Bookkeeping and payroll for mental health professionals in private practice

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What has to happen before January so contractor 1099s are easy?

January feels hard only when the year’s information was never gathered. The work that makes 1099s simple happens months earlier, and it comes down to three habits.

The first one is collecting a W-9 the moment someone starts, before the first payment goes out. You want the legal name, the business name if there is one, the mailing address, the taxpayer ID number, and the entity type. The easiest time to ask is when a new contract supervisor or associate is excited to begin working with you. Tracking down a taxpayer ID in late January from someone who finished up in June is a different experience entirely.

The second habit is paying contractors from the business account and recording every payment to the payee rather than dropping it into a general expense category. If your QuickBooks Online vendors are marked as 1099 eligible and your accounts are mapped, the year-end report practically builds itself. The payments that go missing are almost always the ones made from a personal card or a personal payment app. It is also worth confirming how each payment channel gets reported, since amounts paid by credit card or through certain settlement platforms are often reported by the processor instead of by you.

In my work doing bookkeeping for mental health professionals, the contractor list tends to be longer than practice owners expect. Associate clinicians paid as 1099s, contract clinical supervisors, a part time office manager working as a contractor, IT help, the cleaning service, an attorney, a consultant who helped with your website, and sometimes rent depending on how the lease is written. Naming the payee on every payment matters because different kinds of payments land in different reporting boxes. Whether a particular person should be a contractor or an employee is a question for your attorney or tax preparer, and the books simply record whichever answer is true.

The third habit is a December review. Pull totals by vendor, compare them against the reporting threshold in effect for that year, and flag anyone missing a W-9 or a current address. Thresholds and forms do change, so confirm the current ones with your tax preparer. December is also the last comfortable moment to reach someone who has moved on.

Once those three things are in place, January is administrative. I handle 1099 preparation and filing starting at $100, which includes five forms, with $10 for each additional form. Filing deadlines usually fall at the end of January, so it helps to be ready a couple of weeks ahead.

If you are not sure your contractor records are in shape for this year, let’s take a look together. Book a consultation with me and we can go through what you have and what is still missing.

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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.

More Questions

Which parts of my practice make the most money?

You can only answer this if your books split revenue by service line and you know roughly how many hours each line takes. Individual sessions, couples work, groups, testing, supervision, and workshops all earn differently per hour of your time once direct costs come out.

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Why would a psychiatric nurse practitioner choose a bookkeeper who used to be a nurse?

The bookkeeping itself should be excellent no matter who you hire. What my 15 years as a licensed nurse in mental health changes is how much you have to explain before the work can start. I already know the tempo of a prescribing practice and the language you use.

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What's the difference between profit and the cash in my account?

Profit measures what your practice earned and spent over a period of time. Your bank balance shows what is sitting there at one moment, after payment lags, big annual bills, tax set-asides, and owner draws. Both numbers are true, and they answer different questions.

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Should my associates be W-2 employees or 1099 contractors?

Classification is not really a preference you get to pick. It turns on how much control the practice has over the associate's work, and associates who see the practice's clients on the practice's schedule often land on the employee side of those tests. The call belongs with employment counsel and your tax professional, and I make sure the books and payroll records match whichever answer is true.

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How do no-shows and late cancellations show up in my numbers?

Mostly they show up as an absence, which is why they are so easy to miss. Cancellation fees you actually charge should sit in their own income category so you can see what you recovered, and the cost of the empty slots shows up as the gap between what was scheduled and what was earned.

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When can my practice afford to add another clinician?

You can afford an associate when the arithmetic works, meaning their pay, the extra overhead that comes with them, and several months of a partial caseload all fit inside what your practice actually collects. Your books supply those numbers, and the decision stays yours.

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AD Keeps The Books is Aretha Dirden, a bookkeeper who spent more than 15 years as a licensed nurse in mental health before taking over the books for the people doing that work. She handles monthly bookkeeping, catch-up and clean-up work, and payroll for therapists, psychologists, counselors, and clinical social workers in private practice, and she does the work herself for every client. Based in Lancaster, California, serving practices nationwide. QuickBooks ProAdvisor certified.

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