David From Accounting

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David From Accounting

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Accounting for healthcare practices. Bookkeeping, payroll, and month-end close by the 10th, for a fixed monthly fee. Des Moines, Iowa, and virtual nationwide.

23/10/2026

Here's exactly what I'd do with your books if you hired me for a week.

The Dental Practice Financial Checkup: $1,250, fixed fee, one week. I take your last 12 months of books plus your practice management reports, and I benchmark your overhead, your write-off percentage, and your collections against dental industry norms.

Then I hand you the three biggest leaks in your practice, in plain English, with what each one costs you per year. No 40-page report you'll never read. Just the numbers that matter and where the money is going.

Most owners find at least one leak worth ten times the fee. The PPO write-off line alone surprises almost everyone.

One week. Fixed fee. Message me to book your checkup.

21/10/2026

Money sitting in your accounts receivable past 30 to 45 days isn't a payer problem. It's a collections process problem.

Insurance AR and patient AR need completely different playbooks. Insurance claims stall because nobody works the aging report weekly, appeals the denials, or chases the claims that went into the void. Patient balances stall because statements go out late, or never, and nobody asks for payment at the time of service.

AR days is the first thing I look at in a practice's books. It's the fastest read on whether the front office runs a system or just hopes the money shows up. A practice collecting 98% at 25 AR days and one collecting 98% at 60 AR days are living in completely different cash realities.

How many days of your production are sitting in AR right now?

19/10/2026

The average dental practice presents treatment plans and watches about half of them walk out the door unscheduled.

Think about what that costs. You paid for the exam, the imaging, the doctor's time to diagnose and present. Then the patient leaves and that production evaporates. Not to a competitor. Just to inertia.

Following up on unscheduled treatment is the cheapest production you'll ever find. These patients already trust you, already sat in your chair, and already heard the recommendation. A simple system, a call or text sequence from your front desk, recaptures cases sitting in your software right now.

Most offices have six figures of diagnosed, unscheduled treatment gathering dust in their practice management system. That's not a production problem. It's a follow-up problem.

16/10/2026

Your hygiene department should be a profit center. In too many offices it's a loss leader nobody's watching.

The number that matters: hygiene reappointment rate. The percentage of hygiene patients who leave with their next visit already scheduled. Healthy is 90% plus.

Below 90%, you're staring at chairs sitting empty that you already paid staff to fill. The hygienist's salary doesn't drop because the 2pm slot went unscheduled. That empty chair is lost production on top of fixed payroll.

And it's the easiest production to recover. No marketing spend, no new patient acquisition cost. Just a front desk process for reappointing at checkout and a system for working the unscheduled list.

Under 90% isn't a marketing problem. It's a systems problem, and it shows up in your collections.

14/10/2026

Quick question: what does each PPO plan actually cost you per year in write-offs?

Most dentists can't answer that. They know they're in network with the big carriers, but they've never seen the per-plan math: production vs. adjustments vs. collections, plan by plan.

That's expensive ignorance. One plan might be costing you $80,000 a year in write-offs for patients who would stay cash-pay anyway. Resigning from the wrong plan, or renegotiating your fee schedule, can be worth more than an entire year of marketing spend.

And unlike marketing, finding out costs you nothing. The data is already in your practice management software. It just needs someone to pull it into a report and do the arithmetic.

Your PPO contracts are the biggest expense line you never negotiated. Might be time.

07/10/2026

Uncomfortable stat: roughly half of dentists will deal with embezzlement in their careers, and the typical loss runs into six figures.

It happens because lean offices hand one person the intake, the posting, the deposits, and the reconciliations — with no segregation of duties and nobody independently reviewing adjustments.

An outside accounting team is itself a fraud control: independent reconciliation, a second set of eyes on every write-off and discount, and reporting the owner can actually read.

It's not about distrusting your team. It's about building a system where theft is hard and mistakes get caught early — whether that's a person or a process problem.

If no one outside your office has looked at your books this year, that's worth fixing.

04/10/2026

If you're entering transactions after hours, your books aren't a system — they're a chore.

The pattern I see in dental offices: books two months behind, reconciliations skipped, and tax season turns into a last-minute cleanup project. Meanwhile nobody can answer basic questions — what's our supply % running? Which payer reimburses best? Are we actually more profitable than last year?

A real monthly close fixes that: reconciled, reviewed, and in your hands by the 10th, with a short list of guardrail numbers (supply %, lab %, payroll %, net margin) against benchmarks. Ten minutes to understand your month.

You went into dentistry to treat patients, not to reconcile bank statements at 9pm.

15/05/2026

What's your end-of-month ritual?

Mine includes:
✔ Reconciliations
✔ Profit review
✔ A fresh cup of coffee
✔ A sticky note titled "Weird Stuff"

End of month is when you catch the patterns—or the problems. Make it a habit.

14/05/2026

"Wait…we paid how much for toner?"

One client was spending $800/month on office supplies. They didn't know—until we tracked it.
Small leaks sink ships. Your books should help you plug the holes.

13/05/2026

"I just clicked 'accept all' on my bank feed. Am I doomed?"

Automation is helpful—until it's not.

A client once categorized 87 expenses as "marketing" because it looked right. Except 41 were rent. And 3 were from their kid's soccer team.

Auto-categorizing is a tool. But trust me—you still need eyes on it.

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