Therapist and counselor accounting.
Insurance billing vs cash-pay tracking, package and series deferred revenue, and the S-corp election timing for established providers.
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Mental health practice accounting is structurally simple but operationally tricky. Insurance billing has long A/R cycles. Cash-pay clients sometimes prepay packages. Sliding-scale fees affect actual collected revenue versus billed amount. The framework needs to reflect all three.
We work with solo LCSW and LPC practices, group practices, and supervisory practices with associate clinicians.
What we handle
- Insurance vs cash-pay separation.
- Sliding-scale handling — billed vs collected separated.
- Group practice payroll with W-2 vs 1099 screening for clinicians.
- S-corp election at $100K+.
- Continuing education deductions.
A group practice with 6 associate counselors had been treating them all as 1099. Practice set the schedule, supplied the EHR, billed insurance under the practice. The reclassification cost two years of back payroll tax. We rebuilt with W-2 setup in 30 days.
If you bill insurance, A/R aging by carrier matters.
If you have associates working only at your practice, they are W-2.
If net consistently above $100K, S-corp + 199A analysis.
Real margin per session type, clean clinician pay, S-corp at the right time.
From $400/month solo, $700+ group.
Frequently asked questions
Software?
SimplePractice, TherapyNotes, TheraNest. Sync to QuickBooks.
Sliding scale?
Track billed vs collected as separate KPIs. Write-offs are part of the picture.
Associate 1099?
Almost always W-2 if exclusive to your practice.
199A?
Counseling SSTB; deduction phases out at higher income.