DSO Integration Playbook: Onboarding New Practice Financials

The deal closed Friday. Monday morning, you own a practice with unknown financial processes, unfamiliar systems, and a team wondering what changes are coming. Now what?

The Integration Challenge

Acquiring a dental practice is the beginning, not the end. The real work starts when you take ownership and need to integrate financial operations into your DSO.

Every acquired practice is different. Some have clean books and solid processes. Others are financial chaos masked by good clinical production. You will not know which you have until you get inside.

The first 90 days determine whether integration succeeds or struggles. Move too fast and you break things that work. Move too slow and problems compound. The goal is methodical progress that establishes control without disrupting revenue.

This playbook provides a structured approach for DSO finance teams onboarding new practice financials.

Week 1: Establish Control and Visibility

Day 1-2: Secure Access

Before anything else, ensure you have access to everything financial.

Banking:

Add authorized signers to all accounts
Set up online banking access for central finance
Verify all account numbers and current balances
Understand any outstanding obligations (loans, lines of credit)

Practice Management System:

Obtain administrator credentials
Create central finance user accounts
Verify audit trail is enabled
Document current user access levels

Accounting Software:

Access QuickBooks or equivalent
Verify current state of books
Understand fiscal year and accounting methods

Merchant Accounts:

Access processor portals
Verify deposit accounts are correct
Document fee schedules

Insurance:

Access clearinghouse credentials
Verify ERA delivery is active
Document major payer portal logins

Payroll:

Access payroll system
Verify upcoming pay dates
Understand current payroll process

Day 3-5: Baseline Assessment

With access secured, assess the current state.

Bank Reconciliation Status:

When was the last reconciliation completed?
Are there outstanding items?
What is the current unidentified deposit balance?

Accounts Receivable:

Pull AR aging report
Calculate AR days and over-90-day percentage
Identify major outstanding balances

Accounts Payable:

What bills are outstanding?
Are there any past-due obligations?
What recurring expenses exist?

Credit Balances:

Pull credit balance report
Assess total and aging
Identify any large individual credits

Cash Position:

What is the current operating cash?
What is the upcoming payroll obligation?
Are there adequate reserves?

Day 5-7: Process Documentation

Document how things currently work, even if you plan to change them.

Daily Procedures:

Who handles patient payments?
How are deposits prepared?
What is the end-of-day process?

Weekly Procedures:

Who processes insurance payments?
How are ERA files obtained?
Who manages AR follow-up?

Monthly Procedures:

Who reconciles accounts?
How are financial reports prepared?
What is submitted to the previous owner/accountant?

Key People:

Who has institutional knowledge?
Who handles what function?
What is the coverage plan for absences?

Weeks 2-4: Stabilize Operations

Implement Daily Visibility

You cannot manage what you cannot see. Establish daily reporting from day one.

Daily Deposit Report:

Require daily reporting of all deposits
Match to bank transactions
Flag any unidentified amounts

Daily Collection Summary:

Production for the day
Collections by type
Key variances or issues

Exception Alerts:

Deposits above threshold
Adjustments above threshold
Unusual transactions

Standardize Critical Processes

Focus on the processes with highest financial impact.

Deposit Procedure:

Implement your standard deposit process
Ensure segregation of duties
Require deposit verification

Insurance EFT Matching:

Establish daily ERA retrieval
Require same-day matching to deposits
Create unmatched deposit tracking

Credit Card Reconciliation:

Daily batch settlement
Match to merchant deposits
Track timing differences

Address Immediate Issues

Some findings require immediate action.

Unidentified Deposits:

Catalog all unidentified deposits from baseline
Begin investigation of larger amounts
Set resolution timeline

Past-Due Payables:

Identify any critical past-due obligations
Prioritize payment to avoid disruption
Communicate with vendors as needed

Staff Concerns:

Address any urgent staffing issues
Clarify roles and expectations
Begin building relationships

Maintain Production

Integration should not disrupt clinical operations.

Protect Patient Experience:

Ensure billing questions are handled
Maintain appointment scheduling
Keep insurance verification active

Support Clinical Team:

Supplies must continue flowing
Lab relationships maintained
Equipment service uninterrupted

Weeks 5-8: Implement Standards

Transition to Standard Systems

Begin migrating to your standard platforms and processes.

