Bookkeeping for Private Practice Owners Who'd Rather See Clients Than Chase Receipts
Bookkeeping led by Andrew Pizzello, CPA for therapists, optometrists, veterinarians, dentists, and other clinical private practices. Tax-ready books every month. S-Corp planning built in. From $199/mo.
Private Practices We Serve
Most firms that serve private practices serve all of them. We chose twelve clinical specialties instead, because a therapy practice reconciling EOBs and an optometry practice carrying optical inventory have problems a generalist meets once a year and we meet every week.
LPC, LMHC, LCSW, and LMFT private practices. HIPAA-aware workflows.
Private practice ODs and MDs, with or without an optical shop.
Single-doctor practices to small group hospitals.
PhD, PsyD, and MD-led practices. Testing, forensic work, and medication management.
Independent and collaborative practices, including aesthetic and telehealth.
Solo and small-group practices. Production, hygiene, and lab costs tracked properly.
Outpatient practices mixing commercial insurance, Medicare, and cash-pay.
Solo and group practices. RBT supervision hours and service lines tracked separately.
Solo and group AuD practices. Hearing aid trial periods and manufacturer rebates tracked properly.
Solo and group SLP practices. Cash-pay, school district contracts, and telehealth by state.
Solo and group acupuncture practices. Treatment packages and herbal inventory tracked separately.
Nutritionist and RD private practices. Insurance and cash-pay, packages, and course and group program revenue.
Other solo service practitioner? Book a free consult and we'll tell you honestly whether we're the right fit.
What Makes Private Practice Bookkeeping Different
A generic bookkeeper can reconcile accounts. A private-practice bookkeeper does the reconciling and catches the things that actually move your tax bill.
Prepaid Packages and Memberships, Tracked Until Delivered
Prepaid visit packages, monthly memberships, group program enrollments, and hearing aid trial periods are money you have 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 visits or refunds. Tracking it does not change your taxes: on the cash method most practices use, a prepayment is income in the year you receive it (IRS Publication 538).
QBI and the SSTB Phaseout
Private practices are almost always specified service trades or businesses, which means the 20% QBI deduction phases out fast. S-Corp election and reasonable compensation planning is how you soften the hit, and that planning is done by PizzelloCPA, PLLC, our affiliated CPA firm. We keep the books that make it provable.
Reasonable Compensation, Benchmarked
Setting owner salary too low is the fastest way to get audited as an S-Corp. We benchmark against BLS wage data, AVMA survey data for veterinarians, and profession-specific salary surveys for therapy, optometry, and dental practices, not guesswork.
1099 vs W-2 for Your Team
Contract therapists, per-diem hygienists, 1099 RBTs, relief veterinarians. Misclassification is an expensive mistake in clinical practices. We help you get it right and keep the paper trail clean.
HIPAA-Aware Workflows, BAA Available
We don't touch PHI. We handle the financial side of your practice with the same seriousness you handle patient records. A Business Associate Agreement is available on request for medical, dental, vet, and mental health clients.
Retirement Plans That Actually Move the Needle
Solo 401(k) is table stakes. For a practice clearing $400K or more, a cash balance or defined benefit plan can shelter six figures a year. Most bookkeepers never bring this up. We do.
Multi-State and Telehealth
Remote therapy, multi-state teletherapy and telehealth SLP caseloads, dietitians licensed in several states. State nexus issues are a growing headache. We stay on top of where your practice is earning and where it owes.
Your Practice Software, Connected
We work cleanly alongside Clio, SimplePractice, TherapyNotes, Kareo, Dentrix, Open Dental, Harvest, Stripe, and the rest. QuickBooks Online is our home base, connected properly, not duct-taped together.
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). No long-term contracts. No hidden fees.
Clean books, reconciliation, monthly reports
Enhanced reports, AR/AP, quarterly reviews
CPA review of every deliverable (PizzelloCPA, PLLC), live dashboard, cash flow planning
Common Questions From Private Practice Owners
Do you specialize in one profession or serve all private practices?
We're generalists for private practice owners, not a single-vertical firm. That means we understand what private practices have in common (service revenue, S-Corp planning, owner comp, 1099 vs W-2, QBI phaseout) and we adapt the specifics by profession. If you need a bookkeeper who has seen your exact industry before, we have.
Do you offer a Business Associate Agreement?
Yes. Medical, dental, veterinary, and mental health clients can request a BAA during onboarding. We separate financial data from PHI and our workflows reflect that.
Will you work with my CPA on taxes, or do you handle that too?
Both work. We keep your books tax-ready all year, so the handoff is clean whether PizzelloCPA, PLLC, our affiliated CPA firm, prepares your return under a separate engagement or you send everything to your existing CPA. In Surge, a licensed CPA at PizzelloCPA also reviews every monthly deliverable.
My practice is an LLC. Should I elect S-Corp?
It depends on your net profit, your industry's reasonable-comp benchmarks, and your state. We run the numbers during onboarding so you know the break-even point for the election to pay off. Most private practices clearing $80K+ in profit benefit.
Are you only in North Carolina?
We're based in Greenville, NC, and we serve private practices nationwide. Everything is remote by design, with a secure client portal, document vault, and direct QBO access.
Ready to hand off the books?
Book a free 30-minute consult. We'll look at your current setup, flag the quick wins, and tell you honestly whether we're a fit.
Book Your Free ConsultOr call us: 855.297.BOOK (2665)