Practice accounting for dentists, primary care, and specialty.
Insurance reimbursement timing, payroll for clinical and admin staff, equipment financing, and the entity structure that minimizes tax for high-earning practitioners.
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Medical and dental practice accounting is unlike any other small business. Revenue lags by 30–90 days because insurance carriers do not pay overnight. Payroll is heavy — clinical staff, hygienists, assistants, front desk, and the practitioner all on different pay structures. Equipment is expensive and finances over 5–7 years, which interacts with depreciation rules in non-obvious ways. And the practice owner is typically a high earner with both ordinary tax planning needs and physician-specific issues like 199A QBI limits.
We work with general dentists, dental specialists (orthodontics, oral surgery, endodontics), primary care, urgent care, and several specialty medical practices. Each has its own accounting wrinkles but the framework is consistent.
What we handle for practices
- Insurance A/R aging — track expected reimbursement vs received by carrier and date. Identify slow-pay carriers early.
- Production vs collection reporting — the gap between what was produced (services rendered) and what was collected is the practice's real cash flow story.
- Payroll for clinical staff — hygienists, assistants, technicians, front desk, with proper overtime and benefits handling.
- Equipment financing accounting — capital lease vs operating lease, Section 179 timing, manufacturer rebates.
- Owner compensation strategy — for S-corp / PC practices, the reasonable-comp analysis matters more here than almost anywhere else.
- 199A QBI deduction analysis for specified service trades or businesses (SSTBs) — practices fall under SSTB and the deduction phases out at higher income.
- Quarterly tax planning with retirement-account contributions optimized.
Pricing
| Practice size | Monthly fee |
|---|---|
| Solo practitioner, 2–4 staff | $650 – $1,000 |
| Practice with 1 associate, 8–15 staff | $1,000 – $1,800 |
| Multi-provider, 20+ staff, multiple locations | $1,800 – $4,000 |
A general dentist practice was reporting $1.2M in production but collecting $980K. The gap (write-offs, insurance adjustments, slow pay) was not tracked anywhere. After we set up production-vs-collection reporting, the owner could see exactly which insurance plans were eating margin — and renegotiate or drop the worst three.
If you are a solo practitioner, monthly bookkeeping with insurance A/R aging is the minimum.
If you have associates, you need payroll structured to handle production-based comp models without messing up overtime.
If you are multi-location, the per-location P&L is what tells you whether the second location is funding itself or being subsidized.
Insurance A/R, real production reporting, and the entity structure for high-earning practitioners.
Built for the way medical and dental practices actually run.
Frequently asked questions
How do you handle insurance A/R?
We track expected reimbursement by carrier and aging bucket. Slow-pay carriers and unusual write-offs surface before they become a cash problem. The practice management software (Dentrix, Eaglesoft, Open Dental, Athena) handles the patient-level detail; we reconcile the totals into your books and report the trends.
Can you handle production-based associate comp?
Yes. Associate compensation models (% of collected production, % of net production, daily rate plus production bonus) all have specific accounting and payroll-tax handling. We set up the comp formula once and run it correctly every pay period.
Should my practice be an S-corp or PC?
In Colorado, professional services typically operate as a Professional Corporation (PC) or Professional LLC (PLLC) — the S-corp election applies to either. The right structure depends on your state, your associate structure, and your liability concerns. We coordinate with your healthcare attorney on the structure side.
What about the 199A deduction?
Medical and dental practices fall under "Specified Service Trade or Business" (SSTB) for 199A purposes. The 20% qualified business income deduction phases out as income rises and is fully eliminated at the upper limit. We model whether 199A is in play for your specific situation and adjust planning accordingly.
Can you handle multiple locations?
Yes — we set up per-location P&L tracking so you see the financial story of each office independently. Common shared costs (admin, billing, marketing) get allocated by an agreed-upon method.