Your First Cash-Flow Map
Many practices struggle with timing, not revenue. A simple cash-flow map shows what is coming in, what is going out, and when you can pay yourself without stress. You can build it and keep it current in about 20 minutes a week.
1) Know your weekly burn
List every fixed cost, including annual items spread across 52 weeks: EHR, phone, internet, malpractice, directory, virtual address, rent, software, accountant. Add them to get your weekly burn. Keep that number visible.
Lesser-known move: create sinking funds for annual bills. Transfer the weekly amount into a separate subaccount every Friday so renewals do not sting.
2) Map cash to when it clears
Revenue is not cash until it lands.
Card: usually 1 to 2 business days
ACH: often 3 to 5 days
OON reimbursement: weeks
Checks: sometimes a month
On your calendar, note the expected deposit date by payer type. You now see cash timing, not just visit dates.
Lesser-known move: track your cash conversion time for each visit type for one month. If ACH is slow, encourage card in tight weeks.
3) Build a 12-week rolling view
Create a simple sheet with 12 columns:
Starting balance (cleared cash)
Expected deposits by source and timing
Fixed expenses
One-offs due that week
Owner’s pay
Ending balance
Update every Friday and roll forward one week. The goal is to spot a dip two to four weeks early.
4) Set a buffer
Target 4 to 6 weeks of fixed costs. Start at 2 if needed and grow it. Move a set amount into a buffer subaccount each week.
Traffic light rule:
Green 4+ weeks. Yellow 2 to 4. Red under 2.
Yellow pauses upgrades. Red adds a consult block, warms referrals, and trims discretionary spend for 30 days.
5) Pay yourself on a cadence
Pick two pay dates per month. Transfer owner’s pay from cleared cash based on the 12-week map. Set a floor you can keep in Yellow weeks. When in Green, add a simple month-end sweep: a percentage to owner’s pay and a percentage to buffer.
Lesser-known move: pay only from cleared cash. Do not count projected deposits.
6) Price and schedule with cash in mind
Calculate average revenue per clinical hour, including no-shows at your policy rate. If burn is 900 per week and average revenue is 180 per hour, you need 5 clinical hours to cover fixed costs. Everything after that funds pay, taxes, and buffer.
Seasonality to note: August dip, late November and late December slowdowns, early January uptick, back-to-school ADHD and anxiety inquiries. Warm referrals four weeks ahead and plan short series during slow periods.
7) Protect cash with two policies
Card on file with a 24 or 48-hour cancel window
Refill and portal response during business hours only
8) Automate guardrails
Auto-transfer taxes to a separate account after each payout
Auto-fund sinking accounts weekly
Auto-pay yourself on your two dates
What this gives you
Early visibility on shortfalls
Reliable pay dates
Clear upgrade and hiring decisions
Calm, data-based yes or no on new opportunities
You did not become a provider to manage spreadsheets all day! A cash-flow map keeps money decisions short and useful so you can focus on care.
If you’re feeling overwhelmed, stuck or unsure where to start, come join us inside Strong Roots Mentorship. We take you step by step from ground zero to seeing patients and beyond, without the overwhelm.