What software should a small practice run its money on?
Three pieces. A practice management platform for scheduling and client payments, QuickBooks Online for the books, and a business bank account underneath both. That covers almost every solo and small group practice I work with, and I would rather you run three tools well than seven tools halfway.
The practice management side is whatever you already use. SimplePractice, TherapyNotes, TheraNest, Jane, or something built for ABA or medication management. I do not push people to switch. If it holds your calendar, your documentation, and your client payments, and you are comfortable moving around in it, keep it. What matters for the books is that it gives a clear record of what was charged and what was collected.
QuickBooks Online is where the money actually gets accounted for. Your practice management platform knows what clients owe and what they paid. It does not know about your rent, your liability insurance, your software subscriptions, your mileage, or the money you take out for yourself, and it is not going to hand your tax preparer a clean profit and loss in January. QuickBooks Online will.
Under both of those, keep a business checking account and a business card used only for the practice. It is the least interesting part of the stack and the one that prevents the most cleanup work later.
The spot where this usually breaks is between the payment processor and the bank. A client pays you in the platform. The processor groups several payments together, keeps its fee, and drops one lump sum in your account a day or two later. Your bank feed sees only the lump sum. Somebody has to match that deposit back to the sessions behind it and record the processing fee as an expense. When nobody does, revenue looks smaller than it is and the fees vanish from your numbers entirely. Bookkeeping for therapists goes a lot smoother when that handoff is set up right from the start.
Add a fourth piece only when you truly need one. If you have W-2 staff, you need a payroll system, and I run payroll for practices whose system is already in place. If you pay contract clinicians or supervisors, collect their W-9s the day they start so 1099 season is quiet.
The brand matters less than the setup. QuickBooks Online arrives with a generic chart of accounts written for nobody in particular, and a practice needs categories that match how it really spends, things like continuing education, licensure and board fees, supervision, EHR subscriptions, and office or telehealth costs. I am a QuickBooks ProAdvisor, Level 2 with the Gold Badge, and my QuickBooks Online setup and training gets the file built correctly the first time so it is not something you have to fix a year from now.
If you are choosing software for a new practice, or you have a QuickBooks file you have never quite trusted, book a consultation with me and we will look at what you have and figure out what you actually need.
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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
I've been running my practice through my personal checking account. How do I untangle it?
This is the most common thing practice owners tell me, and it is completely fixable. The fix has two parts, opening dedicated business accounts for everything going forward, and sorting the historical mix so the practice's real activity gets recorded properly.
Read answerI offer sliding scale to a good share of my caseload. What should my books show me about it?
Your books should show your effective rate per session, the gap between your posted fee and what you actually collect, and how much of your weekly caseload sits at a reduced rate. Those three numbers tell you what sliding scale really costs and how much of it your practice can carry.
Read answerWhat 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.
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 answerDo 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.
Read answerI'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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