The Quarter That Decides Whether Your Deal Works

Practice acquisitions live or die in the first 90 days post-close. Not because the diligence was wrong. Because the integration was rushed, deferred, or skipped. The banking layer is half the integration.

This is the day-by-day playbook for the first 90 days at a newly acquired practice. It assumes you have a healthcare-native bank that supports MSO-PC structures and fast onboarding. If not, double every timeline.

Days 1 Through 14: Foundation

Day one: new PC operating account is live (opened pre-close). Initial funding wire has settled. Signer matrix is documented.

Days 2-7: redirect payer EFT enrollments. Start with your top 10 payers by volume. Confirm receipt for each. Track in a spreadsheet with status.

Days 8-14: redirect inbound paper to your platform lockbox. Send remittance address change notifications to remaining payers. Notify the seller's bank of the impending account closure.

Days 15 Through 45: Operational Integration

Days 15-30: parallel run. Both old and new accounts receive deposits. Track inbound volume by payer to detect any missed enrollments. Reconcile against the open AR you inherited.

Days 31-45: cutover. Old account stops accepting new deposits. Any in-flight remits get forwarded for 30 days. Begin closing the old account and unwinding its lockbox.

Days 46 Through 90: Treasury Integration

Days 46-60: enable sweeps on the new PC operating account. Configure the threshold and destination per your platform standard. Confirm activation.

Days 61-75: integrate the PC into your consolidated dashboard. Verify per-entity reporting rolls up cleanly. Update your treasury policy to include the new entity.

Days 76-90: close-out. Final reconciliation against opening balance sheet. Document any post-close adjustments. Hand off ongoing management from the integration team to your standard treasury operations.

The Three Metrics That Tell You It Worked

One: percentage of payer EFTs successfully redirected by day 60. Target 95 percent. Below that, your integration is incomplete.

Two: days from close to first consolidated dashboard view including the new entity. Target 75 days. Above that, your reporting infrastructure is the bottleneck.

Three: variance between projected and actual post-close revenue in month two. Target within 5 percent. Larger variance means you missed something during diligence or integration.

What Stalls Most Integrations

Three patterns we see repeatedly.

One: the seller's banking relationship is more entrenched than expected. Payers who have been routing to that account for years take longer to update than 30 days. Plan for re-notification at days 45 and 75.

Two: the EMR-to-billing integration is incomplete. Encounters get billed but to the wrong entity. Your treasury team sees the symptom (cash landing in the wrong account) but the root cause is in clinical operations.

Three: the integration team disbands at day 30 because everyone assumes the work is done. It is not. Keep the team intact through day 90 minimum.

What This Looks Like in a Steady-State Platform

For a platform closing 10 deals a year, the first-90-days playbook should be a template, not a project. Each new close runs the same sequence with minor variation. The integration team becomes a function, not a one-off staffing decision.

Platforms that build this discipline early scale linearly. Platforms that treat each close as bespoke hit a ceiling at 5-7 deals per year.

The Single Most Important Decision

Open the new PC operating account before closing day, not after. This single decision compresses your first 14 days of integration by a full week. The downstream effect is real money in faster collections, cleaner reconciliation, and lower TSA cost.

Banks that support 5-10 day PC onboarding make this decision easy. Banks that take 6 weeks make it impossible. Pick accordingly.