Bookkeeping and Accounting for Therapists, Counselors, and Mental Health Practices
Bookkeeping for therapists, counselors, and group mental health practices, led by Andrew Pizzello, CPA. We tie your EHR payments to every insurance EFT and card payout, track associate pay by clinician, and keep your books tax-ready in your own QuickBooks Online account, with a BAA available. From $199/mo.
Generic Bookkeeping Misses What Matters in a Therapy Practice
Your practice has economics that look nothing like a generic small business. Insurance payments arrive as net deposits with contractual adjustments baked in. Patient responsibility lingers as AR that may or may not collect. Supervisee splits create pass-through revenue that needs to be tracked separately for tax purposes. And the entire industry runs on EHRs that most bookkeepers have never opened.
The result is books that look fine on the surface but quietly understate or overstate revenue, miss write-off tracking, and leave you with a P&L that does not actually reflect your practice. At tax time, your CPA cleans it up, charges you for the cleanup, and the cycle repeats.
We built our workflow around how mental health practices actually operate. Every month starts with the same tie-out: your SimplePractice, TherapyNotes, or TheraNest payment report against the insurance EFTs and card payouts that actually hit the bank, with processing fees recorded as the expense they are. Revenue is split between insurance and self-pay, and for a group practice it is tagged to the clinician who rendered the session, so associate pay and per-clinician margin come from the same numbers as your P&L.
The rest of the chart of accounts is built for a therapy practice rather than a retail shop. Credentialing services, clinical supervision, CE and license renewals, liability coverage, EHR and telehealth subscriptions, and associate and contractor pay each get their own line. Late-cancel and no-show fees are tracked separately so you can see what the policy produces, and sliding-scale fees are recorded as the price of the session rather than buried in write-offs. Tax work, including S-Corp planning and reasonable compensation, is handled by our affiliated CPA firm, PizzelloCPA, PLLC, under a separate engagement.
Therapists & Counselors We Serve
LPC, LMHC, LCSW, and LMFT practices with one clinician, on or off insurance panels.
Group practices with W-2 clinicians, 1099 contractors, and supervisor-supervisee setups.
Out-of-network or self-pay only. Cleaner revenue tracking, simpler reconciliation.
Multi-payer EOB reconciliation and write-off tracking.
Multi-state telehealth, with revenue reportable by client state for your tax preparer.
Psychologists and testing practices, postdoc through licensed, with assessment and consultation income mixed in.
What We Handle That Generic Bookkeepers Miss
HIPAA-Aware Workflows, BAA Available
We do not handle PHI. We handle the financial side of your practice with the same seriousness you handle clinical records. A Business Associate Agreement is available on request and we keep financial data segregated from session content.
Insurance Reconciliation, Done Right
EOBs are not invoices. Insurance payments are net of contractual adjustments, and the difference between billed, allowed, paid, and patient-responsibility is where most therapy practice books go sideways. We track all four cleanly so your true revenue is visible.
Supervisee Billing and Pass-Through Comp
Group practice supervision arrangements are unique to mental health. We track supervisee revenue separately, set up payment splits cleanly, and keep the books clear about who earned what, so year-end 1099s and W-2s tie to the ledger.
Cash-Pay vs Insurance Mix Tracking
If you run a hybrid panel + cash-pay practice, knowing your cash-pay margin is the difference between a sustainable practice and one that quietly loses money. We separate the streams in your chart of accounts so the picture is honest.
Superbills and Out-of-Network Workflows
For OON practices, superbills are how clients get reimbursed by their insurance. We make sure the documentation flows match accurately to your books so client billing and your books never diverge.
EHR Payments Tied to the Bank
Card payouts from your EHR arrive net of processing fees, and one insurance EFT can cover dozens of sessions across several weeks. We tie your EHR payment report to every deposit each month, record gross revenue with fees as an expense, and chase down refunds and payer recoupments, so your P&L finally matches what your practice software says you collected.
