Q4 Starts Now: What Practice Owners Should Fix Before December

Fall is here, and for a chiropractic practice that means the last full quarter to shape how the year closes. Holiday schedules thin out patient visits, insurance payments lag into January, and many owners do not look at year-end numbers until it is too late to change them. The decisions that matter for Q4 need to happen now, while there is still runway to act.

1. Tie your practice software to your bank

Start by matching what your practice management system says you collected against what actually landed in the bank, month by month. Insurance EFTs, card batches, and patient checks often post as lump deposits, and if nobody ties them back to the visits they paid for, your books can look fine while a whole payer's payments are missing. Fix any gap now, while the payer and the patient still remember the visit.

2. Work the insurance receivables before the year runs out

Pull an aging report and look hard at anything past 90 days. Every payer sets its own timely filing and appeal windows, and some are short, so a claim that is sitting unworked in October can turn into a write-off by January. Sort the old balances by payer, resubmit or appeal what can be saved, and write off what cannot so your receivables reflect money you can actually collect.

3. Compare collections to plan, not charges

Charges are what you billed. Collections are what kept the lights on. Compare year-to-date collections against the goal you set in January and break them out by payer and by cash-pay, so you can see whether a shortfall is a volume problem, a reimbursement problem, or a collections problem. Each one has a different fix.

4. Count your prepaid care plans correctly

If patients prepaid for a package of visits, the visits they have not used yet are a liability, not income. Check that unused visits are tracked and that only the visits delivered have been counted as revenue, otherwise your profit for the year is overstated and your CPA is planning around the wrong number.

5. Plan for the December push and the January dip

Many patients try to use their remaining benefits or flexible spending dollars before year-end, then deductibles reset in January and insurance pays less on each visit for a while. Schedule staff and associates around that pattern now, and build it into your cash forecast so the slower January collections do not catch you off guard.

6. Get W-9s now

If you paid independent contractors this year, such as a fill-in provider, a cleaning service, or marketing help, collect W-9s now. For payments made in 2026, the Form 1099-NEC reporting threshold rose to $2,000 under the 2025 tax law, so confirm with your CPA which contractors need a form before the end of January.

Equipment purchases before year-end should still make clinical sense first. Run the numbers with your CPA, but do not buy a table or an x-ray upgrade just to lower a tax bill.

The decisions you make between now and December decide how the whole year closes. Make them while there is still a quarter left to act.

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.