Medical practices & clinics
Books and taxes for dermatology practices.
Insurance-covered skin checks, cash-pay Botox and filler, retail skincare, and biopsies sent out to pathology. 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
May came in at $37,100. Cosmetic revenue carried the month again, so I kept it apart from the medical visit deposits to show you the real split.
- Availity batch depositMedical visit reimbursements
- Cosmetic injectable paymentsCosmetic service revenue
- SkinCeuticals orderRetail skincare inventory
- Dermpath DiagnosticsPathology lab fees
- Clinical staff payrollClinical wages
Why your books are different
A dermatology practice's books go wrong where medical meets cosmetic.
You are running two practices under one roof: an insurance-billed medical side and a cash-pay cosmetic side. A generalist blends both into one revenue number, and you cannot tell whether Botox is actually carrying the medical side or the other way around.
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1
Medical and cosmetic revenue get blended together
A skin cancer screening billed to insurance and a Botox appointment paid in cash both land in the same bank account, but they run on completely different margins and payment timing.
What we doKeeps medical visit revenue and cosmetic service revenue in separate lines, so you can see which side of the practice is actually driving the month. -
2
Biopsy pathology fees arrive weeks after the visit
A suspicious mole biopsied in the office gets sent to a dermatopathology lab, and the lab's bill often lands weeks after the original visit, disconnected from the appointment that caused it.
What we doKeeps pathology lab fees in their own line so a batch of biopsy bills doesn't read as an unexplained cost spike. -
3
Retail skincare sales blend into treatment revenue
A tube of prescription-strength retinol or a bottle of vitamin C serum sold at checkout carries retail margin, not medical margin, and lumped with visit fees it hides which one is actually padding the bottom line.
What we doKeeps retail skincare sales apart from visit and procedure revenue so the real margin on each stays visible. -
4
Injectable package deals get spent before they're delivered
A patient who prepays for a series of laser sessions or a bank of Botox units hands you the money up front, but the treatments happen over months. Booked as one month's income, it hides what is still owed in future sessions.
What we doKeeps prepaid package revenue visible as its own line, separate from single visits, so a big package sale does not overstate one month.
Your categories
The categories Gus keeps for a dermatology practice.
Set up once for how the medical and cosmetic sides both get paid. You never pick a category. He does, and an accountant checks it.
Money in
- Medical visit reimbursementsDeposits from payers for skin checks, biopsies, and medical treatment.
- Cosmetic service revenueCash-pay Botox, filler, laser, and other elective procedures.
- Prepaid treatment packagesSeries of sessions paid up front, kept apart from single visits.
- Retail skincare salesPrescription-strength and over-the-counter products sold at checkout.
- Manufacturer rebate creditsLoyalty or purchasing rebates from injectable manufacturers, tracked apart from patient revenue.
Money out
- Retail skincare inventoryProduct stock from lines such as SkinCeuticals or Obagi.
- Pathology lab feesBiopsy readings sent to an outside dermatopathology lab.
- Injectable and filler product costsBotox, filler, and similar products purchased from the manufacturer.
- Clinical wagesNurses, estheticians, and injectors, kept apart from provider compensation.
- Laser and treatment equipmentDevices used for cosmetic procedures, logged so they get written off right.
- Rent and utilitiesThe office space, including cosmetic treatment rooms.
- Malpractice insuranceAnnual or quarterly premiums for the practicing physicians.
What we watch for you
- Cosmetic revenue share
How much of each month is cash-pay cosmetic work versus insurance-billed medical care.
- Retail margin
What skincare product sales bring in against what they cost, kept apart from treatment revenue.
- Package revenue owed
How much prepaid package money still represents sessions not yet delivered.
- The set-aside
What you will owe, tracked every month, so April is a number you already knew.
Ask Gus
Things dermatologists 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.
I keep cosmetic revenue apart from medical visit reimbursements, so you can see the split for yourself instead of guessing from the total.
It can be, biopsy readings often bill weeks after the visit that caused them. I keep them in their own line so a batch doesn't read as an unexplained spike.
As a prepaid package, kept apart from single visits, so the full payment doesn't inflate this month when five sessions are still owed.
The tax side
The tax side of a dermatology practice.
Most of what matters here is separating medical from cosmetic revenue 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 dermatology 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.
- Laser and cosmetic equipmentLaser and cosmetic treatment devices can usually be written off the year you buy them, with 100 percent bonus depreciation available for property acquired after January 19, 2025.
- Injectable and skincare inventoryThe cost of injectable products and retail skincare inventory is generally tracked as the cost of what you sell, separate from your other operating expenses.
- Contract or covering dermatologistsA dermatologist covering your practice 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 dermatology practices miss
Your bookkeeper knows what to look for in your statements. You never have to.
- Pathology lab fees
- Laser equipment maintenance
- Injectable product costs
- Malpractice premiums
- CME courses and travel
- Board certification renewal
- Retail product samples
- Practice management software
- Scrubs and clinical apparel
- Cosmetic treatment room supplies
- Marketing for cosmetic services
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 dermatology year, kept every month.
Medical visits, cosmetic bookings, and pathology bills each move on their own rhythm. Your taxes come on a fixed 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.
- January
Plan the year
Last year's return gets started, and you get a monthly set-aside so April is already handled, even with the medical and cosmetic sides moving differently.
- 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 whether cosmetic bookings or medical visit volume changed the number.
- October
Before year end
Gus looks at equipment worth buying and anything worth doing before December, while cosmetic bookings often pick up ahead of the holidays.
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 dermatology 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 dermatologists ask first.
Do you bill insurance for the medical side of the practice?
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.
Can you show us the actual split between medical and cosmetic revenue?
Yes. Gus keeps the two in separate lines from the deposits themselves, so the split is visible without anyone guessing.
We get manufacturer rebate credits for buying injectables in bulk. How does that get booked?
As its own category, apart from patient revenue, so it doesn't get confused with what patients actually paid for their treatments.
Do I owe sales tax on the skincare products I sell?
Retail skincare products are often subject to state sales tax even though the medical visit is not. Gus keeps retail sales in their own line so the accountant can confirm what applies to you.
A patient prepaid for a package and never came back to finish it. What happens to that money?
Gus keeps prepaid package revenue tracked separately from earned revenue. What to do about an unused package is a policy call for you and your accountant, not something Gus decides.
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