Telehealth Therapy Practices
Bookkeeping for online-first mental health practices. Platform and EHR subscriptions, processor fees, and payouts handled by a bookkeeper who works the same way you do, from anywhere in the country.
Practices That Run Online
An online practice spends money differently than an office practice. There is no lease and no waiting room. In their place sits a stack of monthly charges that never stops running. The video platform, the EHR, the scheduling tool, the payment processor, the business phone line, the website, the email service. Each one is small enough to wave off by itself, and together they are often the biggest expense in the practice after what the owner takes home.
That is also how I work. My clients are spread across the country and I have never needed to sit in anyone’s office to keep their books. We meet by video, I work from your bank feed and your QuickBooks Online file, and we talk whenever something needs talking through. An online practice and a remote bookkeeper are the same working model, so nothing has to be invented to make this fit. I spent more than fifteen years as a licensed nurse in mental health before I started doing this work, so the shape of your day is already familiar to me.
Who This Covers
Who This Covers
Therapists and counselors seeing clients entirely by video, psychologists and clinical social workers who stayed online after going hybrid, psychiatric nurse practitioners running medication management visits remotely, and small online group practices with a few associates. Most of the practices I work with have somewhere between one and ten people.
How We Work Together
How We Work Together
Video calls, phone calls, and email, on whatever rhythm suits your schedule. I keep books from bank and card statements, processor payout reports, and your QuickBooks Online file, so I never need your clinical records to do this work. You work with me every month, the same person every time.
What I Handle
The first thing I do with a telehealth practice is give the software its own shape in the books. You see what the EHR costs, what the video platform costs, what scheduling and phone and website cost, and what the whole stack adds up to every month. Most owners have never seen that total in one place, and it is the number that tells you whether a tool is still earning its keep. If your QuickBooks file was built from a generic small business template, QuickBooks Online setup and training fixes that at the root and leaves you comfortable using the file yourself.
Payment processors take their cut before the money reaches your bank, so the deposit is always smaller than what your clients were charged. I record the full amount collected along with the fee that came out of it, which keeps your revenue accurate and puts a real yearly number on what processing costs you. Payouts get matched back to the batches behind them, bank and card accounts are reconciled every month, and the records your tax preparer will ask about stay organized as the year goes along. That is the ordinary monthly work of full-service bookkeeping.
Subscriptions and Processing Fees
Subscriptions and Processing Fees
Every recurring charge tracked and categorized, including the annual renewals that hit once and get forgotten. Gross revenue and processor fees recorded separately so both stay visible. Duplicate tools and plan upgrades you meant to reverse come to light because they finally have a place on the page.
Deposits Matched to the Work
Deposits Matched to the Work
Platform payouts and processor deposits reconciled against what was actually collected, so the money in your bank ties back to the sessions behind it. Home office costs, equipment, internet, and the rest of an online practice’s expenses recorded as they happen and kept tax-ready. I do not prepare returns, and I make sure the person who does is not starting from a shoebox.
What Goes Wrong
The most common problem I see in online practices is revenue recorded straight from the bank deposit. A client is charged $150, the processor keeps its piece, and $145.65 lands in your account. When the books only ever see $145.65, your income runs low all year and your processing costs never appear anywhere at all. Processors report the gross figure at year end, so those two numbers eventually meet, usually in front of your tax preparer in March.
The other slow leak is the software stack on autopilot. A trial from two years ago renews every January on a personal card. Two scheduling tools are being paid for because the switch never quite finished. A plan that got upgraded during a busy stretch never came back down. None of it is large enough to catch your eye on a single statement, and all of it comes out of what you take home. Add payouts that land several days after the sessions they cover, and a month that felt full can read flat on paper for reasons that have nothing to do with your caseload.
Net Deposits Standing In for Revenue
Net Deposits Standing In for Revenue
Income understated, fees invisible, and no honest way to compare this year against last. It also makes fee decisions harder, because you cannot weigh a rate change against a cost you have never measured.
Costs Nobody Is Watching
Costs Nobody Is Watching
Subscriptions running on a personal card that never reach the practice books. Annual renewals that surprise you every single time. Home office and equipment receipts scattered across email folders, and a tax preparer left guessing in April about what belongs to the practice.
What Changes
When the books are kept this way, a monthly report actually answers questions. You see gross revenue, processing fees on their own line, the software stack broken out, and what the practice kept after all of it. You can look at a platform costing a few hundred dollars a year and decide with real numbers whether to keep paying for it. You can see what a full week of sessions earns you after the tools take their share.
When the practice grows into another state, the books grow with it in an organized way, so you can tell what the expansion cost and what it brought back. Licensing questions belong with your board and your attorney, and tax questions belong with your tax preparer. My part is making sure the numbers underneath those conversations are right, current, and easy to hand over.
Decisions Backed by Real Numbers
Decisions Backed by Real Numbers
Whether to keep a platform, whether to raise your fee, whether the practice is ready for another associate. Those answers get easier when the costs and the revenue are both on the page. Books stay current month to month, so you are never rebuilding a year from memory in the spring.
Let's Talk About Your Practice
Let's Talk About Your Practice
Book a consultation with me and we will look at what you have now, what the stack is costing you, and what it would take to get your books current and keep them that way. You will be talking with Aretha, the person who does the work. I am always glad to answer questions before you decide anything.
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.
