Dental

Books and taxes for dental sleep medicine practices.

Medicare and medical insurance payments that arrive weeks late, patient copays, appliance lab bills, and the physicians who refer nearly every patient. Gus sorts every deposit, an accountant checks every transaction, and you get one number each month.

Book a call What we handle
  • From $197 a month
  • An accountant on every transaction
  • Cancel whenever
DecemberExample month
$12,900
what you made

December made $12,900. Medicare's DME payment landed about six weeks after the claim was filed, same as usual, and I kept the appliance lab bill apart from your general dental supplies.

  • Medicare Part B paymentMedicare DME payments
  • Patient copayPatient copays and cash
  • Appliance lab invoiceOral appliance fabrication
  • Billing support service feeBilling support services
  • Sleep physician referral mailersReferral outreach
Money in$38,000
Money out$25,100
Set aside for taxes$2,800
An example month. Yours will have your numbers.

Why your books are different

A sleep medicine practice's books go wrong in four familiar places.

This is medical billing, not a dental PPO claim, and almost every patient arrives through a sleep physician, not an ad. A generalist bookkeeper who does not know that misreads the timing and the source of nearly everything.

  1. 1

    This is medical billing, not dental insurance

    Oral appliances for sleep apnea are billed to medical insurance and Medicare as durable medical equipment, not run through a dental PPO or HMO plan. A generalist bookkeeper who treats every deposit like a dental claim misreads the whole revenue pattern.

    What we doTracks medical and Medicare DME payments as their own category, on their own timeline, separate from any dental-coded income the practice also has.
  2. 2

    Prior authorization delays payment for weeks

    A medical insurance claim for a sleep appliance often needs prior authorization before it is even submitted, so payment can land six to eight weeks after the appliance was delivered, much slower than dental claims.

    What we doTracks how long payments are taking to land, so a slow month reads as a timing lag, not a drop in patients.
  3. 3

    The appliance lab bill is not a dental lab bill

    A custom oral appliance from a sleep medicine lab is priced and billed completely differently than a crown or denture lab bill, but a generalist bookkeeper often lumps all lab costs together.

    What we doKeeps sleep appliance fabrication costs in their own category, apart from any other lab work the practice does.
  4. 4

    Physician referral relationships look like nothing on a bank statement

    Almost every new patient comes from a sleep physician or an ENT, not an ad, but a generalist bookkeeper looking for marketing spend to explain new patients misses where the practice's business actually comes from.

    What we doKeeps physician referral outreach costs in their own place instead of guessing they belong to general marketing.

Your categories

The categories Gus keeps for a dental sleep medicine practice.

Set up once for how the practice gets paid and what it spends. You never pick a category. He does, and an accountant checks it.

Money in

  • Medicare DME paymentsMedicare Part B reimbursement for oral appliances, on its own slower timeline.
  • Medical insurance paymentsPrivate medical insurance reimbursement for sleep appliances, billed as durable medical equipment.
  • Patient copays and cash payWhat patients pay directly at delivery or fitting.
  • Patient financingCareCredit payouts for the patient's share of the appliance cost, net of the fee.

Money out

  • Oral appliance fabricationCustom sleep appliances made by a dental sleep medicine lab.
  • Billing support servicesAn outside service that handles medical insurance and Medicare prior authorization paperwork.
  • Clinical suppliesImpression materials and fitting supplies for appliances.
  • Referral outreachMaterials and visits aimed at the sleep physicians and ENTs who refer patients.
  • Practice software subscriptionsScheduling and billing software built for medical claims.
  • Sterilization suppliesAutoclave supplies and biohazard pickup.

What we watch for you

  • Claim turnaround time

    How long Medicare and medical insurance payments are taking to land, since it moves separately from patient volume.

  • Referral volume

    How many new patients came in from sleep physicians and ENTs, the main driver of the practice.

  • Appliance cost share

    Lab fabrication costs against collections, since appliance pricing varies by case.

  • The set-aside

    What you owe even while Medicare and medical claims lag, tracked so April holds no surprise.

