The Clinic Close That Doesn’t Break: Days Worked, A/R, and the 'Extra Payroll' Month

Financial messes don’t usually come from big, obvious failures. They sneak in through little cracks: miscounting “days worked,” skipping an A/R report, or overlooking the fact that some months have an extra payroll cycle. Each one seems minor, but put together, they distort the picture of how your clinic is performing.

Step 1: Count Days Worked for Each Provider

The most important number in a clinic is often the simplest: days worked. Without it, productivity reports are misleading.

Solution: use a shared calendar where providers mark the days they saw patients. At month’s end, have them confirm the total and lock it. From there, calculate daily averages by provider or service line. When everyone sees their true daily run rate, productivity conversations shift from guesswork to facts.

Step 2: Don’t Skip the A/R Report

Your Accounts Receivable (A/R) aging report shows how much money is waiting to come in, and how long it’s been outstanding. It should never be optional.

• Patient balances over 90 days usually point to front-desk issues. The fix? Collect co-pays at check-in, have a card on file, and train staff to ask about balances at checkout.

• Insurance balances can get stuck if claims aren’t followed up. A weekly “A/R huddle” where staff review overdue accounts, assign an owner, and set deadlines keeps things moving.

Without this, revenue looks fine on paper but cash flow tells a different story.

Step 3: Watch Out for Months With an Extra Payroll

Every so often, a month includes three payroll runs instead of two. If you don’t flag it, labor costs will look inflated compared to other months, even though nothing has really changed.

The fix is simple:

1. Make a note in the close packet that it’s a three-payroll month.

2. Look at cost per clinic day or per visit, instead of just the raw monthly total.

3. Use rolling 12- or 13-month charts to smooth out the noise.

This way, leaders don’t make the mistake of thinking costs suddenly spiked.

Step 4: Use a Monthly Close Checklist

Consistency is what turns good habits into reliable numbers. Build a checklist so nothing slips through the cracks. It might look like this:

• Pull production/visit reports

• Pull A/R aging

• Reconcile charges → adjustments → collections → change in A/R

• Confirm days-worked totals

• Flag months with an extra payroll run

• Publish a one-page summary with visits, average revenue per visit, 90-day collections %, daily run rate, and cash forecast.

Final Word

Small misses add up. When you track days worked, keep A/R front and center, and normalize payroll months, your monthly close becomes stronger. That means fewer surprises, cleaner decisions, and more confidence that the numbers tell the real story.