Bookkeeping and payroll for mental health professionals in private practice

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Why don't my SimplePractice deposits match my session income?

Nothing is broken and you are not missing money. The amount that shows up in your bank account is a payout from the payment processor, and fees have already come out of it. Payouts are also batched on the processor’s schedule rather than one per session, so a single deposit usually covers charges from several appointments across several days.

Fees are the first gap. Card processing on practice platforms commonly runs somewhere around 3 percent plus a small per-transaction fee, though the exact rate varies by platform, plan, and card type, so it is worth checking your own statement instead of assuming. Say you see eight private-pay clients at $150. Your session ledger says $1,200. At roughly 3 percent plus about 30 cents per charge, something like $38 comes off the top and about $1,162 lands in the bank. Run a full caseload every week and that quietly adds up to a few hundred dollars a month, which is real money and a real business expense.

Timing is the second gap. A Wednesday deposit might include Friday’s and Monday’s charges, and charges from the last days of the month often settle in the next month. Even when every single number is correct, your calendar month and your bank month will not line up by themselves.

There are smaller reasons too. Refunds and chargebacks get netted out of a payout. A card may have declined, so a session you completed was never actually paid. Client balances can still be sitting unpaid, sliding scale adjustments change what was charged, and insurance payments arrive on their own rhythm from a different source entirely.

Here is the part that matters. If you record that $1,162 deposit as income and stop there, your revenue is understated and your processing fees never appear in the books at all. You lose a legitimate expense, and you never get to see what payment processing costs your practice. Bookkeeping for therapists comes down to keeping both numbers honest, recording the gross $1,200 as revenue and the fees as their own expense line so the net ties out to what the bank shows.

The way to get there is a monthly reconciliation of three things, your platform’s payout or settlement report, the payouts themselves, and the bank deposits. That is ordinary work in full-service bookkeeping, and once it is set up properly in QuickBooks Online it holds together month after month.

If your deposits and your session totals have never agreed and you would like someone to sort it out with you, book a consultation with me and we will look at your reports together.

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More Questions

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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What makes ABA practice books harder than a therapy practice's?

It comes down to people, volume, and speed. An ABA practice runs a team of technicians and analysts, so real payroll happens every period, high session volume means revenue arrives as remittances that have to reconcile against the work delivered, and the numbers change fast when the practice grows.

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How do you keep my financial information secure?

I only need financial records, never clinical ones. Documents move through secure file sharing rather than email, I work in QuickBooks Online under my own user login, and I use read-only bank connections instead of shared passwords wherever the bank supports it.

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Do you work with practices outside California?

Yes. I work with mental health practices in all fifty states. Lancaster, California is where I sit, and most of my clients are somewhere else entirely, working with me through QuickBooks Online, secure document sharing, and scheduled calls.

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How many sessions a week does my practice actually need?

Add your real overhead, the pay you want to take home, and the tax reserve your tax preparer sets, then divide by what you actually collect per session. Common benchmarks put a sustainable full caseload somewhere around 18 to 22 sessions a week. Clean books give you honest numbers to put into that math.

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

Almost everything. Collect a W-9 from every contractor before the first payment, record payments by payee all year long, and review the totals in December. Do that and January is nothing more than paperwork.

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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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