4 min read
2026-06-16
Derm platforms collect medical claims revenue and cosmetic cash at the same front desk. Separating those flows in your banking layer keeps audit, payer reporting, and sales tax clean.
Two Cash Flows, One Front Desk
A modern dermatology practice runs two businesses at the same desk. The first is medical dermatology: insurance-billed visits for acne, psoriasis, skin cancer screening, biopsies. Those revenues come through claims, 835s, and lockbox checks. The second is cosmetic: Botox, fillers, lasers. Those revenues come through credit card and cash, billed and collected the same day.
Both flow through the same patients and the same providers. Neither flows through the same accounting buckets. If your banking design does not separate them at the deposit layer, your audit, payer reporting, and sales tax all get harder than they need to be.
Why Separation Matters Below the EBITDA Line
Three places this shows up.
Sales tax. Most states tax cosmetic services but not medical services. If your point-of-sale system bundles both into a single daily deposit, your accounting team has to back into the taxable share monthly. With separate deposit streams, the tax filing reads off the cash directly.
Payer audit. If you ever get a payer audit (when, not if, at scale), the auditor wants to see only the medical claims revenue. If your banking layer commingles cosmetic, you produce more documentation than you need to.
Per-location reporting. PE-backed rollups want medical and cosmetic revenue tracked by location, by provider, and by service line. Banking that supports this from day one saves a quarterly back-office cleanup project.
The Architecture for a 20-Location Derm Platform
Three account layers per PC.
A claims revenue account that receives all insurance 835s and lockbox checks. EFT enrollments point here. Reconciliation runs against open claims.
A cosmetic revenue account that receives merchant settlement deposits for credit card and cash. Sales-tax-eligible revenue posts here.
An operating account that disburses payroll, vendor payments, and overhead. The first two accounts sweep into this on a defined schedule.
For 20 locations, multiply by 20. With virtual accounts under a healthcare-native bank, that's 60 virtual numbers but one banking relationship and one consolidated dashboard.
What Changes for Your CFO
Three numbers become accessible that were not before.
Medical revenue per location, per provider, per payer, end of each day
Cosmetic revenue per location, per service line, end of each day
Sales tax accrual that ties to actual cosmetic cash, not an estimate
Those numbers also become defensible. Your audit committee can answer questions in 10 seconds. Your PE sponsor's quarterly review gets cleaner. Your tax filings shrink.
FAQ
Common questions