My practice is brand new. When should bookkeeping start?
Right at the beginning. If you can manage it, before the first client payment lands.
I know that sounds like a bookkeeper talking, so here is the honest reason. Nearly every cleanup I take on started as a brand new practice where nobody set anything up. Eight months of deposits went into a personal checking account. The office furniture and the family groceries are on the same credit card. There is a payment app with a balance nobody has looked at since spring. None of that happens because someone was careless. It happens because a clinician was busy building a caseload, which is exactly what they should have been doing.
Starting is smaller than most people expect. Open a business checking account and a business card in the practice’s name, and run everything through them from the first dollar. Get your bookkeeping software configured with a chart of accounts that actually reflects how a mental health practice earns and spends. Then settle into a monthly rhythm so a stack never forms.
For a new practice, the natural first step is QuickBooks Online setup and training. I am a QuickBooks ProAdvisor, and I set the file up the way a therapy, testing, or prescribing practice needs it, then walk you through using it so you are not guessing in month two. That is a one time piece of work, and it saves you from the generic template that categorizes your EHR subscription and your liability insurance into a bin called Other.
You do not have to buy everything at once. Plenty of practices start with the setup, keep things tidy themselves for a few months, and move to monthly service once the caseload fills in. Monthly bookkeeping with me starts at $165, and a catch-up or clean-up engagement almost always costs more than the months of steady work would have. Private practice bookkeeping is one of the few expenses where paying early is cheaper than paying late. Pricing does change over time, so confirm current rates with me when we talk.
There is a tax reason too. Your very first year sets the baseline your tax preparer works from, including startup costs, equipment, and any home office records. Clean books from month one mean your preparer gets what they need without reconstructing anything, and the questions about amounts owed and strategy go to them with real numbers behind them.
If you are opening now or you opened a few months ago and want to get on solid footing, book a consultation with me and we will figure out the right starting point together.
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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
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.
Read answerWhat changes in the books when a solo practice becomes a group?
Once you are paying other clinicians, the books have to answer new questions. Payroll or contractor payments begin, revenue needs to be traceable to each clinician, shared overhead has to be spread across the team, and your own pay becomes a deliberate line instead of whatever is left over.
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 answerHow 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.
Read answerPrivate-pay and insurance money arrive on completely different rhythms. How do the books keep that straight?
Card payments usually land in a couple of business days while insurance remittances take weeks, so any month's deposits are a mix of recent sessions and older claims. Clean books date revenue consistently, separate the payer streams, and break lump deposits back into their pieces so you can tell a slow payment week from a slow month of work.
Read answerI'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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