Health & wellness practices
Bookkeeping for health and wellness practices
In a practice that bills insurance, what you charged and what you will be paid are two different numbers. The books have to work from the second one.
Billed charges are an aspiration. Contracted rates, adjustments, denials and patient responsibility all sit between the charge and the deposit, and a practice that records revenue at the billed amount will carry a receivable balance that never comes true.
The practical answer is to record revenue as it is actually realized and reconcile deposits against the remittance advice, so the accounts and the billing system tell the same story.
Where the books go wrong
What we look at first
Revenue recorded at billed charges
Contractual adjustments are not bad debt and not a discount. Without them, receivables inflate month after month.Deposits that cover many claims
One insurance payment can settle thirty claims across three months. Applied as a lump sum, it makes reconciliation impossible.Patient balances and payment plans
Copays, deductibles and plans running over months need tracking that the bank feed alone cannot provide.Contracted providers paid inconsistently
Associates on percentage splits, per-session rates or hourly pay all need records that match the agreement, and W-9s collected before the first payment.
What we do each month
- Revenue recorded at realizable amounts, with contractual adjustments shown separately
- Insurance deposits reconciled against remittance advice, not just to the bank
- Patient payments, copays and plan balances tracked and aged
- Provider compensation reconciled to the split or rate actually agreed
- Clinical supplies, equipment and lease costs recorded consistently
- Bank, credit card and equipment finance accounts reconciled
Setting up QuickBooks for it
QuickBooks Online holds the financial picture while the practice management or billing system holds patient detail. We keep the boundary clear rather than duplicating patient records in the accounting file.
Separate income accounts by payer type — insurance, self-pay, contracted programs — make the mix visible without extra work.
Deposit reconciliation is driven by the remittance advice, with a standing monthly step to clear the difference between billed and realized.
Carey is a QuickBooks Online Advanced ProAdvisor, so a file can be set up, cleaned up or migrated as part of the same engagement — see QuickBooks services.
Reporting
The numbers worth watching
Net collection rate
What was collected against what was realistically collectible. The health measure for a billing operation.Revenue per provider
What each provider generates against what they cost, whether employed or contracted.Days in receivables
How long money takes to arrive after the visit, which is usually longer than anyone expects.
Questions we are asked
Will you have access to patient information?
We work from financial records — deposits, remittance summaries, payroll and expenses — and we do not need clinical detail to do that. Where any document does contain patient information, it is handled under whatever agreement your practice requires. We will discuss what is needed, and what is not, before anything is shared.
Do you handle medical billing or claim submission?
No. Billing and claim submission are a separate specialty and stay with your billing service or in-house team. Our work begins where the money does: reconciling what arrives against what was expected, and reporting on the result.
Start with a conversation
Let's look at your books together
Tell us about your church or business and where your bookkeeping stands. Carey will follow up to arrange a consultation, and you'll receive a written scope before any work begins.