Clinic ERP Consultant, USA

Production, collections and provider pay

Provider compensation is usually the most sensitive number in a US clinic group, and the most fragile spreadsheet. Associate dentists are often paid a percentage of production or of collections, sometimes with lab fees deducted. Physicians and nurse practitioners may combine a base salary with productivity bonuses. Physical therapists can be salaried with incentives tied to visits, and injectors in aesthetic practices are frequently paid per unit or per treatment. Acquired practices bring their own legacy agreements on top.

The choice between production and collections matters for system design. Production can be read from the practice management system on the day of service, while collections depend on payments that arrive later from payers and patients, with adjustments and refunds in between. I trace each pay plan back to the data it needs, decide which system holds that data, and design a calculation that runs from the same figures finance reports. Draws, guarantees and clawbacks become written rules rather than something one person remembers.

Whether a provider is an employee or an independent contractor, and how agreements are structured, are questions for your employment counsel and accountant. What I own is making sure the ERP and payroll process carry the arrangements they approve, with an audit trail from service to payout.

Payer receivables, patient balances and HIPAA boundaries

Most US clinic groups collect from commercial health or dental plans, government programs such as Medicare where the specialty applies, and patients paying copays, deductibles or the full fee. Claim submission, eligibility checks, denials and patient statements belong in the practice management or revenue cycle tools, where those workflows are already built. The ERP does not need to repeat them.

Finance instead needs a dependable summary by location, payer class and period: charges, contractual adjustments, payments, refunds and the open balance. I specify that summary, how card and ACH deposits are matched to it, and how credit balances owed back to patients or payers are tracked until resolved. Merchant fees and patient financing payouts are reconciled in the same flow, so the bank account and the practice system tell one story.

Keeping protected health information out of the ERP makes the design simpler and reduces exposure. The interface carries location codes, payer classes, amounts and references, not names or diagnoses. Your privacy or compliance lead reviews each data flow and decides which agreements and controls the selected vendors need under HIPAA. I document the flows so that review is quick and complete.

Memberships, packages and sales tax on retail products

Many dental groups now offer in-office membership plans for uninsured patients, billed monthly or annually. Dermatology and med spa groups sell treatment packages, prepaid series and product bundles. These help cash flow, but they also create liabilities: money collected for care not yet delivered. If the practice system records the sale as revenue on the day of payment, location results look better than they are, and refunds for cancelled packages become hard to trace.

I design how memberships and packages move between the practice system, the payment processor and the ledger. That covers deferred revenue by location, recognition as visits or sessions are used, rules for expiry and transfers between locations, and reporting on outstanding package balances. Your CPA sets the accounting policy; the system then applies it the same way everywhere.

Sales tax is a separate touchpoint. Professional medical and dental services are generally treated differently from goods, but retail skincare, supplements and other products sold at the front desk may be taxable depending on the state and sometimes the locality. Groups operating in several states need product tax categories that the ERP or a connected tax engine can apply per location. Which items are taxable where is confirmed with your tax advisor, not assumed during configuration.

Supplies, injectables and the location rollout template

Consumables in outpatient groups range from gloves, sterilization supplies and impression materials to implants, neurotoxins, dermal fillers and orthotic stock. Most of it comes through national or regional distributors, with manufacturer programs for higher-value products. Without a shared catalog, each location orders by its own habits, and the same item appears under several descriptions and prices.

I define an item master with approved suppliers, par levels by location, and lot and expiry capture for the products where a recall or a usage audit would need it. Supply cost per visit or per procedure becomes a routine report once usage and purchasing come from the same records.

Growth is where the design pays off. US groups often add locations through de novo openings and acquisitions in the same year, and each one needs a predictable setup. I write a location template covering the location or entity record, chart of accounts mapping, payer classes, catalog assignment, bank and merchant accounts, the practice system connection and a first month-end checklist. The pilot location tests the template, and later openings follow it instead of starting from a blank page.

Platform fit, QuickBooks migration and remote delivery

Many US clinic groups run QuickBooks or another small business accounting tool, with a separate payroll provider, distributor portals for ordering and spreadsheets for compensation. The question is rarely whether to replace the practice management system; it is how to put a structured back office behind it. Zoho, Odoo, ERPNext and Microsoft Dynamics 365 get scored against scenarios taken from your own locations: a day of mixed insured and cash visits, a provider pay period, a package refund and a new location setup.

Migration covers the chart of accounts, open payables, supplier and item records, opening balances by location and historic compensation data where you want comparisons. I plan it inside the data migration scope and test the summary interface with real days of data.

The work runs remotely, with workshops scheduled for overlap across US time zones and recordings for location managers who cannot attend live. For the general clinic model see ERP for clinics; hospitals, surgery centers and larger provider organizations are covered on the US healthcare ERP page. Broader country context sits on my ERP consulting page for the United States and the USA country hub.