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Where the EHR stops and the ledger starts
Most healthcare finance problems we see come from asking one system to do both jobs. The EHR and practice management platform are built for patients, visits, CPT codes, payer rules and denials. They are poor general ledgers. Business Central is a strong general ledger and a poor place for claim-level detail.
The clean line is a summary interface. Once a day or once a month, charges, payments, contractual adjustments and write-offs flow into Business Central as journal lines grouped by location, provider and payer class. The accountant reconciles that journal to the practice management close report, and nobody has to key totals by hand.
A side benefit: when the ledger holds totals rather than patient rows, far less protected health information sits in your ERP. That makes access control, sandbox copies and auditor requests simpler to manage.
Jobs a physician group hands to Business Central
Profit and loss by site
Dimensions tag every entry with clinic, department and provider, so one chart of accounts produces a P&L for each location without a separate company per office.
Management company structures
Groups that run a management services organization beside one or more professional corporations keep each entity as its own company, post intercompany fees, and consolidate for lenders and owners.
Clinical supplies and implants
Items can require lot or serial numbers with expiration dates, so a recalled lot of a device or medication can be located across every stock room.
Imaging and lab equipment
The fixed asset module runs depreciation on scanners, chairs and lab analyzers, with a second depreciation book when tax and book methods differ.
Vendor bills and approvals
Approval workflows route invoices from medical suppliers and landlords to the right manager, and US 1099 reporting covers contracted clinicians paid as vendors.
Budget against actual
G/L budgets by department and site let the operations lead compare spending each month to the plan the board approved.
Patient data: what to settle with counsel before go-live
- ✓We do not certify anyone as HIPAA compliant, and no software makes an organization compliant on its own. Compliance depends on your policies, contracts and people.
- ✓Microsoft's published compliance documentation lists which of its online services are in scope for its HIPAA Business Associate Agreement. Confirm that Business Central and every connected Microsoft service you plan to use appear on that list, and have your counsel read the terms.
- ✓Decide in writing which data enters Business Central. Summary journals by site and payer usually need no patient identifiers at all.
- ✓Check every integration and add-on vendor separately: a connector or reporting tool that touches patient data needs its own agreement.
- ✓Restrict permission sets so only finance staff see ledger detail, and turn on the change log for sensitive tables.
- ✓Sandbox environments copied from production carry the same data, so treat them with the same controls.
- ✓Power BI reports built on the ledger should be shared through workspaces with named access, not public links.
Standard feature, add-on, or a different system
Rollout order for a multi-site practice
- 1
Agree the reporting grid
Finance, operations and the physician owners agree which sites, departments and payer classes the reports must show. That list becomes the dimension design.
- 2
Build the summary interface
We map the practice management close report to journal lines and test it against a closed month you already trust.
- 3
Bring in vendors and assets
Open payables, supplier records and the fixed asset register move next, reconciled to the old system's balances.
- 4
Switch on supply tracking
Stock rooms that carry lot-controlled items go live with counts taken on the cutover day.
- 5
Add the next entity
Once one company closes cleanly, further entities and consolidation follow from the same template.
Questions healthcare finance leaders ask
Is there a separate Dynamics 365 product just for healthcare?
Microsoft markets Microsoft Cloud for Healthcare, which combines Dynamics 365, Power Platform and Azure capabilities aimed at patient engagement and care coordination. Our work sits on the finance side, where Business Central is the usual fit for small and mid-sized providers. The two can live together, but they solve different problems. Tell us which problem is costing you time and we will say which one applies.
Can Business Central replace our practice management system?
No, and we would advise against trying. Practice management software understands payer contracts, eligibility checks, claim scrubbing and remittance files, none of which a general ERP does. Business Central receives the financial results of that work. Keeping the boundary clear is what makes both systems easier to run.
How do we get provider-level profitability?
Tag revenue and direct costs with a provider dimension, then allocate shared costs such as rent and front-desk staff with recurring allocation journals. Financial reports and Power BI can then show contribution by provider and by site. The hard part is agreeing the allocation rules with the physicians, which we help document before building anything.
We own several practices bought over time. Do they need one company each?
If they are separate legal entities with their own tax filings, yes, each should be its own company in Business Central. Shared vendors and chart of accounts can be copied between companies, intercompany charges post automatically, and consolidation produces the group view. If they are simply locations of one entity, a site dimension is usually enough.
What do you need from our side to scope a project?
A recent trial balance, your entity chart, a sample practice management close report and a list of the reports the owners actually read. With that, the scoping call sets the plan and we put the scope in writing before any work starts. We do not quote over email.
Talk to us about your project.
Tell us what you run today and what has to change. A senior consultant replies with a written next step.