A lot of practice owners track patient volume closely, how many visits happened this week, how many new patients came in this month, and treat that number as the main signal of how the practice is doing. Visit count matters, but it's not the number that actually determines whether the practice is financially healthy. Collections are.

Collections means what you actually receive, not what you billed or what a fee schedule says a service is worth. A busy week of visits doesn't automatically translate into a busy week of cash in the door, especially with insurance-based practices where reimbursement timing and adjustments sit between the visit and the money that actually lands in your account.

The gap between charges and collections comes from a few places. Insurance adjustments, meaning the difference between what you billed and what the payer's contracted rate actually allows, reduce what's collectible before a single payment even arrives. Denied claims that never get appealed or resubmitted quietly disappear from revenue entirely. Patient responsibility, meaning copays, deductibles, and coinsurance, doesn't always get collected at the time of service, and the longer it sits as accounts receivable, the less likely it ever gets collected at all.

Tracking your actual collection rate, meaning collections as a percentage of what you billed, tells you something visit counts never will. A practice with strong visit volume and a weak collection rate is busier than it is profitable. A practice with more modest visit volume and a strong collection rate might be in far better financial shape than the raw numbers suggest.

Getting a clear collection rate requires your books to separate charges, adjustments, and actual payments cleanly, which is often not how practices structure things when the front desk software and the bookkeeping aren't really talking to each other.

If you've never calculated your practice's actual collection rate, that's worth doing before assuming a busy schedule means a healthy bottom line.

Jeremy Brewer is the founder of 911 Bookkeepers LLC in Baton Rouge, Louisiana. 911 Bookkeepers partners with MBJA Accounting Service to give chiropractic and MDVIP practices clean, current financials. He is a Xero Certified Advisor.