More than $30,000 recorded as paid that had never been collected

The practice

Savannah Facial Plastic Surgery is a cash-pay facial plastic surgery practice with a medspa in Savannah, Georgia. Dr. Timothy Minton owns it and operates there. On a typical day the front desk and the patient care coordinator take cards, checks, cash, financing plans, and rewards redemptions across two entities, and all of it gets recorded in the EMR at checkout.

Like most practices its size, it had no reconciliation process. The EMR recorded what was paid and the bank showed what arrived, but nobody was comparing the two transaction by transaction. There wasn't time, and there was no obvious reason to think anything was wrong.

The first version

Aaron Toly joined the practice as COO after running reconciliation operations at Invesco PowerShares, where the daily work was confirming that the firm's records matched what custodians actually held. The practice's situation looked familiar to him. He built the first version of MiraCore as a spreadsheet: export the EMR's financial activity report, pull the records from the card processor, financing companies, rewards programs, and bank, and match every checkout to an actual deposit, funding, or redemption.

He ran it every morning.

What it found

Over the first few months the reconciliation turned up more than $30,000 that the EMR showed as paid but that had never reached the practice's accounts. None of it had been flagged by anyone. Each transaction was a normal completed checkout with a payment method attached.

The exceptions fell into the categories MiraCore still watches for:

• Financing plans that were recorded at checkout but never funded
• Rewards codes applied in the EMR but never redeemed in the rewards portal
• Checks logged as received that had not been deposited
• Card transactions that were voided, declined, or refunded after being recorded as paid

Some of it could be recovered once it was found. Financing could be re-run, some redemptions could still be completed, and some patients could be contacted. Some of it could not. Either way, once the process was in place, a missed payment stopped being something that could sit unnoticed for months.

What changed

The spreadsheet became a daily routine and eventually the software. Now a member of the practice's team opens MiraCore each morning, works through the short list of exceptions, and resolves them while the details are still fresh, whether that means calling the financing company, completing a redemption, or following up on a check. Dr. Minton looks at the dashboard, sees where things stand, and gets on with his day.

Commissions are paid on revenue that has already been matched to a deposit. And the owner has a basis for trusting the numbers that isn't just trusting the people.

Why it became a product

Most practices will never have someone with a reconciliation background on staff, and they shouldn't need one. MiraCore was rebuilt as software so a front-desk employee can run it and an owner can read it without any training in this area.