Ask Gus

Things dental sleep medicine 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.

Why did this month look slow when I fit just as many appliances as last month?

A batch of Medicare payments is still working through prior authorization. I checked the timing and it lines up with normal claim delays, not fewer patients.

How do you tell the difference between Medicare and private medical insurance payments?

I keep them in separate categories since they move on different timelines and rates. Both are still medical billing, not a dental PPO or HMO claim, so neither gets mixed in with dental-style categories.

Should I hire a billing service to handle prior authorizations?

I can show you what you are spending now on delays and any current billing help, but whether hiring a service pays for itself is above my pay grade. The accountant can help you run the numbers.

The tax side

The tax side of a dental sleep medicine practice.

Most of what goes wrong here is timing, not the rules themselves. Medicare and medical claims land slower than a dental claim ever does.

What your return has to get right

Your accountant signs it, so it gets done right the first time.

  • Equipment for fitting and imagingA sleep study or imaging device used in the practice can usually be written off the year you buy it. Bonus depreciation is 100 percent for property bought after January 19, 2025.
  • Medicare and medical claim timingMedicare and medical insurance payments often land weeks after a dental claim would. That affects when cash arrives, not whether the income is taxable once it does.
  • Contractor 1099sA billing service or a relief provider paid $2,000 or more in 2026 who is not on payroll gets a 1099-NEC by January 31.
  • The pass-through deductionMost owners can take up to 20 percent of profit off their taxable income. It works differently for personal-service practices like a dental sleep medicine office as income climbs.

Deductions dental sleep medicine practices miss

Your bookkeeper knows what to look for in your statements. You never have to.

  • Oral appliance fabrication costs
  • Impression and fitting materials
  • Billing support services
  • Malpractice insurance
  • Continuing education
  • Sleep medicine association dues
  • Physician referral outreach
  • Practice software subscriptions
  • Sterilization supplies
  • Credit card processing fees

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 dental sleep medicine year, kept every month.

Medicare and medical claims move on their own slow clock. Your taxes move on the calendar's schedule. Your team keeps you ahead of both. Every month in between, your bookkeeper closes the books and speaks up the moment something looks off.

  1. January

    Plan the year

    Last year's return gets started, the contractor list for any billing service is ready, and a monthly set-aside begins so April is not a scramble.

  2. April

    Filed and signed

    Your business return is filed. Because the set-aside has been running since January, the number due holds no surprise, even with slow-paying claims behind it.

  3. July

    Midyear read

    A look at where the practice stands, what you will owe, and whether physician referrals are keeping pace with the rest of the year.

  4. October

    Before the slow stretch

    Referral volume from physicians can dip around the holidays. Before that hits, Gus flags equipment worth buying and anything worth doing before December.

What you get

Starts at$197a month

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 dental sleep 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 dental sleep medicine owners ask first.

How is this different from how a dentist's office handles insurance?

Sleep appliances are billed to medical insurance and Medicare as durable medical equipment, not through a dental PPO or HMO plan. Gus tracks that income and its slower timeline separately from any dental-coded work the practice does.

Why does it take so long for Medicare to pay for an appliance?

Prior authorization has to clear before a claim is even submitted, so payment can land six to eight weeks after delivery. Gus tracks that lag so a slow-looking month reads correctly.

Almost all my patients come from sleep physicians, not marketing. Does that matter for the books?

It does not change how the books are kept, but Gus keeps physician referral outreach costs in their own category instead of lumping them into general marketing, so you can see what that relationship actually costs.

Do you handle the medical billing or prior authorization paperwork?

No. Gus works from your bank statement and keeps the books, he does not submit claims or handle prior authorizations. If you use a billing service for that, its cost shows up as its own expense category.

My books are behind since I added a second appliance lab. Can Gus catch up?

Yes. Send the statements from that period. Gus works through the backlog against both labs' invoices, and the accountant reviews it once it is settled.

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 dental

We keep books for the business next door too.

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