PMS Decisions:

Continue with existing PMS or migrate?
If migrating, plan timeline carefully
If continuing, configure for your reporting needs

Accounting Integration:

Set up accounts in your chart of accounts
Configure reporting to match your standards
Establish data flow to central accounting

Banking:

Transition to your standard banking relationship if planned
Update EFT information with payers
Redirect merchant deposits

Train Staff on Standards

Your processes only work if staff follows them.

EOD Procedures:

Train on your standard end-of-day checklist
Verify compliance daily initially
Address gaps immediately

Reconciliation Expectations:

Explain what is expected
Provide tools and templates
Review results regularly

Reporting Requirements:

Clarify what reports are due when
Establish submission method
Create accountability for timeliness

Establish Oversight

Build the monitoring infrastructure for ongoing management.

Regular Check-Ins:

Weekly calls with office manager initially
Review key metrics together
Address questions and concerns

Report Review:

Incorporate into central reporting package
Compare to other locations
Flag outliers for investigation

Audit Schedule:

Plan periodic audits
Both desk audits and on-site visits
Document findings and follow-up

Weeks 9-12: Optimize and Stabilize

Resolve Outstanding Items

Clean up anything lingering from the transition.

Aged Unidentified Deposits:

Final push to identify or write off
Document resolution for each
Establish go-forward protocol

AR Cleanup:

Address aged AR from pre-acquisition
Determine what is collectible
Write off what is not

Credit Balance Resolution:

Process refunds for legitimate overpayments
Correct posting errors
Clear old, unresolvable items

Optimize Performance

With basics stable, look for improvement opportunities.

Collection Rate:

Compare to other locations
Identify gaps and causes
Implement targeted improvements

Denial Management:

Analyze denial patterns
Address systematic issues
Improve submission quality

Process Efficiency:

Identify bottlenecks
Streamline where possible
Consider technology improvements

Establish Steady State

Transition from integration mode to normal operations.

Reduce Check-In Frequency:

Move from weekly to bi-weekly
Then to monthly as appropriate
Maintain exception-based escalation

Integrate Into Standard Reporting:

Location appears in normal dashboards
No special handling required
Comparable to peer locations

Declare Integration Complete:

Formally close integration project
Document lessons learned
Celebrate success

Integration Checklist

Week 1: Control and Visibility

Bank account access secured
PMS admin access obtained
Accounting software access confirmed
Merchant account access verified
Clearinghouse access confirmed
Baseline reconciliation assessed
AR and credit balances documented
Current processes documented

Weeks 2-4: Stabilization

Daily deposit reporting active
Daily collection summary implemented
Standard deposit procedures in place
ERA matching process established
Credit card reconciliation active
Immediate issues addressed
Staff roles clarified

Weeks 5-8: Standardization

PMS decision made and executing
Accounting integration complete
Banking transitions complete
Staff trained on standards
Oversight infrastructure active
Reporting integrated

Weeks 9-12: Optimization

Unidentified deposits resolved
AR cleanup complete
Credit balances resolved
Performance optimization underway
Steady state achieved
Integration formally closed

Common Integration Pitfalls

Moving Too Fast

Changing everything at once overwhelms staff and breaks working processes. Prioritize changes that matter most. Sequence carefully.

Ignoring Cultural Fit

Financial integration happens within a human context. Staff who feel disrespected or ignored will resist. Bring them along.

Underestimating Cleanup

Pre-acquisition due diligence catches some issues. Post-close, you find the rest. Budget time and resources for cleanup.

Neglecting Documentation

What you learn during integration has value. Document processes, issues, and solutions. Future acquisitions benefit.

Declaring Victory Too Early

Integration is not complete when the immediate fires are out. It is complete when the practice operates to your standards consistently. That takes time.

Integrating newly acquired practices? Zeldent provides DSO finance teams with immediate reconciliation visibility across your entire portfolio. See every location's deposit matching status, flag exceptions automatically, and ensure newly integrated practices meet your standards from week one. Schedule a demo to see DSO-scale financial oversight.