Bookkeeping & payroll
Your books close three months late. Your decisions are three months behind.
Monthly close on the calendar. GAAP-readable financial reports. Payroll that handles the quirks of medical-practice compensation — wRVU models, partner K-1s, per-session physicians. This is the CPA wedge, sharpest here.
Most medical practices run bookkeeping on vibes. A part-time bookkeeper updates QuickBooks when they can. Year-end accounting crams three quarters of reconciliation into January. By the time the owner sees a real P&L, the fiscal year is over.
This is fine until it isn't. Until a provider asks for a partnership buy-in calculation and nobody can produce clean numbers. Until a tax question comes up mid-year and the answer is "ask me in February." Until a payer contract renewal negotiation requires a line-of-business profitability analysis and the data isn't there.
A CPA-led firm treats bookkeeping as the foundation everything else sits on. Not a compliance chore. A management tool.
Concretely, this is the work.
Monthly close by the 10th business day — not the 90th.
GAAP-readable financial statements: P&L, balance sheet, cash flow.
Department- and provider-level profitability reporting.
Accounts payable management and vendor payment discipline.
Payroll processing — W-2 employees, 1099 contractors, per-session physicians, wRVU-based compensation.
Partner distributions and K-1 schedule preparation.
Sales and use tax compliance for practices selling products.
Tax coordination with your external CPA or handled in-house.
CPA-led, not bookkeeper-led
A bookkeeper records. A CPA reports. The difference is the difference between data entry and management information.
Medical-practice-specific
Stark-compliant compensation structures, wRVU math, partnership K-1s — these aren't generic-bookkeeper territory.
Tax-aware operations
Every operational decision has a tax consequence. We name it in the moment, not in April.
No cliff. No rip-and-replace.
Month 1 · Clean-up
Historical books reviewed and corrected. Chart of accounts aligned to practice management categories. Prior-year reconciliation complete.
Month 2 · Calendar
Monthly close moves to the 10th-business-day calendar. First clean month closes. Payroll transitioned.
Month 3 · Reporting
Department and provider profitability reports live. Partner distribution schedule confirmed. First quarterly tax-implication review.
Real numbers, measured against your own baseline.
- Monthly close commitment
- By day 10
- Report format
- GAAP
- Profitability visibility
- Per provider
- Tax review cadence
- Quarterly
Any practice that wants to make decisions on current numbers instead of trailing ones. Partnership practices benefit the most — the clarity is worth the investment on its own, and the MSO stack compounds it.
Free audit
Curious where your practice is leaking money?
We'll audit your current workflow for free and show you exactly where to act — usually in under a week. No contract. You keep whatever we find.