How much does bookkeeping cost for a private practice?
Full-service monthly bookkeeping for a private practice starts at $165 a month. That covers your transactions categorized, your bank and credit card accounts reconciled every month, and monthly reports that show what the practice actually earned and what it spent. For most solo practices, that starting number is the number.
From there you add only what you actually need. Payroll processing starts at $150 a month for practices whose payroll system is already up and running. Bill payment starts at $85 a month, and invoicing starts at $85 a month. Year-end 1099s start at $100, which includes five forms, with $10 for each additional form. QuickBooks Online setup and training is a one-time project starting at $400, and I do that work myself as a QuickBooks ProAdvisor.
Catch-up and clean-up work gets quoted per engagement. I would not feel right putting a number on that until I see what exists, because a practice with four months untouched is a very different job than one with three years of DIY entries and accounts that have never been reconciled. So I look first, tell you honestly what I find, and give you one price before any work begins. And whatever shape your books are in, I have seen worse and I am not here to make you feel bad about it.
What moves the monthly number is volume and moving parts. A solo therapist with one business checking account, one business card, and a single payment processor sits at the low end. A group practice with several associates, multiple cards, payroll, and money arriving from different places takes more hours, so it prices higher. The same goes for practices carrying a long list of software subscriptions or a mixed schedule of therapy, testing, and consulting.
Here is how I would ask you to think about the cost. At typical session rates around the country, bookkeeping for therapists and other private practice owners runs less than two sessions a month. For that you get books that stay current, records your tax preparer can work from without an April scramble, and an honest monthly picture of what your practice is really making.
A few things the price does not include, so there are no surprises. I do not prepare tax returns. I keep your books tax-ready and your tax preparer takes it from there, and questions about what you will owe or how to plan for it belong with that professional. I run payroll where a payroll system is already set up, and I do not build the system itself. I also do not handle insurance billing, claims, credentialing, or coding.
Prices and rates shift over time, so treat these as current starting points and let me confirm your number in writing. If you want to know what your practice would actually cost, book a consultation with me. We will talk through what you have and what you need, and I will quote you plainly.
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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
Where do my payment processing fees actually go in my books?
Processing fees belong in their own expense account, with your session revenue recorded at the full amount clients paid. If you only record the smaller net deposit that lands in your bank, both your revenue and your fees disappear from view.
Read answerWhat should I look at in my reports each month if I only have ten minutes?
Look at four things. Revenue compared to last month and the same month last year, the few expense lines that actually move, profit for the month, and cash on hand. That is enough to know whether the practice is healthy, and anything that looks strange can be a quick conversation.
Read answerHow should insurance payments show up in my books if you don't do billing?
I don't do insurance billing, claims, ERA posting, or credentialing. That work stays in your practice management system or with your biller. What bookkeeping does is reconcile what that process produces, matching every payer deposit that reaches your bank against what your records say you were paid.
Read answerWhen 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.
Read answerWhat kind of practice fits AD Keeps The Books best?
Mental health practices with one to about ten people, anywhere in the country. Solo therapists, psychologists, LCSWs, addiction counselors, psychiatric nurse practitioners, group practices, telehealth practices, and ABA providers. If you want your books current and a bookkeeper who already speaks your language, you're the fit.
Read answerWhy does it matter that my bookkeeper knows mental health?
It saves you from explaining your own practice before you can ask a question, and it keeps your books categorized in the language of a practice rather than a generic business. After more than 15 years as a nurse in mental health, the learning curve happened long before my first bookkeeping client.
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