See exactly how much cash is trapped in your A/R and what bridging the gap costs vs leaving it.
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Fill in your practice numbers above and click Calculate.
The reimbursement gap is the cash that's been earned but not collected. It sits on payer desks for 30, 60, 90, sometimes 180 days. Meanwhile your payroll runs every other Friday.
Here's the math underwriters see.
Step 1: Days in A/R drives collection probability.
Fresh A/R under 30 days collects above 95%. Once it ages past 120 days, you're recovering 10-20% at best. The H1 data shows behavioral health practices average 65-75 days, SUD residential runs 60-180 days, $800-$1,800 per claim.
Step 2: Denial rates are higher than most practices admit.
Dermatology hits 14-20% denials, three times the industry average. And 60% of denied claims never get resubmitted. That's pure margin walking out the door.
Step 3: CMS-0057-F changed the prior auth game January 1, 2026.
Payers now have 72 hours for urgent and 7 days for standard prior auth decisions. Plus the 2027 FHIR API mandate that's coming. Underwriting evaluates whether your billing infrastructure can handle the new requirements.
The Bank of Big Medicine reality.
While independent practice ownership dropped from 75% in the 1980s to about 33% in 2024, the largest payers are sitting on receivables AND offering fire-sale loans to acquire the practices that can't bridge their own gaps. UnitedHealth's response to the Change Healthcare hack (emergency cash loans to providers) was a textbook example. The capital structure of healthcare is being rewritten in plain sight.
The faster move: bridge with A/R financing or a working capital LOC. Take out with SBA at year 10. The H4 data shows that refinance saves typical practice owners $200K+ in interest.
Sources: H1-H6 NotebookLM Deep Research reports, CMS-0057-F Final Rule, Federal Reserve SBCS 2025, SBA.gov product matrix, Fed funds rate H.15.
A/R financing turns specific invoices into cash. Approval is based on your payer's credit, not your FICO. Same-day funding, no debt on your books.
A working capital LOC is revolving credit you draw against when needed. It's secured against your business, requires 600+ FICO and 6 months TIB.
A/R fits when payer mix is strong but cycle times are long. LOC fits when you need flexibility across payroll, supplies, and unexpected expenses.
Same day to 48 hours after approval, depending on the lender. Payer verification is the bottleneck, not your underwriting.
Yes. 42 CFR Part 2 was updated in 2024 to align SUD records with HIPAA, which simplified the lender consent process. Behavioral health A/R financing is now a core product, with the longer cycle times (65-180 days) priced in.
Yes, with caveats. Naturopathic, acupuncture, functional medicine, and hypnotherapy practices typically collect at time of service. Your trapped cash will show low.
The calculator still helps you size monthly burn vs collections and evaluate growth capital options like SBA 7(a) for clinic expansion.
Typically around year 10 of the bridge. The H4 data shows a typical SBA-to-conventional refinance at year 10 saves $200K+ in interest.
Variable SBA 7(a) rates run 7.5-9% vs conventional fixed 5-6%. Refinancing requires the practice to be cash-flow positive with DSCR above 1.25 and clean operating history.