Bookkeeping and payroll for mental health professionals in private practice

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How do you keep my financial information secure?

I’m always glad when a practice owner asks me this before we start working together. The short version is that I only need financial records, I use secure standard tools to get them, and I keep my access as narrow as the work allows.

Scope matters most, so let me start there. Bookkeeping runs on bank and credit card activity, merchant processor payouts, payroll reports, and vendor bills. I don’t need your EHR login. I don’t need progress notes, treatment plans, diagnoses, or anything else about the people you see. Those records belong in your clinical system and they stay there. If I need a revenue figure that lives in your practice management software, you can export a financial summary and send that instead of handing me the keys to the whole thing.

For documents, I use secure file sharing rather than email attachments. Bank statements sitting in an inbox for years are a risk nobody needs to carry. In QuickBooks Online, I work as an added user with my own login and my own credentials, so no password is ever shared and my access can be removed at any time. When a bank supports a read-only or accountant-level connection, that’s what I use, so I can see transactions without any ability to move money. When a bank doesn’t offer that, we use statement uploads instead. I would rather do a little extra work than ask you to give me a password.

Names do surface occasionally. A deposit description, a client statement, or a returned payment can carry one. When that happens, I handle it the way I handled everything else during more than fifteen years as a licensed nurse in mental health. Confidentiality was never a policy I read once and filed away. It was simply how the day worked, and that habit came with me into this work. It’s also part of why bookkeeping for therapists is the only kind of bookkeeping I do.

One more thing worth knowing is that I’m a solo bookkeeper. You work directly with me, not a rotating team and not subcontractors you’ve never met. Fewer hands on your records is its own form of protection.

I’ll also be honest about what I won’t claim. I’m not going to tell you that hiring me makes your practice compliant with any particular standard. That conversation belongs with your own attorney or advisor. What I can tell you plainly is which accounts I touch, how your documents reach me, and what I never ask for. If your attorney wants a written confidentiality agreement in place, I’m happy to sign one.

There are a few things that help on your end too. Keep a business bank account and card separate from personal, give each person their own login instead of sharing one, and remove access whenever someone stops working with the practice. Clean access is part of what makes full-service bookkeeping run smoothly month after month.

If you’d like to talk through exactly what access I would need for your practice, book a consultation with me and we’ll walk through it together.

Helping the People Who Help Others

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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.

More Questions

How do quarterly estimated taxes fit into my bookkeeping?

Your tax preparer calculates the amounts. Your books supply the current profit number those calculations depend on, and they keep the record of what you paid and when. When the books are months behind, every estimate turns into a guess.

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How do refunds and client credits get handled properly?

A refund reduces revenue in the period you give it back, and prepaid sessions sit as a liability until the session actually happens. Client credit balances need to be tracked by name so nobody's money quietly disappears into the books.

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I'm a good therapist and my books are a disaster. How normal is that?

It is extremely normal. Clinicians spend years training for the work in the room and almost no time learning bookkeeping, so the money side is usually the part that slips. Catch-up work has a clear beginning and a clear end, and it says nothing about your skill as a clinician.

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What does the practice actually pay beyond an employee's wages?

The wage is only the starting number. Employer payroll taxes, unemployment insurance, workers compensation, and benefits all sit on top, which is why a 60 percent W-2 split and a 60 percent 1099 split are completely different economics for both sides.

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I'm embarrassed to show anyone my books. What will you think of me?

I think it took something to ask. Close to half the people who contact me open with an apology, so you are in good company. The state of your books tells me what work needs doing, and nothing at all about who you are.

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How much does bookkeeping cost for a private practice?

Full-service monthly bookkeeping for a private practice starts at $165 a month. Add-ons like payroll processing, bill payment, invoicing, and 1099s each have their own starting price, and catch-up or clean-up work gets quoted once I see what you have.

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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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