Bookkeeping and Accounting for Speech-Language Pathologists
Bookkeeping and accounting for solo and group SLP practices, led by Andrew Pizzello, CPA. Cash-pay pediatric work, school district and early-intervention contracts, telehealth revenue by state, prepaid package and membership tracking, S-Corp planning, and HIPAA-aware workflows. From $199/mo.
SLP Practices Mix Cash-Pay, School Contracts, and Telehealth in Ways Generic Bookkeeping Cannot Handle
Speech therapy practices today blend at least three distinct revenue streams: parent-pay pediatric private therapy, school district and early-intervention contracts (with 60 to 120 day payment cycles), and increasingly multi-state telehealth. Some practices add adult rehab, voice and accent modification, dysphagia work, and AAC device support on top.
Each stream has different cash-recognition timing, different collection mechanics, different licensure considerations. Generic bookkeepers see deposits and book everything as one revenue line. The result is books that look fine on the surface but cannot answer which side of the practice is actually paying the bills.
We built our workflow around how SLP practices actually operate. Every client gets stream-level revenue tracking, contract receivable aging by school or agency, a running schedule of prepaid packages and memberships, telehealth revenue tracked by client state, and HIPAA-aware financial workflows, in an engagement led by Andrew Pizzello, CPA.
Speech-Language Pathologists We Serve
Parent-pay private practices serving children with articulation, language, fluency, and feeding needs.
Multi-clinician shops with associate SLPs, SLP assistants, and clinical fellows on supervised hours.
Practices with district contracts, early-intervention agency contracts, and IEP-driven billing.
Aphasia, dysphagia, voice therapy, and gender-affirming voice work, often blending insurance and cash-pay.
Multi-state telepractice under the licensure compact, with revenue tracked by client state.
Augmentative and alternative communication device support, accent modification, and other specialty cash-pay work.
What We Handle That Generic Bookkeepers Miss
School District and Early-Intervention Receivables
School and EI contracts often pay 60 to 120 days after services. We track contract receivables by district or agency, age the AR honestly, and reconcile against payment cycles so you are never surprised by a slow district.
Cash-Pay Package and Membership Plans
Prepaid session packages, monthly memberships, and AAC support contracts are money collected for care you still owe. Your monthly reports stay on the cash basis, and we keep a running schedule of what is still undelivered, so you always know what you owe in sessions or refunds.
Insurance Reconciliation for Adult Practices
Adult rehab and voice practices that bill insurance get full EOB reconciliation: gross billed, contractual write-offs, and net collected by payer with AR aging that drives decisions.
Multi-State Telehealth, Tracked by State
Telehealth-heavy SLPs often deliver care across multiple states. We record revenue by client state so it can be reported when it is asked for; whether that creates a filing obligation is a question for your tax preparer, which for our clients is PizzelloCPA, PLLC under a separate engagement.
SLP Assistant and Clinical Fellow Comp
Group practices with SLPAs and CFs paid on percent-of-collected need a comp formula modeled in the books. We capture per-clinician revenue (regardless of whose NPI billed) so the comp math is auditable every month.
HIPAA-Aware Workflows, BAA Available
For SLPs billing insurance or working in HIPAA-covered settings, we sign Business Associate Agreements and segregate financial data from clinical by design.
S-Corp Election and Reasonable Comp
SLP services are SSTB so QBI phases out fast. The S-Corp self-employment tax savings still pencil out once profit clears overhead. We benchmark reasonable comp against BLS SLP wage data with adjustments for your specialty mix.
Your Practice Software, Connected
TheraPlatform, SimplePractice, Fusion Web Clinic, Theralytics, and CentralReach (for SLPs in BCBA-adjacent settings). We pull billing data into QuickBooks Online cleanly so your EMR 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, and tax-ready books. Surge adds a licensed CPA's review of every deliverable (PizzelloCPA, PLLC).
Solo SLP, clean books, prepaid package tracking
School AR aging, EOB recon, multi-stream tracking
Group practices, multi-state telehealth, live dashboard
Common Questions
How do you handle school district and early-intervention contracts?
We track contract receivables by district or agency, age the AR by payer, and reconcile against contract terms. Districts notoriously pay slowly. Knowing exactly who owes what stops cash-flow surprises.
How do you handle prepaid session packages?
We keep a running schedule of each family's unused sessions, and your monthly reports stay on the cash basis, so you always know what you still owe, and a refund comes off the schedule when it is paid. The schedule does not change your taxes: on the cash method most practices use, a package payment is income in the year you receive it (IRS Publication 538).
Do you offer a Business Associate Agreement?
Yes. SLP clients can request a BAA during onboarding. We never need PHI to do bookkeeping. Financial data is segregated from clinical records by design.
I do telepractice in multiple states. Is that a tax problem?
It can be. Whether telepractice in another state creates a filing obligation depends on the states involved and is a question for your tax preparer; for our clients that is PizzelloCPA, PLLC under a separate engagement. Our part is making sure revenue can be reported by client state when it is asked for.
Should my SLP practice elect S-Corp status?
Often, once profit clears about $80,000 for a solo. SLP services are SSTB so QBI phases out quickly, but self-employment tax savings on owner draws still make sense. We run the analysis during onboarding.
Do you handle accounting for speech therapy practices, or just bookkeeping?
Both layers. Your dedicated bookkeeper runs the monthly work: contract AR, the prepaid package schedule, and clean financials. PizzelloCPA, PLLC, our affiliated CPA firm, handles the tax side under a separate engagement: S-Corp comp, multi-state questions, and the return itself. Practices searching for a speech therapist accountant usually need this combination.
How do you handle SLPA and CF comp?
We model the comp formula (typically percent-of-collected) in your chart of accounts so the math is auditable every month. Per-clinician revenue tracking comes standard for any practice with associates or fellows.
Do you integrate with TheraPlatform or Fusion Web Clinic?
Yes. We pull billing data from your practice software into QuickBooks Online so your clinical system stays the system of record for patient care, and QBO is the system of record for finance.
What does pricing look like for a solo SLP?
Most solo practices start at our $199/mo Starter tier. Group practices or those with heavy school contracts and multi-state telehealth usually land in Grow ($349/mo) or Surge (custom). Every engagement is led by Andrew Pizzello, CPA, and Surge adds a licensed CPA's review of every deliverable.
Cited authorities and resources
We benchmark our work against primary sources, not opinion. Some of the references we coordinate with for speech-language pathologists 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 are performed by our affiliated CPA firm, PizzelloCPA, PLLC, under a separate engagement (see PizzelloCPA’s tax services for speech-language pathologists). For legal questions, we coordinate with your attorney.
Guides from our blog for speech-language pathologists
Year-end bookkeeping for private practices · School district receivables for SLPs
Not in speech therapy?
We serve the full private practice ecosystem. Therapists & Counselors, Veterinarians, Optometrists & Ophthalmologists, Nurse Practitioners, Physical Therapists, Psychologists & Psychiatrists, Audiologists, Nutritionists & Dietitians, Acupuncturists, Dentists, Behavior Analysts (BCBAs), and more.
Books built for speech therapy practices
Book a free 30-minute consult. Bring a recent month's deposits and a typical school contract or package structure. We'll show you what cleaner books would look like.
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