Bookkeeping for independent practices.
Dental, physical therapy, chiropractic, optometry, mental health, small family medicine. Usually one to six providers, with billing running through a practice management system that never quite agrees with the books. I've worked inside clinical settings for most of my career, so you won't spend the first three calls explaining how a practice works.
What I already know about your books
These are the things that get missed.
Your A/R does not belong in QuickBooks. It lives in the practice management system, and rebuilding it in the books just creates a second set of numbers that disagrees with the first. I reconcile deposits against remittances instead of duplicating your billing.
Billed, allowed, and collected are three different numbers. A Profit and Loss built on billed charges is fiction. Revenue gets recorded at what actually arrived.
The money and the paperwork arrive separately. Payers send funds by ACH and the remittance advice travels on its own path. Matching a lump deposit back to the claims it paid is the actual work, and it's where most practice books come apart.
A rejection isn't a denial. A clearinghouse rejects on format, before the payer ever sees it. A payer denies on coverage. Different problem, different fix, different person to call.
A payroll liability account that climbs and never clears is an emergency. Withheld income tax and the employee share of FICA are trust fund taxes. That exposure reaches responsible people personally and it doesn't go away in bankruptcy. It's invisible on a Profit and Loss, so it's one of the first things worth checking.
Most small practices are modified cash basis. Cash for revenue and operating expenses, accrual for fixed assets and debt. I set the file up to match the basis your tax preparer actually uses.
How the work is set up
- Class tracking, so you can see which chair, room, or clinician is actually carrying the practice — quoted separately from the monthly fee
- A business associate agreement where the work touches records covered by health privacy law. I'll sign one.
- I work inside your own QuickBooks Online file, under access you grant and can revoke at any time
- No access to your funds, ever. I don't sign, transfer, or pay anything.
- Books closed and reconciled monthly, with statements by a stated date. Every client has a set day each week when I work their file.
I record what your billing produces. I don't do billing, coding, claim submission, or denial appeals, and I don't work inside your practice management system. If that's what you need, you need a billing company, and I'll say so rather than take the work.
Start with a free consult
Start with a conversation about where the practice's books stand. If you're on QuickBooks Online, I'll go through the file too — including whether those payroll liabilities are clearing. No charge.