Medical practices & clinics
Books and taxes for concierge medicine practices.
A yearly retainer paid up front, insurance reimbursements for the visits themselves, and a national affiliation fee coming out the other side. 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
December came in at $37,300. Retainer renewals ran heavy this month, so I kept them tagged as prepaid membership rather than one month's income.
- Retainer renewal batchAnnual retainer fees
- Anthem payoutInsurance visit reimbursements
- SignatureMD affiliation feeAffiliation and licensing fees
- Executive health lab panelLab and screening costs
- Suite lease, floor 6Rent
Why your books are different
A concierge practice's books go wrong where the retainer meets the insurance side.
You are running two businesses in one: a retainer relationship with a capped panel, and an insurance-billed practice underneath it. A generalist blends the two, and you lose sight of whether the retainer is actually paying for the extra access it promises.
-
1
A year's retainer lands in one renewal month
Most concierge patients renew their retainer once a year, often in the same season. A $2,800 annual fee from three hundred patients hitting in the same month makes that month look enormous and the rest of the year look thin by comparison.
What we doKeeps retainer revenue tagged as prepaid membership so the renewal spike does not drown out how the practice is doing month to month. -
2
The affiliation fee gets missed as a real cost
National concierge networks such as SignatureMD or Specialdocs charge the practice a per-patient affiliation fee for marketing, the patient portal, and the brand. Left unlabeled, it looks like a vague software bill instead of the cost of the model itself.
What we doKeeps the affiliation fee in its own line so you can see it against retainer revenue and know the relationship is worth it. -
3
Executive physicals blur two kinds of revenue
An extended annual physical often includes services billed to insurance and services the retainer already covers. Lumped together, you cannot tell what insurance actually reimbursed versus what came from the retainer.
What we doKeeps insurance-reimbursed visit revenue apart from retainer-covered services so both sides of the model stay visible. -
4
A capped panel hides shrinking margin
Concierge practices deliberately cap the patient panel, so a few non-renewals can shrink revenue without the practice noticing until the next renewal season.
What we doTracks retainer revenue against the prior renewal cycle so a shrinking panel shows up before the next renewal season, not after.
Your categories
The categories Gus keeps for a concierge medicine practice.
Set up once for how your retainer and your insurance side both get paid. You never pick a category. He does, and an accountant checks it.
Money in
- Annual retainer feesThe membership fee patients pay for extended access, same-day visits, and direct contact.
- Insurance visit reimbursementsWhat payers such as Anthem, Aetna, or Medicare deposit for the visits themselves.
- Executive physical feesExtended annual physicals, split between what insurance covered and what the retainer covered.
- Patient copaysCollected at the visit alongside whatever the retainer already covers.
Money out
- Affiliation and licensing feesSignatureMD, Specialdocs, or a similar national concierge network fee, usually per patient.
- Lab and screening costsExtended lab panels and screenings used in executive physicals.
- Rent for an upgraded suiteConcierge practices often carry nicer, larger space than a standard panel supports.
- Front desk and clinical staff wagesKept apart from provider pay so labor cost stays visible.
- Marketing to a smaller, targeted panelReferral events, direct mail, and the concierge network's own marketing charges.
- Malpractice insuranceAnnual or quarterly premiums for the practicing physician.
- Practice management and EHR softwareathenahealth, DrChrono, or whatever runs scheduling and charting.
What we watch for you
- Retainer renewal rate
What share of last cycle's retainer revenue came back this cycle, tracked from deposits alone.
- Revenue per patient
Total retainer and visit revenue divided by panel size, the number that justifies staying capped.
- Affiliation fee share
What the national network costs against what the retainer brings in, worth knowing before a renewal decision.
- The set-aside
What you will owe, tracked every month, so April is a number you already knew.
Ask Gus
Things concierge medicine doctors 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.
No, but I keep it tagged as retainer revenue rather than a normal month of visits, so your year-round numbers still make sense side by side.
I keep it as its own line against what your retainer brings in each cycle, so you can see the ratio for yourself. What to do about it is a business call, not mine.
If she bills you directly and sets her own schedule, that usually points to a contractor, and she gets a 1099-NEC if you pay her $2,000 or more this year. I flagged it for the accountant to confirm.
The tax side
The tax side of a concierge medicine practice.
Most of what matters here is keeping retainer and insurance revenue straight 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 outA medical practice 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.
- Retainer revenue timingA retainer collected up front for a year of enhanced access is still income when received, but keeping it labeled clearly helps the accountant match it to the right period when the return is prepared.
- Covering physician payA physician who covers your panel occasionally and 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.
- Screening equipment purchasesEquipment used for executive physicals, such as advanced cardiac screening tools, can usually be written off the year you buy it, with 100 percent bonus depreciation available for property acquired after January 19, 2025.
Deductions concierge medicine practices miss
Your bookkeeper knows what to look for in your statements. You never have to.
- National network affiliation fees
- Extended physical lab panels
- Malpractice premiums
- Practice management software
- CME courses and travel
- Board certification renewal
- Marketing to a capped panel
- Upgraded suite rent
- Concierge patient portal fees
- Screening equipment maintenance
- Scrubs and clinical apparel
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
A concierge medicine year, kept every month.
Your retainer cycle runs on its own calendar. Your taxes run on another. 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, any covering physician's 1099 is ready, and you get a monthly set-aside so April is already handled.
- 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 retainer renewal cycle changed the number.
- October
Before renewal season
Many practices renew retainers around year end. Gus looks at equipment worth buying and anything worth doing before December.
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 concierge medicine practices. 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 concierge medicine doctors ask first.
Do you bill insurance for the visits themselves?
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.
My retainer renews once a year in one big batch. Does that mess up my books?
No. Gus keeps a renewal batch tagged as retainer revenue rather than a normal month of visits, so the surrounding months still read clearly.
Do I separate the network affiliation fee from other software costs?
Yes. Gus keeps it in its own line so you can see it against what the retainer brings in, rather than buried with your EHR and other subscriptions.
My panel is capped at 500 patients. Does that change how you keep the books?
Not the mechanics, but Gus tracks revenue per patient and renewal rate, which matter more to a capped panel than raw visit volume does.
How does Gus handle the mix of retainer and insurance-reimbursed visits in the same appointment?
He keeps retainer revenue and insurance-reimbursed revenue in separate lines, based on what actually lands in the bank from each source, so neither one hides inside the other.
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.
More in medical practices & clinics
We keep books for the business next door too.
- Compounding pharmacies
- Durable medical equipment (DME) suppliers
- Elective 3D/4D ultrasound studios
- Independent pharmacies
- Medical billing companies
- Mobile nursing & concierge nurse services
- Mobile phlebotomy services
- Mobile x-ray & ultrasound services
- Occupational health & DOT physical clinics
- Orthotics & prosthetics providers
- Sleep clinics
- Wound care clinics
- Allergy clinics
- Audiology & hearing aid centers
- Direct primary care (DPC) practices
- Independent eyewear boutiques
- Naturopathic doctors
- Occupational therapy practices
- Pediatric therapy clinics
- Podiatrists
- Speech therapy practices
- Sports medicine clinics
- Tattoo removal clinics
- Fertility clinics
- Functional medicine practices
- Independent urgent care clinics
- Optometrists
- Pain management clinics
- Private practice physical therapy
- Regenerative medicine clinics
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