> [llms.txt](https://getlemma.com/llms.txt)

# Mohs surgery and the 90-day insurance cash gap

Mohs surgery practices operate with a significant cash flow challenge. These high-volume, insurance-billed businesses typically experience 60 to 90 day reimbursement cycles and traditionally fund the resulting gap using lines of credit, the same working-capital squeeze retina practices feel funding anti-VEGF drugs ahead of reimbursement, covered in [how retina practices bridge the buy-and-bill cash gap](/provider-guides/anti-vegf-buy-and-bill-cash-flow). However, a yield-bearing reserve combined with virtual accounts offers an alternative approach.

## The Mohs cash flow problem in detail

A typical Mohs case generates several thousand dollars in billed revenue. Volume practices usually handle 10 to 30 cases weekly. While the economics are sound, success depends entirely on timely cash arrival.

Insurance reimbursement timing varies by payer type:

- Commercial payers: 14 to 45 days
- Medicare and Medicare Advantage: 14 to 30 days
- Medicaid: highly variable
- Patient responsibility and HSA reimbursements: extended timelines, often complicated by [paper EOBs that still need manual posting](/lockbox)

When accounts receivable average 60 to 90 days, practices carry approximately two months of revenue as receivables continuously. This AR must be funded, typically through expensive lines of credit.

## How a yield-bearing reserve changes the equation

An effective structure includes:

- Operating account earning up to 1.75% APY on idle cash
- Reserve virtual account with FDIC coverage up to $10M per entity
- Case-specific cost reserve for lab supplies, pathology, and reconstruction materials
- Payroll reserve funded weekly from operating revenue
- Tax reserve

For a $1M to $3M operating reserve, idle cash earning interest generates $17,500 to $52,500 a year, the same yield math covered in [how to optimize yield on a $1M practice operating balance](/provider-guides/optimize-yield-1m-practice-operating-cash). This approach doesn't eliminate the need for credit lines on difficult weeks but reduces dependency and creates a buffer for slower periods.

Banking features built for [dermatology-specific revenue cycles](/dermatology) include flat $15 wire fees and free ACH transfers in both directions, enabling cost-effective cash management.

## Your bank doesn't know healthcare. Lemma does.

Lemma is business banking for healthcare practices, MSOs, DSOs, and multi-entity groups: free ACH, up to 1.75% APY, $10M FDIC protection, entity management, cash sweeps, and an AI-powered lockbox that digitizes checks and EOBs on arrival.

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