Bookkeeping for medical practices and healthcare offices
ERA/EOB payments reconciled to your bank deposits, insurance reimbursement lag tracked by payer, contractual adjustments separated from bad debt, provider compensation reconciled monthly, and a payer-mix P&L — so you see collections by payer category and know exactly where revenue is being written off.
We work with medical practices and healthcare offices on ERA/EOB reconciliation, insurance reimbursement tracking, provider compensation accuracy, and books that show you payer-mix performance and write-off rates every month. We coordinate with your CPA on tax filings. Austin, TX.
QuickBooks Online · Gusto · Ramp — professional liability insured — month-to-month, 30-day notice
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Medical practices don't run on invoices — they run on reimbursement cycles, contractual write-offs, and payer mix. ERA/EOB reconciliation, reimbursement lag, and provider compensation accuracy are where your books either give you management data or just report history. Most bookkeepers have never touched any of it.
What changes with TurnkeyCFO
Every service below is built for how medical practices actually operate — reimbursement cycles, provider compensation, and insurance payer relationships.
Accurate categorization of insurance reimbursements, patient payments, contractual adjustments, provider compensation, and all operating expenses. Full monthly close with P&L, balance sheet, and commentary — with a payer-mix breakout so you know which payers are performing and which are eroding collections.
Every ERA payment matched to the corresponding bank deposit and reconciled against claims billed. Underpayments, recoupments, and lagged payments surfaced by payer and date — so you catch the commercial payer that's paying 45 days late and the government payer that clawed back a payment without notice.
Provider salary, wRVU-based bonus, and owner distributions reconciled to payroll and documented monthly. Each provider's total compensation tracked separately so your books support the calculation if ever reviewed under fair market value standards — and so your CPA has clean data for Schedule K-1 or W-2 treatment at year-end.
Credentialing fees, DEA registration, state medical license renewals, malpractice insurance premiums, and hospital privileging costs tracked by provider and renewal date. Know what credentialing costs per FTE, and never miss a renewal that could interrupt your ability to bill a payer.
Patient overpayments create a refund liability — not income. We track your patient credit balance monthly by aging bucket, flag balances due for refund under your policy, and ensure they never flow through revenue. Keeps your collections reporting clean and your compliance posture defensible.
Medical supplies categorized by type — physician-preference implants and devices (high-cost, patient-specific), general consumables (exam gloves, syringes, wound care), and capital equipment. Gives you the cost granularity to see which supply categories are rising and where contract renegotiation makes sense.
Revenue, contractual adjustments, bad debt, and net collections reported by payer category — Medicare, Medicaid, commercial, and self-pay broken out separately. Know your effective reimbursement rate by payer and where write-offs are concentrated before your billing company tells you to renegotiate your contracts.
Tax filings and legal matters — coordinated with your CPA or attorney. TurnkeyCFO does not provide tax or legal advice; we keep your books filing-ready and support the process end-to-end.
The day-to-day realities most bookkeepers have never touched. We have.
Claims submitted today won't pay for 14–45 days — sometimes longer.
Insurance payers have processing windows ranging from two weeks (commercial, electronic claims) to 45+ days (Medicaid, certain Medicare Advantage plans). We track outstanding claims as receivables by payer and aging bucket so you can see the true cash conversion cycle — not just what hit the bank this month — and forecast cash accurately.
Two very different write-offs that most books treat the same way.
A contractual adjustment is revenue you agreed to forgo under a payer contract — expected, not a failure. Bad debt is a patient balance you billed correctly but couldn't collect — a failure mode worth tracking. Mixing them overstates bad debt, distorts your true collection rate, and hides whether your payer contracts are performing. We separate them by payer and report both every month.
Work RVU-based pay is precise by design — your books should match.
If your practice compensates providers based on wRVUs, the monthly calculation involves productivity reports, guarantee thresholds, bonus tiers, and sometimes retroactive adjustments. We reconcile the monthly wRVU report to payroll, document the calculation in the books, and flag variances so compensation is accurate — and defensible if reviewed against fair market value benchmarks.
Overpayments are a liability — not a windfall — and most payers require timely refunds.
Commercial payer contracts and Medicare conditions of participation require refunds of patient overpayments within defined windows (typically 60–120 days). Patient credit balances that sit unaddressed are both a compliance risk and a balance sheet misrepresentation. We track the liability monthly, flag aged balances, and ensure your P&L never treats overpayments as income.
Credentialing is a recurring cost — and a gap in credentialing means a gap in billing.
DEA registration, state medical licenses, malpractice insurance, hospital privileges, and payer panel applications each have fees and renewal cycles. We track these costs per provider with renewal dates so nothing lapses unnoticed — and so you know the true administrative cost per FTE when evaluating new hires or practice expansion.
Your financial data and your patient data are two different things — we work with the former.
Our bookkeeping workflow uses aggregate ERA/EOB summary reports, practice management export summaries, deposit batches, and payroll data — not individual patient records. No PHI flows through QuickBooks. All platform access is role-scoped, credential-secured, and limited to financial data. Professional liability insurance maintained. We coordinate with your compliance officer if workflow questions arise.
Simple, fast, and designed to work around your clinical schedule.
We learn your payer mix, practice management software, provider compensation structure, and where the books are currently breaking down — so we set up right the first time.
Revenue by payer category, contractual adjustment accounts, bad debt, patient credit balance liability, provider compensation, and credentialing expense — all built before we touch a transaction.
Full close every month with ERA/EOB reconciliation, payer-mix collections breakout, write-off rate analysis, and cash flow forecast — so you're managing with data, not calling the billing company every week.
No — we work alongside your CPA. We keep books clean and filing-ready year-round so your CPA can file without a month of cleanup. If you need a CPA who specializes in medical practices, we can refer one.
An ERA is the payer's explanation of how they processed a claim — what they paid, adjusted, and left to the patient. We reconcile ERA payments to your bank deposits and match them against billed charges so you can see underpayments, denials, and lag by payer — rather than discovering problems weeks later.
A contractual adjustment is the discount you agreed to under a payer contract — expected and not collectible. Bad debt is a patient balance you billed correctly but cannot collect. Mixing them overstates bad debt and hides payer-specific performance. We track them separately every month.
Yes. We reconcile monthly wRVU reports to payroll and document the calculation for each provider — useful for internal accuracy and for supporting the compensation structure if reviewed under fair market value standards.
Patient credit balances are a liability — you owe the patient a refund or must apply the credit to a future visit. They should never be recognized as income. We track the liability monthly and flag balances aging past your practice's refund policy.
We work with aggregate financial outputs — ERA/EOB summary reports, deposit batches, and provider productivity summaries — that contain no PHI. All platform access is role-scoped per QuickBooks Online, Gusto, and Ramp security standards. Professional liability insurance maintained.
Everything lives in QuickBooks Online, Gusto, and Ramp — enterprise-grade platforms with role-scoped access. Credentials are never shared by email and we maintain professional liability insurance.
Month-to-month, 30-day notice. No multi-year contracts. We keep clients because the work is good, not because the paperwork traps them.
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