Medical practices & clinics
Books and taxes for allergy clinics.
Insurance-billed allergy shots, cash-pay sublingual drops, custom serum mixed per patient, and pollen seasons that double your testing volume. Gus sorts all of it, an accountant checks every transaction, and you get one number a month.
- From $197 a month
- An accountant on every transaction
- Cancel whenever
April came in at $18,700. Spring pollen season doubled our testing visits, and a fresh batch of custom serum for six patients landed, so I kept that cost tied to this month, not smoothed out.
- Availity batch depositInsurance visit reimbursements
- Custom serum compounding batchSerum compounding costs
- Sublingual drop program feesCash-pay immunotherapy revenue
- Skin prick test suppliesAllergy testing supplies
- Clinical staff payrollClinical wages
Why your books are different
An allergy clinic's books go wrong across a treatment plan that runs for years.
A patient on immunotherapy might come in weekly for shots over three to five years, mixed with pollen seasons that swing testing volume hard and a custom serum cost that varies patient by patient. A generalist treats it like a normal visit-based practice and loses the pattern entirely.
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1
Custom serum costs vary by patient and by batch
Each patient's immunotherapy serum is mixed specifically to their test results, and a batch of new serum for several patients can be one of the largest single costs of the month, landing irregularly rather than steadily.
What we doKeeps serum compounding costs in their own line, tied to the month a batch was mixed, so it reads as a real, if irregular, cost rather than a mystery spike. -
2
Insurance-billed shots and cash-pay drops get blended
A weekly allergy shot billed to insurance and a sublingual drop program paid directly by the patient are two different treatment paths with different margins, and blended together you cannot tell which one patients are actually choosing.
What we doKeeps insurance-billed immunotherapy and cash-pay sublingual programs in separate lines, so the real mix between the two is visible. -
3
Pollen season swings look like inconsistency
Testing volume can double in spring and fall pollen seasons and drop off in the quieter months, and without that pattern tracked, a slow winter month can look like the clinic is struggling.
What we doTracks testing and visit revenue against the same season last year, so a normal seasonal swing reads as a pattern, not a problem. -
4
A multi-year treatment plan hides whether it's actually profitable
An immunotherapy patient may be worth more over three years than a single visit ever shows, but the books rarely track a treatment plan's revenue over its full length.
What we doTracks recurring immunotherapy revenue by patient over time where the bank data allows it, so a long treatment plan's real value becomes visible.
Your categories
The categories Gus keeps for an allergy clinic.
Set up once for how testing, shots, and drop programs all get paid. You never pick a category. He does, and an accountant checks it.
Money in
- Insurance visit reimbursementsDeposits from payers for testing and immunotherapy shots.
- Cash-pay immunotherapy revenueSublingual drop programs and other treatment paid directly by patients.
- Allergy testing feesSkin prick and blood panel testing, kept apart from ongoing treatment.
- Food allergy panel feesSpecialty testing for food sensitivities and allergies.
Money out
- Serum compounding costsCustom immunotherapy serum mixed per patient's test results.
- Allergy testing suppliesSkin prick trays, extracts, and panel testing materials.
- Clinical wagesNurses and clinical staff who administer shots and run testing.
- Rent and utilitiesThe clinic space, including observation areas for shot reactions.
- Malpractice insuranceAnnual or quarterly premiums for the practicing physicians.
- Practice management softwareScheduling, charting, and billing tools.
- Emergency suppliesEpinephrine and reaction monitoring equipment kept on hand.
What we watch for you
- Serum cost per batch
What compounding custom serum costs, tracked against immunotherapy revenue for the same period.
- Cash versus insurance share
How much comes from cash-pay drop programs versus insurance-billed shots.
- Seasonal testing volume
How this pollen season compares to the same season last year.
- The set-aside
What you will owe, tracked every month, so April is a number you already knew.
Ask Gus
Things allergy clinic owners ask Gus.
Text him like you would text anybody. He answers in plain English, and when a question is above his pay grade, an accountant looks and gets back to you.
Probably not, a batch for several patients landed at once. I keep that cost tied to the month it happened so it reads as a real cost, not a random spike.
I keep the two revenue lines apart, so you can watch that mix shift over time instead of guessing from the total.
I track testing volume against the same season last year, and a winter dip next to a spring and fall spike is a normal pattern here, not a sign of trouble.
The tax side
The tax side of an allergy clinic.
Most of what matters here is treating serum and testing costs correctly and knowing where the pass-through deduction starts to phase out.
