Industries · medical & dental
Practice bookkeeping for billed vs collected.
Monthly bookkeeping: $550–$1,800/mo
Insurance AR aged, contractual adjustments booked honestly, collections reconciled against production, and your practice-management software tied to the bank. Bookkeeping built for the way a medical or dental practice actually earns — and waits to collect.
Production vs collection · insurance & patient AR · PMS reconciled. Fixed-fee, CPA-ready. We're not a CPA firm.
Reviewed before delivery: a documented check proves the accounts against their statements and puts open items in writing. How it works.
Quick answer
A practice's real income is what's collected, not the production total its practice-management system reports: billed work less contractual adjustments less what's still owed. Each month the system's collections report is tied to bank deposits. When the two disagree, the difference is traced to merchant fees, financing fees, a payment posted in the wrong month or another cause.
Included in monthly bookkeeping ($550–$1,800 a month); your exact fee is scoped in writing. For a practice, the count of deposit sources and payers to reconcile is the biggest lever on the figure. What the ranges cover.
The reality of practice books
Why a profitable-looking practice can still be starved for cash.
A practice can have a strong production month and a weak bank balance, because production and cash are two different things separated by insurers, adjustments, and time. The whole job of practice bookkeeping is to make that separation visible: what you produced, what you agreed to write off, what's still sitting in receivables, and what actually arrived.
Get it wrong and the damage is quiet. Contractual adjustments booked as revenue inflate income; insurance AR that nobody ages hides a collection problem until it's a crisis; a practice-management system that's never reconciled to the bank lets fees and financing payouts drift. We keep each of these straight so the practice's real financial health is readable.
Reconciled monthly, closed on a fixed date, and reported in plain terms — with payroll for associates and staff kept reconciled too via our payroll support.
Production vs collection
Collections reconciled against production so you can see whether a soft month was less work or just slower payers.
Adjustments booked honestly
Contractual write-downs recorded as adjustments, not buried — so revenue reflects what you'll actually keep.
PMS reconciled to the bank
Deposits, merchant fees, and patient-financing payouts tied out, so the software and the books finally agree.
Worked example · one month
A practice month closed, deposit by deposit.
What the close does with a month of processor batches, insurance payments, a financing payout, payroll and an owner draw. Books only: billing, coding and payer rules stay with the practice.
Illustrative example — not client data. Assumptions stated.
| Item | Source document | Figures | What the close records |
|---|---|---|---|
| Card-processor batches (patient payments) | Processor statement | $18,450.00 collected; $541.20 fees; $17,908.80 deposited | Patient collections at the gross amount; fees to merchant-fee expense |
| Insurance payments | Remittance advice, matched to each deposit | $42,310.00 across the month's deposits | Insurance collections, by payer |
| Patient-financing payout | Financing company's statement | $3,880.00 financed; $232.80 fee; $3,647.20 deposited | Patient collections at the gross amount; fee to expense |
| Collections tie-out | Collections report from the practice-management system | $64,640.00 reported collections | Equals the three gross lines above; the $774.00 of fees explains why the bank shows $63,866.00 |
| Payroll | Payroll provider's register | $26,400.00 gross wages; $5,530.00 withheld; $20,870.00 net pay; $2,019.60 employer taxes | Wages and payroll-tax expense; withholdings and employer taxes held as liabilities until the provider remits them |
| Owner distribution | Bank transfer | $12,000.00 | Owner distributions (equity), kept out of expenses |
| Lock | Every statement for the month | Each account tied to its statement; payroll liabilities back to $0.00 once remitted | Period closed, reports issued |
The line that makes practice books trustworthy is the tie-out: the practice-management system says $64,640.00 was collected, the bank received $63,866.00, and the difference is fully explained by $541.20 of processor fees and $232.80 of financing fees. When those three numbers don't reconcile, the close stops until they do.
- A two-provider practice with one operating account, one card processor, one patient-financing company and a payroll provider.
- Cash-basis books. On accrual books, production would post to receivables and contractual adjustments would reduce them.
- The figures are made up for this page.
- Payer rules, coding and billing decisions sit with the practice's billing team; the close records what was collected.
What practices come to us for
The work behind clean practice books.
Monthly bookkeeping
Production, collections, AR, and PMS reconciliation kept current every month.
Monthly bookkeepingPayroll support
Payroll for associates, hygienists and staff recorded and reconciled to the books; running it is a scoped add-on.
Payroll supportBooks behind?
Months of unreconciled deposits and untracked AR — caught up to a clean baseline.
Bookkeeping cleanupWe serve businesses across the US remotely, Texas-first, practices included. We keep the books; coding, billing, and tax stay with your team and CPA.
FAQ · Updated October 2026
Practice owners' questions, answered.
See your real collection rate
Get practice books that show what you actually keep.
We review how your practice's books are kept and scope a fixed monthly fee to run them right — collections reconciled to production, AR aged, PMS tied to the bank. Nothing is owed for the review.