Improving Payment Reconciliation for a Healthcare Practice
Riverbend Specialty Health could not tie deposits to patients, providers, or locations. A reporting redesign cut reconciliation from three days to four hours.
- Client
- Riverbend Specialty Health
- Client type
- Specialty medical practice
- Company size
- 100–500 employees
- Locations
- 6
- Processing volume
- $1.1M / month
Executive summary
Riverbend's deposits arrived as aggregated lump sums with no way to attribute them to a patient, provider, or site. We rebuilt the reporting layer with location-level identifiers and connected the practice management system so every deposit decomposes into its source transactions.
Reconciliation time reduced from three days to four hours.
Unmatched deposits reduced by 88%.
Provider-level reporting available daily instead of monthly.
Location-level deposits visible without manual allocation.
Client profile
- Industry
- Specialty healthcare (orthopedics and rehabilitation)
- Locations
- 6
- Providers
- 38
- Monthly volume
- $1.1 million
- Payment mix
- 51% card present, 34% portal, 15% payment plans
The challenge
Deposits were difficult to match with patients, providers, and locations.
- A single daily deposit combined six locations and three payment channels.
- Roughly 11% of deposit value was unmatched at the end of each month.
- Provider productivity reporting was delayed by the reconciliation backlog.
- Refunds and chargebacks netted into deposits with no visible detail.
Why the previous setup was failing
- • One merchant account shared across all six sites with no location identifiers.
- • Provider-level attribution reconstructed manually from the practice management system.
- • Payment plan installments reported separately from one-time payments.
- • Reconciliation performed by one administrator with a large spreadsheet.
- • One MID for six locations made location attribution mathematically impossible from settlement data alone.
- • The portal wrote a different patient reference format than the front desk.
- • Payment plan installments carried no link back to the originating encounter.
- • Netting refunds into deposits hid the true gross activity.
Our assessment
- Traced 30 days of deposits back to source transactions to quantify the match rate.
- Audited reference-field formats across every payment channel.
- Reviewed practice management integration capabilities for identifier pass-through.
- Evaluated MID structure options for location-level settlement.
The recommended solution
- Split settlement by location using child MIDs under one group hierarchy.
- Standardize a single reference schema across front desk, portal, and payment plans.
- Integrate the practice management system so identifiers travel with each transaction.
- Report gross deposits with refunds and adjustments itemized separately.
- Deliver a daily automated reconciliation report instead of a monthly manual one.
Implementation Process
- 1
Weeks 1–2: Diagnosis
Match-rate analysis and reference schema audit across all channels.
- 2
Weeks 3–4: Restructure
Location MIDs provisioned, gross settlement enabled, reference schema standardized.
- 3
Weeks 5–6: Integration
Practice management integration deployed and validated against historical encounters.
- 4
Week 7: Handover
Daily reconciliation report live; administrator trained on the exception workflow.
Technology and integrations
Integration changes
- • Practice management integration writes patient, provider, and location identifiers into every transaction.
- • Portal and terminal payments now share one reference schema.
- • Daily reconciliation file delivered to accounting with exception flags.
Processing changes
- • Six child MIDs for location-level settlement and deposits.
- • Gross settlement with separately itemized refunds, chargebacks, and fees.
- • Payment plan installments tagged to the originating encounter.
Obstacles and resolutions
Historical payment plans had no encounter linkage.
Backfilled the active plan population with a one-time mapping exercise rather than attempting full history.
Front-desk staff entered reference data inconsistently.
Removed free text from the workflow — identifiers now populate from the practice management system automatically.
Gross settlement changed the deposit amounts finance expected.
Ran a two-week bridging report showing gross-to-net so accounting could adapt without surprises.
Measurable results
≈$34,000 annualized administrative recovery; write-offs from unmatched deposits reduced materially.
Operational improvements
- • One administrator no longer spends three days a month on matching.
- • Refund and chargeback investigation starts from itemized detail.
- • Exception handling replaced full manual reconciliation.
Reporting improvements
- • Deposits decompose to patient, provider, and location.
- • Daily automated reconciliation report with flagged exceptions.
- • Gross activity visible instead of net-only deposits.
Funding improvements
- • Deposits arrive per location, matching how the practice manages budgets.
- • Batch-to-deposit variance investigated the same day rather than at month end.
Customer experience improvements
- • Patient payment questions answered on the first call.
- • Payment plan balances accurate in the portal in real time.
- • Refunds processed faster because the source transaction is easy to locate.
Before and after
| Measure | Before | After |
|---|---|---|
| Reconciliation time | 3 days/month | 4 hours/month |
| Unmatched deposit value | ≈11% | ≈1.3% |
| Settlement detail | 1 pooled MID | 6 location MIDs |
| Provider reporting | Monthly | Daily |
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Learn moreFrequently asked questions
Are these results guaranteed?+
No. This engagement is demonstration content built on realistic scenarios. Actual outcomes depend on your volume, mix, software, and current pricing — which is exactly what a review establishes.
How long did the Riverbend Specialty Health engagement take?+
The implementation ran across 4 phases; most comparable environments cut over in 7 to 14 business days once scope is agreed.
Do we have to change software to see similar results?+
Usually not. Most of this work happens in merchant structure, pricing, data capture, and integration configuration around software you already run.
Can we see a version of this analysis for our business?+
Yes. A payment review returns the same structure — assessment, recommendation, projected impact — against your own statements.
Want this analysis for your business?
Send us your current setup and we'll return a written assessment covering cost, integrations, reporting, and funding.
Related solutions and references
The pages that explain the payment methods, integrations and account structure behind this engagement.
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