Bookkeeping for Nurse Practitioners in Independent Practice
Books supervised by PizzelloCPA, PLLC for solo and group nurse practitioner practices. Insurance reconciliation, collaborative-physician fee tracking, S-Corp planning, multi-state telehealth, and HIPAA-aware workflows. From $199/mo.
NP Practices Carry Compliance Mechanics Most Bookkeepers Have Never Seen
Nurse practitioners practicing independently or in collaborative arrangements face accounting mechanics that look superficially like a physician practice but differ in important ways. Collaborative-physician fees are deductible as a real expense in collaborative-practice states. Insurance billing varies by payer rules around incident-to billing. State scope-of-practice authority changes how revenue is generated and which billing arrangements are even legal.
Generic bookkeepers tend to treat NP practices as ordinary medical practices and miss the specifics: collaborative fees lumped into general overhead, NP-specific reasonable comp benchmarks not used at all, multi-state nexus risk for telehealth NPs ignored. The result is books that do not reflect the practice and tax planning that leaves money on the table.
We built our workflow around how NP practices actually operate. Every NP client gets payer reconciliation, collaborative-fee tracking where it applies, NP-specific reasonable comp benchmarking, and CPA oversight from PizzelloCPA, PLLC on the moves that meaningfully affect your tax bill.
Nurse Practitioners We Serve
NPs in states allowing independent practice without supervisory agreements.
NPs in collaborative or supervisory states, with physician collaboration agreements.
Psychiatric/mental health NPs, family NPs, women's health NPs, acute care NPs.
Cosmetic injectables, laser, and aesthetic practices with retail product mix.
Multi-state telehealth practices with licensure and nexus implications.
Multi-NP practices with associate compensation and partner accounts.
What We Handle That Generic Bookkeepers Miss
Collaborative Physician Fees, Tracked Cleanly
In collaborative-practice states, the fees you pay your collaborating physician are real, recurring practice expenses that need to be tracked separately. We line-item them so you can see the true cost and so the deduction is clean at tax time.
Payer Reconciliation by Payer Rules
Each payer has different rules for NP billing (incident-to vs direct, supervised vs independent). We reconcile EOBs by payer so your real revenue mix is visible and you can spot underpayments quickly.
Multi-State Telehealth and Nexus
Multi-state NPs face state income tax nexus and licensing fees on top of the clinical licensure they already track. We monitor revenue by state to flag potential filing obligations before they become problems.
Aesthetic Inventory and Retail
Botox, fillers, neurotoxins, lasers, and skincare retail are real inventory with real COGS. We track them properly so your margin per service is honest and your tax treatment is right.
Reasonable Comp Benchmarked for NPs
NP services are SSTB so QBI phases out fast. Reasonable comp set too low is the most common audit trigger we see. We benchmark against BLS NP wage data and AANP salary surveys, not generic medical-practice numbers.
HIPAA-Aware Workflows, BAA Available
We never need access to PHI to do bookkeeping. We separate clinical and financial data by design and offer a Business Associate Agreement on request.
Equipment and Capital Purchase Planning
Lasers, RF devices, exam equipment, and aesthetic capital are major investments. We track depreciation properly, and PizzelloCPA, PLLC, our affiliated CPA firm, handles the Section 179 versus bonus depreciation versus MACRS choice, or we coordinate with your own CPA.
Your Practice Software, Connected
Tebra (Kareo), AdvancedMD, SimplePractice, Athenahealth, Aesthetic Record, Nextech, and similar platforms. We pull financial data into QuickBooks Online cleanly so your software stays the system of record for clinical, and QBO is the system of record for finance.
Packages Starting at $199/mo
Every package includes a dedicated bookkeeper, monthly reports, CPA oversight (PizzelloCPA, PLLC), and tax-ready books.
Solo NP, clean books, payer reconciliation
Collaborative fees, AR aging, aesthetic inventory
Multi-NP practices, partner accounts, live dashboard
Common Questions
Do you handle collaborative-physician fees correctly?
Yes. In collaborative or supervisory practice states, we line-item the collaborating physician fee as a recurring expense so the deduction is clean and the cost is visible in your overhead.
Do you offer a Business Associate Agreement?
Yes. NP clients can request a BAA during onboarding. We never need access to PHI to do bookkeeping; financial data is segregated from clinical records by design.
Should my NP practice elect S-Corp status?
Usually yes once profit clears about $80,000. NP services are SSTB so the QBI deduction phases out, but the self-employment tax savings on owner draws are still significant. We benchmark reasonable comp against BLS and AANP data during onboarding.
I run an aesthetic practice with retail products. Do you handle inventory?
Yes. Botox, fillers, neurotoxins, and skincare retail all need real inventory accounting. We track inventory and COGS so your margin per service is honest and supplement sales tax handling is right.
I see telehealth patients in multiple states. Does that create issues?
Possibly. State income tax nexus is triggered differently across states. We track where revenue is earned so we can flag if you have a new filing obligation. For genuinely complex multi-state tax-law questions we bring in a state-tax specialist.
Do you integrate with Tebra or AdvancedMD?
Yes. We pull financial data from your practice management system into QuickBooks Online so your software stays the system of record for clinical, and QBO is the system of record for finance.
What does pricing look like for a solo NP?
Solo NPs usually start at our $199/mo Starter tier. Aesthetic practices with inventory or multi-NP practices with collaborative fees usually land in Grow ($349/mo) or Surge (custom). Every engagement includes CPA oversight from PizzelloCPA, PLLC.
Are you familiar with full practice authority versus collaborative practice rules?
We track the financial mechanics that flow from your scope-of-practice setup, but we do not give legal advice on practice structure. We coordinate with your healthcare attorney when structural questions come up.
Cited authorities and resources
We benchmark our work against primary sources, not opinion. Some of the references we coordinate with for nurse practitioners engagements:
- • BLS Occupational Employment & Wage Statistics for reasonable-compensation benchmarks.
- • IRS Form 2553 for S-Corp election timing and eligibility.
- • IRS Section 199A (QBI) guidance for the SSTB phaseout that applies to most private practices.
- • IRS Publication 946 for depreciation, Section 179, and bonus depreciation choices on practice equipment.
- • HHS HIPAA for Professionals for the workflow expectations on practices that touch PHI.
S-Corp planning, reasonable-comp analysis, and tax-strategy coordination are included in our engagement. For legal questions, we coordinate with your attorney.
Not a nurse practitioner?
We serve the full private practice ecosystem. Therapists, Veterinarians, Optometrists & Ophthalmologists, and more.
Books built around how NP practices actually operate
Book a free 30-minute consult. Bring your collaborating physician agreement (if you have one) and a recent month's deposits. We'll tell you what's working and where the tax dollars are leaking.
Book Your Free ConsultOr call us: 855.297.BOOK (2665)