Bookkeeping for
Medical, Dental & Veterinary Practices

Most small-business bookkeeping assumes that what you bill is roughly what you collect. In a practice that accepts insurance, that assumption is wrong by a wide margin. You bill at fee schedule rates, insurance pays a contracted amount, and the difference is written off as a contractual adjustment. If your books record billed amounts as revenue, your income is significantly overstated. Patient balances, claim denials, and collection timing add more complexity on top of that. None of it is impossible to manage, but it requires a setup built for how the money actually moves.

Insurance-based practices bill at fee schedule rates and collect a contracted fraction of that amount. The difference is a contractual adjustment that needs to be written off correctly, not left sitting in accounts receivable as if it's still collectible. We reconcile insurance payments, patient copays, and contractual write-offs so your reported revenue reflects what the practice actually collects. For veterinary and cash-pay practices, the reconciliation is simpler, but the principle is the same: the books should reflect real collections, not invoiced amounts that may never be paid.

Healthcare AR is messier than most. Claims get denied and need to be resubmitted or appealed. Patients owe balances that collect slowly or not at all. Write-offs happen at irregular intervals, and different payers move at different speeds. Without ongoing attention, receivables age out in ways that distort your financials and quietly reduce what the practice collects. We keep AR current, flag balances that are aging past reasonable collection windows, and handle write-offs consistently so your receivables reflect what the practice can realistically expect to bring in.

Multi-provider practices need to track revenue and overhead by provider to understand what it actually costs to add capacity, whether a new associate is covering their overhead, and where profitability is concentrated. Even a solo practice benefits from knowing its overhead ratio, the percentage of collections that goes to fixed costs before a dollar flows to the owner. We set up reporting that gives you that visibility without requiring a practice management consultant. For S-corp practices, we also make sure owner compensation is documented correctly relative to distributions, which matters both for payroll tax compliance and for how the practice looks to a lender.

Medical and dental equipment is expensive and depreciates over a longer timeline than most business assets. A new imaging system or chair is a capital expenditure, not a supply run, and it needs to be recorded on the balance sheet and depreciated over its useful life rather than expensed in the month of purchase. We handle depreciation schedules for major equipment, track consumable supplies separately from capital assets, and for veterinary practices, manage medication and product inventory in a way that keeps cost of goods accurate. When you need a loan or are planning a major purchase, the balance sheet will be in the shape a lender expects to see.

Practice owners operating as S-corps or professional LLCs have specific requirements around owner compensation, retirement contributions, and distributions that need to be structured and recorded correctly throughout the year. Getting this wrong creates tax exposure and complicates the filing. We keep your books current and properly organized so that year-end is a clean handoff to your CPA rather than a weeks-long back-and-forth over categorization. If you don't have a CPA who works with practices regularly, we can refer you to one who does.