Bookkeeping and Controller Support for Medical Practices in Dallas

Where medical practice books usually go wrong

Most practices come to us with books that are current but not trustworthy. The bookkeeping was done, yet the owner cannot tell what the practice actually collected, what each provider costs, or why the bank balance disagrees with the profit report. The same problems show up again and again:

• Lump-sum insurance deposits. A payer sends one electronic payment covering dozens of claims, so the deposit matches no single visit and gets posted as generic income.
• Card deposits recorded net of fees. Processing fees disappear, which understates both revenue and overhead.
• Charges treated as income. Revenue is booked from what the practice billed instead of what it collected, so the P&L looks better than the bank account.
• Patient refunds and credit balances posted as expenses, or not recorded at all.
• One payroll line for everyone. Dentists, physicians, therapists, hygienists and front-desk staff are lumped together, hiding the cost of each provider.
• Rent and fees between related companies recorded differently each month when the owners also hold the building or a management company.

How we reconcile insurance reimbursements and patient payments

1. Match every deposit to its source. Insurance payments are matched to remittance totals, card batches to the processor’s settlement report, and checks or cash to the deposit log.
2. Tie collections to the practice-management system. The month’s collections report from your practice software is compared with the deposits recorded in QuickBooks, and any gap is traced: timing, unposted payments, or payments applied to the wrong period.
3. Record fees and refunds where they belong. Card deposits are grossed up so processing fees show as an expense, and refunds of patient overpayments are recorded against revenue instead of buried in supplies or miscellaneous.
4. Reconcile every bank and card account. Operating, payroll and credit card accounts are reconciled monthly, so the balance sheet is something you can rely on.
5. Review before delivery. A senior team member reviews the close before the Executive Summary, Profit & Loss, Balance Sheet and Statement of Cash Flows go to you.

Practice-management software and QuickBooks: what lives where

We do not replace your billing team or your clinical software. Your practice-management or EHR system stays the record of charges and patient balances; QuickBooks Online becomes the record of cash, expenses and financial position. The work is keeping the two in agreement.

Monthly bookkeeping for a practice can usually run on summary reports, which limits how much patient-level detail anyone outside the office needs to see. Even so, ask any outside financial vendor how they handle protected health information and whether a business associate agreement is needed. HHS lists accounting among the services that can make a vendor a business associate under HIPAA when the work involves access to that information. LUCI works in secure cloud systems with multi-factor authentication, role-based access and encrypted file sharing.

Practices we work with

Provider payroll and reporting for medical offices

Payroll management is available as an add-on to any monthly engagement. For practices, that usually means recording pay by provider or role, calculating production- or collections-based compensation from the reports your practice software already produces, and keeping benefits and payroll taxes coded so you can see what each provider truly costs. Whether a provider should be paid as an employee or a contractor depends on the facts of the relationship, and your CPA or attorney should confirm it.

Reporting grows with the practice. The Core tier covers the monthly statements and a year-end package for your tax preparer. Growth adds quarterly review meetings, budget-to-actual and trend reporting. Scale adds a CFO-level partner, cash forecasting and a KPI dashboard; our article on what a fractional CFO does for a medical practice covers that level in detail. Practices that pay a related management company should also read how management fees between practice entities affect valuation.

Getting started is straightforward: a discovery call, a fixed-fee proposal based on transaction volume, accounts, payroll and reporting needs, then onboarding that typically takes two to four weeks. The first commitment is three months, then month-to-month.

What controller support covers for a practice

Bookkeeping records what happened. Controller support makes sure the monthly numbers are complete and right before the practice owner relies on them. For a medical or dental practice that usually means:

• Owning the monthly close on a set timeline, so the financial package arrives when it is still useful.
• Tying collections to the bank, so deposits from insurance payers and patients match what the practice-management system says was collected.
• Reviewing provider payroll coding and the expense side before statements go out.
• Budget-to-actual and KPI reporting on collections, overhead and payroll as a share of revenue.
• Approval and access controls, so the same person is not adding vendors, paying bills and reconciling the account.

See how this works across industries on our outsourced controller services page, or read what a controller does for a medical or dental practice.