Sliding Scale, No-Show Fees, and Credentialing Costs
Sliding-scale fees are recorded as the price of the session, not as write-offs. Late-cancel and no-show fees get their own income line. Credentialing services, clinical supervision, CE, license renewals, and liability coverage each get their own expense line, so the costs specific to running a therapy practice are visible instead of lumped into one professional fees account.
S-Corp Payroll, Recorded Right
Therapy practices are a specified service trade, so the QBI deduction phases out for higher earners and the S-Corp decision matters. Whether to elect and what your reasonable compensation should be are tax questions answered by our affiliated CPA firm, PizzelloCPA, PLLC, under a separate engagement. Our side is making sure owner payroll runs as planned and lands in the books correctly.
1099 vs W-2 Clinicians
Misclassifying a contracted therapist as 1099 when they should be W-2 is the most common practice setup mistake we see. State labor departments are aggressive about this. Classification is a legal decision for the practice and its employment attorney, and some state boards, California's among them, do not allow pre-licensed associates to be contractors at all. Our side is recording each clinician consistently with the classification you choose: payroll for employees, one contract labor account and a W-9 for contractors.
More Than Accounting Software
SimplePractice and TherapyNotes are practice management, not accounting. QuickBooks Online alone is software without judgment. Most practices searching for accounting software for therapists or mental health accounting software actually need the combination we run: QBO configured for a therapy chart of accounts and a dedicated bookkeeper reconciling EOBs and deposits every month, with CPA review from PizzelloCPA, PLLC available on our Surge plan.
Your Practice Software, Connected
We work alongside SimplePractice, TherapyNotes, Tebra, TheraNest, and similar EHR/billing platforms. We pull the financial data into QuickBooks Online cleanly so your clinical software stays the system of record for clinical work, and QBO stays 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 clinicians, clean books, EOB reconciliation
Group practices, supervisee splits, AR tracking
Multi-clinician, multi-entity, live dashboard
Common Questions
Do you sign a Business Associate Agreement?
Yes. Mental health clients can request a BAA during onboarding. We keep your financial data separated from any clinical or PHI information by design. We never need access to session notes, diagnoses, or treatment plans to do bookkeeping.
Do you integrate with SimplePractice or TherapyNotes?
Yes. We pull the financial data (charges, payments, write-offs, refunds) into QuickBooks Online. Your clinical EHR stays the system of record for clinical work. We do not touch session content.
How do you handle insurance reconciliation?
We reconcile EOBs against deposits, track contractual adjustments and write-offs separately from revenue, and keep patient-responsibility AR visible. Most generic bookkeepers just record the net deposit, which hides the real economic picture of an insurance-paneled practice.
Should my therapy practice elect S-Corp status?
It depends on your profit, your state, and what running payroll will cost you, so there is no single threshold that fits every practice. That analysis is tax work, performed by our affiliated CPA firm, PizzelloCPA, PLLC, under a separate engagement. Our part is keeping the books clean enough to model it and recording owner payroll correctly once the election is made.
How much does bookkeeping for a therapy practice cost?
Our pricing is public. Starter begins at $199/mo for monthly categorization, reconciliation, and reports, which fits most solo therapists. Group practices that need receivables tracking, a custom chart of accounts, and quarterly reviews usually fit Grow, from $349/mo. Surge is custom pricing and adds CPA review from PizzelloCPA, PLLC and a live dashboard.
What is the difference between bookkeeping and accounting for therapists?
Bookkeeping is the monthly work: tying EHR payments to deposits, categorizing expenses, reconciling accounts, and producing a P&L and balance sheet. Accounting in the fuller sense uses those numbers for tax returns, S-Corp decisions, and planning. We do the bookkeeping, and the tax side is handled by our affiliated CPA firm, PizzelloCPA, PLLC, under its own engagement.
I have supervisees in my group practice. Can you handle the comp split?
Yes. Supervisee billing splits, supervision fee carve-outs, and pass-through revenue are core to how mental health group practices operate. We track them cleanly so contractor 1099 totals and payroll records tie to the books at year end.
I see clients in multiple states via telehealth. Is that a problem?
