Mental & behavioral health
Books and taxes for eating disorder treatment programs.
A per-diem insurance payment for a client stepped down from residential to PHP, a dietitian's session fee billed apart from therapy, groceries for a supervised meal plan, and a medical consult. 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
October came in at $26,000. Three clients stepped down from PHP to IOP mid-month, so billing shifted rates partway through, and I noted where that happened.
- Insurance PHP billingPHP level billing
- Insurance IOP billingIOP level billing
- Dietitian payrollDietitian wages
- Grocery order, meal programMeal program costs
- Medical consult feeMedical services
Why your books are different
An eating disorder program's books go wrong around levels of care and the team.
A generalist sees a deposit and a payroll run. Your program bills different rates for PHP and IOP levels of care, pays a multidisciplinary team of therapists, dietitians, and medical staff, and runs a supervised meal program with real, ongoing food costs. When the books flatten all of that, the month misleads.
-
1
PHP and IOP billing rates get blended into one number
Partial hospitalization and intensive outpatient levels of care bill at very different rates, and a client stepping down mid-month shifts both the revenue and the cost of care without warning if the books do not track the change.
What we doKeeps PHP and IOP billing in separate lines so a step-down in level of care is visible, not buried in one blended number. -
2
The multidisciplinary team's pay looks like one large payroll line
A program running therapists, dietitians, and medical or nursing staff together often books it all as one payroll number, which hides what each discipline actually costs against the level of care it supports.
What we doKeeps therapist, dietitian, and medical staff wages in their own lines so the true cost of the team is visible by role. -
3
Supervised meal costs get mistaken for general overhead
A program running a supervised meal plan buys groceries and food regularly as part of clinical care, not as office overhead, and mixed with general expenses it is impossible to see what the meal program actually costs per client.
What we doKeeps meal program costs in their own line, separate from office supplies, so the real cost of that part of care is visible. -
4
Medical consult and lab costs come and go unevenly
Clients in eating disorder treatment often need periodic medical monitoring, and those consult and lab costs land irregularly, which can make an otherwise steady month look erratic.
What we doKeeps medical services in their own line and flags an irregular month as a monitoring cycle, not a budgeting problem.
Your categories
The categories Gus keeps for an eating disorder treatment program.
Set up once for how the program gets paid and what it spends. Nobody hand-sorts a category. Gus does, and an accountant checks it.
Money in
- PHP level billingInsurance payments for partial hospitalization level of care.
- IOP level billingInsurance payments for intensive outpatient level of care, tracked apart from PHP.
- Individual therapy billingStandalone therapy sessions outside the structured program.
- Private payFamilies paying directly for care insurance does not fully cover.
Money out
- Therapist wagesPay for the clinical therapy team, kept apart from dietitian and medical pay.
- Dietitian wagesPay for registered dietitians running the nutrition side of care.
- Medical servicesConsulting physician, nursing, or lab costs for medical monitoring.
- Meal program costsGroceries and food service for supervised meals, kept apart from office supplies.
- Facility costsRent, utilities, and maintenance for the program space.
- Malpractice insuranceCoverage for the full multidisciplinary clinical team.
What we watch for you
- Level-of-care mix
PHP versus IOP billing, so a client stepping down in care is visible in the numbers, not just the chart.
- Team cost by discipline
Therapist, dietitian, and medical wages against total billing, so staffing cost by role is visible.
- Meal cost per client
Meal program costs against active caseload, so a swing reads as census change, not overspending.
- The set-aside
What the program will owe, tracked every month, so April is a number already known.
Ask Gus
Things eating disorder program 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.
No. I keep PHP and IOP billing separate, so the shift shows up as a level-of-care change, not a confusing drop in revenue.
Your caseload needing more nutrition sessions grew too, so it tracked with billing, not against it. I keep dietitian pay in its own line so you can see that relationship clearly.
That is a real decision with cost and coverage trade-offs on both sides. I can show you what the per-consult arrangement has actually cost this year, and the accountant can help you weigh a change.
The tax side
The tax side of an eating disorder treatment program.
Most of what goes wrong here is labels: level-of-care billing blended together, and a multidisciplinary team's pay treated as one line instead of several.
What your return has to get right
Your accountant signs it, so it gets done right the first time.
- Worker classification for the clinical teamA therapist or dietitian who works set hours on the program's schedule is almost always an employee, not a contractor. A consulting physician paid per visit may be a legitimate contractor, but the line depends on the facts.
- Contractor 1099sAny consulting physician, supervisor, or contractor paid $2,000 or more in 2026 who is not on payroll gets a 1099-NEC by January 31.
- Payroll tax obligationsOnce staff are properly classified as employees, the program owes its share of payroll taxes and needs state unemployment insurance registration. Gus does not run payroll but keeps the books ready for whoever does.
- The pass-through deductionA program owner can often deduct up to 20 percent of profit before it is taxed, though as a personal-service clinical business, that benefit can shrink or disappear once income climbs past the threshold.
Deductions eating disorder treatment programs miss
Your bookkeeper knows what to look for in your statements. You never have to.
- Malpractice insurance for the team
- Dietitian certification and renewal fees
- Consulting physician fees
- Continuing education for staff
- Meal program groceries
- Program space rent
- EHR and scheduling software
- Background check fees for new hires
- Lab and medical monitoring costs
- Client education materials
- Professional association dues
- Business insurance beyond malpractice
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 eating disorder program's year, kept every month.
Census and level-of-care mix shift throughout the year more than the calendar does. Gus keeps the program ahead of both the numbers and the tax deadlines. 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 the monthly set-aside is planned around your typical level-of-care mix.
- April
Filed. Done.
The business return is filed and signed. No surprise bill, because the set-aside has been running since January.
- July
Halfway check
Where the program stands, what it will owe, and whether census shifts this year changed the number.
- October
Before year-end
Gus looks at any staffing or equipment moves worth making 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 eating disorder treatment programs. 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 eating disorder program owners ask first.
Can Gus separate PHP and IOP billing in our books?
Yes. They are kept in their own lines so a client stepping down or up in level of care is visible in the numbers.
Does Gus submit our insurance authorizations for each level of care?
No. Gus books the per-diem or session payment once insurance pays it. Submitting authorizations, coding, and claims stays with your billing team.
Does Gus track our meal program food costs separately from office expenses?
Yes. Meal program groceries and food service are kept in their own category, separate from general office supplies, so the real cost of that part of care is visible.
We use a consulting physician instead of an employed medical director. Is that a bookkeeping problem?
It is worth a look. Gus flags a consulting arrangement that resembles employment so you can talk through it with the accountant, but a genuine per-consult contractor is common and workable.
Our census swings a lot depending on referrals. Is that normal?
It is common in this field. Gus tracks the swing so a slow month reads as a census dip, not a financial problem, and a strong month does not get overbuilt on.
Our books have never separated level-of-care billing. Can that be fixed?
Yes. Share your billing history by level of care and Gus will re-sort past months to match, then keep PHP and IOP apart automatically going forward.
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 mental & behavioral health
We keep books for the business next door too.
- Neurofeedback clinics
- Psychological testing & assessment practices
- Child & adolescent therapy practices
- Sober living homes
- ABA therapy providers
- Couples & marriage counselors
- Group therapy practices
- Ketamine clinics
- Psychiatry practices
- Solo private practice therapists
- TMS clinics
- Intensive outpatient programs (IOP)
- Addiction treatment centers
- 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
- Birth doulas
- Breathwork facilitators
- Dental labs
- Dental sleep medicine practices
- Denturists & denture 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