Quality of Earnings and CFO services for specialty clinics
Clinic earnings live in the revenue cycle. We test payer mix, denials, contractual allowances, and when revenue is really earned, including devices still in fabrication.
Talk about a deal Talk about the businessReply within one business day · Fixed fee in writing · No obligation
Reimbursement rules are changing
- CMS has set the next DMEPOS competitive bidding round for January 1, 2028, including some off-the-shelf braces, with bidding opening in 2026. Source
- Since October 1, 2026, SBA 7(a) acquisitions of $3 million or more need an independent Quality of Earnings, and lenders size the loan on its normalized earnings. The rule explained →
We work with lenders and buyers in Utah, Denver, Phoenix, Dallas-Fort Worth, Boise, Las Vegas, and nationwide.
Net revenue per patientDays in A/RDenial ratePayer mixRevenue per practitionerEBITDA margin
Gross charges mean little. Buyers value what's collected after allowances, denials, and recoupments.
What buyers and lenders test in a specialty clinic QoE
Revenue cycle
Payer mix, contractual allowances, denials, and A/R aging tested against cash.
Revenue timing
Revenue recognized at delivery, with devices in fabrication treated as work in progress.
Audit exposure
Documentation practices and the risk of payer audits and recoupments.
Practitioner concentration
Revenue by certified practitioner and referral source.
Inventory and components
Components and inventory costed and counted.
Cash to accrual
Most clinics run cash-basis books. Buyers need accrual earnings.
Specialty clinics QoE: what's included
- Payer mix and contractual allowance analysis
- Denial and A/R collectability testing
- Revenue timing and WIP devices
- Practitioner and referral concentration
- Cash-to-accrual conversion
Specialty clinics add-ons
| Each location over three | $1,500 |
| Each additional legal entity | $2,500 |
| Inventory testing (counts, costing, reserves) | $5,000 |
Fees by deal size
| Purchase price / EV | QoE fee |
|---|---|
| Under $3M | $11,500 (sell-side $9,000) |
| $3M to $4M | $12,500 |
| $4M to $5M | $14,500 |
| $5M to $10M | $19,500 |
| $10M to $15M | from $26,500 |
| Lower middle market & PE add-ons | typically $25,000 to $70,000 |
Larger deals are quoted from revenue, entities, inventory, and report format. Pre-LOI earnings screen $1,950. All fees →
Before an LOI, run the seller's numbers through our free add-back sanity check. Terms like SDE, cash proof, and DSCR are explained in the QoE glossary.
Where clinic owners lose money
- Denials and write-offs no one tracks to a root cause
- Prior authorizations that delay cash
- Cash-basis books that hide margin by location
- Billing vendor reports that don't tie to the bank
Priced for your industry
Clinics need revenue cycle reporting the owner trusts, on an accrual close.
Start with a $2,500 finance diagnostic, credited to your first month. Interim CFO or controller coverage is also available, part time from $10,500/mo or full time.
Books & close
- Monthly bookkeeping and reconciliations
- Accrual close by business day 10
- Monthly financial package
- Quarterly review call
Controller
- Everything in Books & close
- KPI dashboard for your industry
- Payroll, AP, and sales tax oversight
- Quarterly 13-week cash forecast
- Monthly review call
CFO
- Everything in Controller
- Denial and collection dashboard
- Location and practitioner profitability
- Billing vendor oversight
- Monthly CFO meeting
Fixed monthly fees, month to month after three months. Day-to-day bookkeeping may be done by trained staff working to our checklists, always with CPA review and sign-off by Edwin van Stam. Talk about the right package →
Specialty clinics engagements Edwin has led
- Financial due diligence on a prosthetics and orthotics clinic
Includes engagements Edwin performed with prior and affiliated firms. Client names are confidential.
CFO work for healthcare practices can be led by consulting CFO Brad Berrett, with 35 years as a CFO and chief accounting officer, including healthcare.
Specialty clinics questions
Does an SBA loan for this kind of acquisition need a QoE?
Under SBA SOP 50 10 8.1, a 7(a) change-of-ownership loan with a business purchase price of $3 million or more needs a Quality of Earnings, and the lender sizes the loan on the QoE's normalized earnings. Below $3 million many lenders still ask for one. Check your deal →
Why is revenue timing an issue for O&P clinics?
Devices are measured, fabricated, and delivered over weeks. Revenue belongs to the period of delivery, so open cases need to be treated as work in progress to get earnings right.
What do buyers worry about most?
Payer concentration, denial trends, and documentation that could lead to recoupments after closing.
Buying, selling, or running a specialty clinic?
Buying, financing, or selling? Start with a QoE conversation. Running the business? Start with a finance diagnostic.