equation
The structure that works for a Mohs practice:
Operating account that earns 1.75% APY on idle cash.
Reserve virtual account with FDIC coverage up to $10M per entity through the IntraFi sweep network.
Virtual account: case-specific cost reserve (lab supplies, pathology, reconstruction materials).
Virtual account: payroll reserve, funded from operating revenue weekly.
Virtual account: tax reserve.
Idle cash earning 1.75% APY across a $1M to $3M operating reserve generates $17,500 to $52,500 a year. That is real money against the carrying cost of your AR. It does not replace your line of credit on bad weeks, but it offsets the cost of having one and creates a buffer for slower months.
Wires are flat $15 if you ever need to settle a vendor in a hurry. ACH is $0 in both directions, so funding the case-specific reserve from the operating account is free. The dashboard shows balances and incoming payer activity in one view, which makes weekly cash forecasting a much shorter exercise.
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