Daily deposits and patient payment posting come first. Compare the deposits hitting your bank account against what the front desk collected and what the practice management software shows was posted to patient accounts. Discrepancies here usually mean a copay was collected but not recorded, a deposit was missed, or a refund slipped through without documentation. Reviewing this monthly catches problems while they are still traceable.

Insurance payments and EOB reconciliation come next. Carriers pay differently than what you billed, and the explanation of benefits shows the adjustments, write-offs, and patient responsibility amounts. Your books should match what the practice management software shows for insurance receipts. When they do not match, either an EOB was not posted, a payment was applied to the wrong patient, or a contractual adjustment was missed.

Pull the patient accounts receivable aging report and look at what is outstanding from patients versus insurance carriers. Patient balances over 90 days usually mean statements are not going out, the front desk is not collecting at the time of service, or there is a billing issue. Insurance balances aging past 60 days mean claims need follow-up before they get denied for timely filing.

Payroll and benefits need a careful look every month. Review gross wages, payroll taxes, retirement contributions, and health insurance premiums posted for the period. Make sure employer matches on 401(k) or SIMPLE plans were funded. Confirm that health and dental premiums withheld from employee paychecks plus the employer portion tie to what was actually paid to the insurance carrier.

Merchant processing fees deserve their own line of attention. A practice running $80,000 in monthly card revenue easily pays $2,000 to $2,500 in processing fees. Gross deposits should be booked separately from the fees, not just the net amount hitting your account. Otherwise revenue and expenses both get understated and you lose visibility into what card processing is actually costing you. Practice bookkeeping done right separates these out so you can negotiate with processors based on real numbers.

Supply purchases need monthly categorization review. Lab fees, clinical supplies, office supplies, and small instruments all belong in separate accounts. Lumping them into one supplies category makes it impossible to see where the money is actually going or to benchmark against industry ratios.

Equipment financing activity matters too. If you have financed chairs, digital x-ray, sterilizers, CBCT units, or operatory build-outs, each monthly payment splits between principal and interest. Only the interest portion is an expense. Many practices book the entire payment to expense, which overstates costs and ignores the reduction in loan balance on the balance sheet.

Finally, review the profit and loss statement and balance sheet against prior months. A drop in collections that does not match production, or a spike in supplies without a clear reason, points to something that needs attention. Monthly bookkeeping, tax and consulting services built around these reviews keep the books aligned with how the practice actually operates and make tax season far less stressful.