Bookkeeping and Accounting for Therapists and Mental Health Practices
Bookkeeping and accounting for solo and group mental health practices, supervised by PizzelloCPA, PLLC. EOB reconciliation, supervisee comp splits, S-Corp planning, and HIPAA-aware workflows with 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 therapy client gets HIPAA-aware bookkeeping with EOB reconciliation, supervisee tracking, and CPA oversight from PizzelloCPA, PLLC on the tax-sensitive moves.
Therapists We Serve
One-clinician practices, 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 licensing and nexus implications, kept clean.
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 K-1s and 1099s come out right.
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.
S-Corp Election and Reasonable Comp
Mental health falls under SSTB rules so the QBI deduction phases out fast. The S-Corp self-employment tax savings often still pencil out. We benchmark reasonable compensation against BLS data for therapists, psychologists, and clinical social workers, by state.
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. We help you set the relationship correctly and document the working arrangement so the classification holds.
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 actually need the combination we run: QBO configured for a therapy chart of accounts, a human reconciling EOBs monthly, and a CPA reviewing the tax-sensitive moves.
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, CPA oversight (PizzelloCPA, PLLC), and tax-ready books.
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?
Often, once net profit clears about $80,000 for a solo. Mental health is a specified service trade so the QBI deduction phases out quickly, but the self-employment tax savings on owner draws are usually worth it. We run the numbers during onboarding so you know your break-even.
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 K-1s, 1099s, and W-2s all come out right at year end.
I see clients in multiple states via telehealth. Is that a problem?
It can be. State income tax nexus is triggered differently across states, and some states are aggressive about pulling in remote service providers. We track where your revenue is earned so we can flag if you have a filing obligation in a new state. For genuinely complex multi-state tax-law questions we bring in a state-tax specialist.
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 S-Corp comp decisions 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 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 multi-owner K-1 allocations 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 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.
Guides from our blog for therapists
Supervisee billing and comp splits · Psych testing revenue recognition · Best accounting software for therapists · bookkeepz vs. Heard, compared honestly
Not a therapist?
We serve the full private practice ecosystem. Veterinarians, Optometrists & Ophthalmologists, Nurse Practitioners, and more.
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.
Book Your Free ConsultOr call us: 855.297.BOOK (2665)