How to run one treasury across multiple PCs

What "centralized" actually means

Centralized doesn't mean one bank account. It can't, legally, not in how the MSO-PC structure is put together (opens in a new tab). CPOM keeps PCs separate by design.

What it means: one dashboard, one set of policies, one point of control. The money sits in many accounts. The decisions sit in one place.

The hard rule: Money stays in its lane

Patient and payer dollars hit the PC first. Always. The PC then pays the MSO a management fee on a documented schedule. Cash moves down the contractual chain, never sideways.

Break this rule and you've got fee-splitting, which most state medical boards treat as a felony.

The five things to centralize

You can centralize these without touching ownership:

• Sweep rules configured across every PC and the MSO (opens in a new tab)
• A single treasury policy (idle cash thresholds, max single-bank exposure, signing limits)
• One reconciliation feed for ERA 835s, payer EFTs, and check deposits
• Consolidated reporting (cash, AR, deposit insurance coverage)
• Vendor and payroll origination, run from the MSO and charged back to PCs via MSA

What to keep separate

Don't centralize these. Ever.

• PC ownership and signers
• Patient-facing account names and DBAs
• Clinical revenue accounts
• Tax reporting

The PC is its own legal entity. It needs to look and act like one in every audit.

Signs you need this now

You're past DIY when:

• A new PC opening took 4+ weeks
• You had to manually move cash to cover payroll last month
• Two banks called about minimum balances on the same day
• Your CFO can't tell you total deposit coverage in under 30 seconds
• You're carrying $1M+ in idle cash earning under 1%

If two of these hit, you're already paying for the wrong setup.

What it costs to wait

Decentralized treasury isn't free. It costs in three places:

• CFO time: 4-6 hours a week reconciling across portals
• Idle cash drag: $1M sitting at 0.5% leaves $12,500 a year on the table
• Audit risk: messy intercompany flows are the first thing PE diligence flags

A lean treasury team shouldn't be the team that loses its weekends.

The setup that works

A clean centralized treasury looks like this:

1. Each PC has its own operating account
2. The MSO has its own operating account
3. All accounts sit at one bank that supports multi-entity dashboards
4. Sweep rules push idle PC cash to interest-bearing or sweep-network accounts
5. Reconciling ERA 835s and deposits across every PC (opens in a new tab), with deposits posting to the right entity automatically
6. Management fee transfers run on a schedule, papered to the MSA

For Lemma, that looks like $10M FDIC per entity through the IntraFi sweep network, virtual accounts per location for payer EFT routing, and a single dashboard your CFO actually checks on a Tuesday.

Centralized treasury isn't one account. It's one source of truth. Pick a single dashboard across the whole entity structure (opens in a new tab), and the work shrinks from a Friday spreadsheet to a Monday glance.