Bookkeeping for
Medical Practices

Bookkeeping built for independent medical practices

Independent medical practices have accounting problems that generalist bookkeepers do not even recognize as problems. Insurance A/R behaves nothing like commercial A/R — a claim can sit 45 days before adjudication, come back denied, get resubmitted, partially pay from the primary payer, get adjusted by the secondary, and finally close months later at a fraction of billed charges. If your books show gross charges as revenue, your P&L is fiction. If they show only cash receipts, you cannot see the A/R that is aging out of collectability. We reconcile your practice management system (Athena, Kareo, eClinicalWorks, DrChrono, PracticeFusion) to QuickBooks at the posting level so your books show collected revenue, adjustments, and true A/R aging separately.

Our medical practice bookkeeping handles the specific issues physician-owners face: insurance A/R aging (0–30, 30–60, 60–90, 90+) with denial and adjustment tracking separated from true collections; HSA and FSA card reconciliation when patients pay with pre-tax funds; multiple fee schedules across payers with contractual adjustments booked correctly; RCM (revenue cycle management) integration if you outsource billing, so the RCM close matches your books; 1099-NEC tracking for contracted providers, locum tenens, medical directors, and PRN staff; equipment financing and depreciation on imaging, diagnostics, and EHR investments; and categorization of CME, DEA fees, malpractice premiums, and license renewals. We work only with HIPAA-aware cloud bookkeeping tools and sign a BAA on request.

Most independent physicians and dentists in the DMV leave significant tax savings on the table. An S-corp election for a practice earning $300K+ typically saves $10K–$25K per year in self-employment tax after payroll costs. A properly structured retirement plan (solo 401(k), SEP-IRA, or defined benefit for high earners) can shelter $60K to $300K+ per year. A cost segregation study on a newly purchased or renovated practice building accelerates depreciation into the early years when income is highest. None of this works without clean bookkeeping as the foundation. We build the foundation. Your CPA and financial advisor do the rest.

Serving the DMV

Our medical practice bookkeeping practice is based in the Washington DC metro area and works with clients across Washington, DC, Arlington, VA, Alexandria, VA, Bethesda, MD, Silver Spring, MD, Rockville, MD, Kensington, MD, Montgomery County, MD, and Adams Morgan, DC.

Industry-specific FAQ

My insurance A/R is out of control — how should I reconcile my practice management system to QuickBooks?

You reconcile at three levels. First, posting-level: every charge, payment, and adjustment posted in your PM system for the month should tie to a journal entry in QuickBooks (charges to A/R and revenue, payments to cash and A/R, adjustments to contractual allowance and A/R). Second, deposit-level: every bank deposit from each payer or merchant processor should tie to the sum of EOBs posted that day. Third, A/R aging: your PM system A/R report and your QuickBooks A/R balance should agree to the dollar at month-end. If they do not, the gap is usually unposted payments, posted payments that never hit the bank, or adjustments booked in one system but not the other. We build the reconciliation cadence and do it monthly.

Can a solo physician or dentist in the DMV deduct CME, DEA fees, and license renewals?

Yes, all of these are ordinary and necessary business expenses deductible in full for a practice structured as a sole proprietorship, LLC, S-corp, or partnership. The rules are the same for a physician whether you practice in DC, Maryland, or Virginia. CME registration, travel to CME conferences (airfare, lodging, meals subject to the 50% meal limit), DEA registration fees, state medical license renewals, specialty board certification fees, and journal subscriptions all qualify. We set up a separate expense account for each category so you have a clean substantiation trail if the IRS asks.

At what practice income level does an S-corp election make sense for a DMV physician?

Generally around $200,000–$300,000 in net profit, but the math depends on your reasonable compensation. An S-corp lets you split your earnings into a W-2 salary (subject to Social Security and Medicare tax) and a distribution (not subject to self-employment tax). The more you can defensibly treat as distribution, the more you save. For a specialist billing $400K net, paying yourself a $200K salary and taking $200K as distribution saves roughly $6K in Medicare tax annually, minus the cost of payroll and a second tax return. We run the numbers against your actual practice data and document a defensible reasonable-compensation analysis in case of audit.