Psychiatric Nurse Practitioners & Psychiatrists
Bookkeeping for prescribing mental health practices, from a bookkeeper who spent more than 15 years as a licensed nurse. Aretha knows the world PMHNPs and psychiatrists work in firsthand, and she keeps the books for medication management practices at the volume and rhythm they actually have.
From One Nurse to Another
I spent more than fifteen years as a licensed nurse working in mental health before I ever opened QuickBooks for a living. So when you tell me your Tuesday got away from you because two intakes stacked up behind a full afternoon of follow-ups, and the messages and refill requests waited until after your last patient, I know exactly what that day felt like. I know the language. I know how a prescribing practice moves. You will never have to explain your clinical work to me before we can talk about your numbers.
That shared background shows up in the practical parts too. A medication management practice creates a lot of small activity. More visits in a day than a talk-therapy practice, shorter appointments, money arriving from more than one direction, and a quiet stack of subscriptions, renewals, and professional costs running in the background. Books like that need steady monthly attention from someone who already understands what they are looking at.
Who This Is For
Who This Is For
Psychiatric nurse practitioners and psychiatrists in private practice. Solo prescribers, small medication management practices, telepsychiatry practices, and prescribers who have a front desk person, a medical assistant, or another clinician or two working with them. Most of the practices I serve have somewhere between one and ten people, anywhere in the country.
What Makes These Books Different
What Makes These Books Different
Higher visit volume across shorter appointments means more transactions every month. Money often lands in batches that do not line up neatly with visit dates. And the cost side carries items other practices never see, like e-prescribing and EHR subscriptions, malpractice coverage, license and DEA renewals in one state or several, and collaborating physician arrangements where a state requires one. Those all deserve their own place in the books.
What I Handle
The core of my work is steady monthly bookkeeping. Every transaction categorized, bank and credit card accounts reconciled, the month closed, and clear reports in your hands. Revenue gets reconciled from what your practice systems and payment processor show against what actually reached your bank account, so the number in your books is the money you really received. You can read more about the monthly rhythm on my Full-Service Bookkeeping page.
On the cost side, I keep your overhead visible instead of lumped together. Rent or a shared suite, EHR and e-prescribing software, telehealth platform, malpractice, licensing and renewals, continuing education, supervision or collaborating physician payments where your state requires them, and staff wages all get tracked as what they are. One honest note about my lane. I record and reconcile. I do not do insurance billing, claims, coding, or credentialing, and I do not give clinical or regulatory guidance. Bookkeeping is the work, and I do it carefully.
Revenue Reconciled to the Bank
Revenue Reconciled to the Bank
Deposits come in as batches, often with processor fees already taken out. I match those deposits back to what your systems reported, record the fees where you can see them, and reconcile every account each month. The result is revenue you can trust and a clear view of what the practice earned in a given month.
Payroll for Practices With Staff
Payroll for Practices With Staff
If you have a medical assistant, a front desk person, or clinicians on payroll, I run each pay period on time so payday stops living in your head. One boundary I state plainly. I run payroll for practices whose payroll system is already set up, and I do not handle the initial setup. Details are on my Full-Service Payroll page.
Where These Books Get Muddy
The most common tangle I see in prescriber practices comes from deposit batches. A single deposit can cover a dozen visits spread across three different weeks, with a processing fee already pulled out before the money landed. When that shows up in the books as one lump with no detail behind it, revenue drifts into the wrong month and the fees disappear entirely. Six months of that becomes genuinely hard to read, and it is usually the reason a practice owner cannot tell what a full clinic week actually earns.
The other one is the calendar. Clinical days fill up. The books slide to the weekend, then to next month, then to sometime after the holidays. This happens to careful, conscientious people running good practices, and I have never once thought less of anyone for it. It is a schedule problem. Once someone sits down with the statements and works through it period by period, it gets sorted out.
One Card for Everything
One Card for Everything
The same card covers the EHR subscription, a conference flight, groceries, and a license renewal. Money moves from the practice account to personal with no pattern anyone could describe later. By year end, the practice looks either far more expensive or far more profitable than it really is, and nobody can say which.
Overhead Hiding in One Bucket
Overhead Hiding in One Bucket
Malpractice, licenses in three states, a collaborating physician arrangement, EHR, e-prescribing, and the telehealth platform all dropped into a single professional expenses line. It reconciles fine and tells you nothing. When those costs are separated, you can finally answer a simple question about what it costs to keep your doors open each month.
What Changes
Each month you get a short set of reports you can absorb in a few minutes between visits. What came in, what it cost to run the practice, what was left. Deposits tie out to your bank. Processing fees are visible instead of buried. Your overhead is broken out the way a prescribing practice actually spends money, so the picture matches the practice you recognize.
From there, the decisions get easier because there are real numbers underneath them. Whether to add a clinic day, bring on a medical assistant, or make room for a second prescriber. You decide those things, and I make sure the numbers you decide with are accurate and current. If your books feel behind or you have never had them kept by someone who knows this world, book a consultation with me and tell me where things stand. I will look at what you have and tell you honestly what it would take.
Reports Sized for a Full Schedule
Reports Sized for a Full Schedule
Plain language, no accounting jargon, nothing that needs a study session. If anything on the report raises a question, call me or send a message and I will walk you through it. You work directly with me every month, so you are never explaining your practice to a new person.
Tax Time Without the Scramble
Tax Time Without the Scramble
Your books stay current and organized all year, so when your tax preparer asks for numbers, the numbers are ready. I do not prepare tax returns myself. What I do is keep the records clean and reconciled so the person who files for you has a straightforward job and you are not reconstructing a year in April.
Helping the People Who Help Others
Let's Start With
a Short Conversation
Tell me where your books stand right now, even if the honest answer is that nobody has looked at them in a year. I'll ask a few questions and give you a clear idea of how I can help.