What your return has to get right
Your accountant signs it, so it gets done right the first time.
- The pass-through deduction phases outAn allergy clinic can lose part or all of the 20 percent pass-through deduction once taxable income passes $201,750 single or $403,500 joint, since medical practices are a specified service trade.
- Serum and testing costsCustom serum compounding and testing supplies are generally deductible as ordinary business expenses in the year they are purchased or used.
- Testing equipment purchasesLarger testing equipment can usually be written off the year you buy it, with 100 percent bonus depreciation available for property acquired after January 19, 2025.
- Contract or covering allergistsAn allergist covering your clinic occasionally who bills you directly is often a contractor and gets a 1099-NEC if you pay them $2,000 or more in 2026, due January 31.
Deductions allergy clinics miss
Your bookkeeper knows what to look for in your statements. You never have to.
- Serum compounding costs
- Allergy testing supplies
- Emergency reaction supplies
- Malpractice premiums
- Practice management software
- CME courses and travel
- License and board renewal fees
- Scrubs and clinical apparel
- Patient education materials
- Answering and scheduling service
General information about 2026 federal rules, not advice for your business. Your accountant looks at your actual numbers before anything gets filed.
All year, not just April
An allergy clinic year, kept every month.
Pollen seasons and multi-year treatment plans run on their own rhythm. Your taxes run on a fixed one. Your team keeps you ahead of both. Every month in between, your bookkeeper closes the books and speaks up the moment something looks off.
- January
Plan the year
Last year's return gets started, and you get a monthly set-aside so April is already handled, ahead of the spring pollen rush.
- April
Filed. Done.
Your return is filed and signed. No surprise bill, because the set-aside has been running since January.
- July
Halfway check
Where you stand, what you will owe, and how the spring pollen season's testing volume compared to last year.
- October
Before year end
Gus looks at anything worth doing before December, right as fall pollen season brings another wave of testing volume.
What you get
What you pay depends on what your business needs, and it does not move after that, busy season or slow. No hourly bills, no surprise invoices, no setup fee.
Book a call- Monthly bookkeeping
Every transaction sorted into categories set up for allergy clinics. You never categorize a thing.
- An accountant checks every transaction
Real review, every month, before your books close. Not a spot check.
- Your business tax return, filed
Prepared, reviewed, and signed by that same accountant every year.
- The monthly number
What you made, what you spent, what to set aside for taxes.
- Your own bookkeeper
A real person assigned to your business, in the app whenever you need them. No hold music.
- On your books all year
Every month, not just in April. Your team speaks up whenever something is worth your attention.
- Cancel any time
No contract. No cancellation call. Your books are yours.
Straight answers
Questions allergy clinic owners ask first.
Do you bill insurance for testing or immunotherapy shots?
No. Gus does not handle insurance billing, medical coding, or claims of any kind. Your practice management software or billing service still does that. Gus works from what actually lands in your bank account.
How do you handle the cost of custom serum for each patient?
It stays in its own line, tied to the month a batch was compounded, so a heavy compounding month reads as a real cost rather than an unexplained spike.
Can Gus tell me if patients are shifting toward sublingual drops instead of shots?
Yes, since cash-pay drop revenue and insurance-billed shot revenue are kept in separate lines, you can watch that mix shift over time.
Our testing volume swings hard between pollen seasons. Does that confuse the books?
No. Gus tracks testing revenue against the same season last year, so the swing reads as a normal pattern rather than a mystery.
Some patients have been on immunotherapy with us for three years. Is that tracked anywhere?
Where the bank data allows it, Gus tracks recurring revenue by patient over time, so a long treatment plan's real value becomes visible instead of disappearing into single visit totals.
Is a real accountant checking my books?
Yes. You get your own bookkeeper, Gus does the first pass on every transaction, and an accountant checks every one before your month closes. That same accountant prepares, signs, and files your business return. Goatkeeper is not a CPA firm, and we never pretend a person looked when they did not.
What does it cost, and can I cancel?
It starts at $197 a month, depending on what your business needs. No setup fee, no hourly bills, no contract. Cancel any time from the app, and your books go with you.
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What makes a bookkeeper worth paying for Every business we keep books for
Book a call
Pick a time. That's the whole signup.
Fifteen minutes with a real person on our team. They look at where your books are, tell you straight what it takes to get caught up, and get you set up on the spot if it fits.
- $197 a month to start
- An accountant on every transaction
- Cancel whenever