It can be. Whether seeing clients 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.
What software do I need on my end?
QuickBooks Online and your existing EHR/billing platform. We handle the integration. If you are not on QBO yet, we migrate your books as part of onboarding.
What is the best accounting software for therapists?
QuickBooks Online, configured with a therapy-specific chart of accounts and connected to your EHR (SimplePractice, TherapyNotes, Tebra). The software alone still leaves EOB reconciliation, supervisee splits, and monthly reconciliation on your plate, and that is the part we take over. If you only need software guidance, we will tell you that on a free consult.
Do you work with counselors as well as therapists?
Yes. Licensed professional counselors (LPC, LMHC), clinical social workers (LCSW), and marriage and family therapists (LMFT) run practices with the same economics: insurance EFTs, EHR payouts, sliding-scale fees, and associate or supervisee pay. The monthly work is the same whatever the license says, and psychologists have their own page because testing and assessment income adds a layer.
Do you work with group therapy practices?
Yes, group practices are the core of our mental health work. Supervisee splits, 1099 vs W-2 clinician setups, per-clinician profitability, and per-owner profit allocations in the books are exactly where generic bookkeeping breaks down, and where our workflow starts.
Do you work with psychologists and testing practices?
Yes. Psychologists, neuropsychologists, and assessment-heavy practices are a natural fit. Testing batteries and report-writing create revenue that spans weeks, and forensic or consultation income needs separate tracking. We handle both alongside the standard therapy practice workflow.
Do you work with non-licensed practices like coaching?
We work with coaches and other consulting-type service practices. The accounting patterns rhyme with licensed therapy practices except for the licensure-specific items. Book a consult and we will tell you honestly if we are the right fit.
Cited authorities and resources
We benchmark our work against primary sources, not opinion. Some of the references we coordinate with for therapists & counselors 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 therapists & counselors). For legal questions, we coordinate with your attorney.
bookkeepz at a glance
bookkeepz, LLC is a remote bookkeeping firm for therapists, counselors, psychologists, and other clinical private practices, based in Greenville, North Carolina and serving clients nationwide.
Every engagement is led by Andrew Pizzello, CPA, and every client works with a dedicated bookkeeper inside the client’s own QuickBooks Online account.
Starter is from $199 per month and covers monthly transaction categorization, bank and credit card reconciliation, a monthly P&L and balance sheet, tax-ready books, and client portal access.
Grow is from $349 per month and adds enhanced financial reports, receivables and payables tracking, quarterly review meetings, a custom chart of accounts, and year-end tax prep support.
Surge is custom-priced and adds a licensed CPA’s review of every monthly deliverable by PizzelloCPA, PLLC, monthly review meetings, a live financial dashboard, cash flow forecasting, priority support, and multi-entity support.
CPA review is included only in Surge. Tax preparation and filing are a separate engagement with PizzelloCPA, PLLC, an affiliated licensed CPA firm, because bookkeepz is not a CPA firm and does not provide attest services.
The QuickBooks Online subscription is not included in any package. The client pays Intuit directly, and clients who start a new QuickBooks subscription through us get our ProAdvisor discount on it.
Packages are billed monthly with no long-term contract and can be cancelled with 15 days’ notice. Mental health practices can request a Business Associate Agreement.
Full package details are on our services page.
Guides from our blog for therapists & counselors
Bookkeeping for group therapy practices · Year-end bookkeeping for private practices · W-2 vs 1099 clinicians: how each shows up in your books · Best accounting software for therapists · What monthly bookkeeping does for a therapy practice · Supervisee billing and associate pay splits · Signs your therapy practice's books aren't tax-ready · Psych testing revenue recognition · bookkeepz vs. Heard, compared honestly · Heard alternatives for therapists · What bookkeeping costs for a therapy practice · bookkeepz vs. QuickBooks Live · bookkeepz vs. Collective
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Books built around how your practice actually works
Book a free 30-minute consult. Bring your current EHR setup and a recent month's deposits. We'll tell you what's working and what's hiding revenue.
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