Medical practices & clinics
Books and taxes for fertility clinics.
Multi-cycle packages with a refund guarantee, embryo storage fees that recur for years, donor egg costs passed through, and coverage that looks nothing alike from state to state. 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
March came in at $63,700. One multi-cycle package patient didn't achieve a pregnancy and requested her partial refund, so I tracked that against the original package revenue instead of the current month.
- Multi-cycle package enrollmentMulti-cycle package revenue
- Availity batch depositInsurance cycle reimbursements
- Donor egg agency paymentDonor and third-party costs
- Embryo storage annual feesCryopreservation storage revenue
- Clinical and lab staff payrollClinical wages
Why your books are different
A fertility clinic's books go wrong around the multi-cycle package and the long tail of storage.
A single patient relationship can span a multi-cycle package with a refund guarantee, donor costs passed through to an agency, and embryo storage fees that keep coming in for years after treatment ends. A generalist has no framework for any of that.
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1
Multi-cycle packages carry a refund risk
A shared-risk or multi-cycle package charges one price up front for several IVF attempts, often with a partial refund if none succeed, which means some of that revenue may need to come back out later.
What we doKeeps multi-cycle package revenue in its own line and tracks any refunds against the original package, so a later refund doesn't distort the current month. -
2
Donor and surrogacy costs pass through your account
Donor egg fees and surrogacy agency payments are often large, six-figure-adjacent amounts that move through your bank account on behalf of the patient, but they're a pass-through cost, not your revenue or your expense in the usual sense.
What we doKeeps donor and third-party pass-through costs in their own line, separate from your actual clinical revenue, so your real margin isn't distorted by money that was never really yours. -
3
Embryo storage fees recur long after treatment ends
A patient can keep paying an annual storage fee for embryos or eggs for years after active treatment stops, a small, steady, easy-to-overlook revenue stream compared to the size of a cycle package.
What we doKeeps storage fee revenue in its own line, so this long tail of recurring income stays visible instead of disappearing next to bigger cycle numbers. -
4
Insurance coverage looks completely different by state
Some states mandate insurance coverage for fertility treatment and others don't require any, so what portion of a cycle gets billed to insurance versus paid in cash can vary enormously depending on where your patients live.
What we doSets up categories based on how your patients actually pay, rather than assuming one insurance and cash-pay mix fits every fertility clinic.
Your categories
The categories Gus keeps for a fertility clinic.
Set up once for how cycles, storage, and donor costs all get paid. You never pick a category. He does, and an accountant checks it.
Money in
- Insurance cycle reimbursementsDeposits from payers where state-mandated coverage applies.
- Cash-pay cycle revenueSingle-cycle fees paid directly by patients.
- Multi-cycle package revenueShared-risk or multi-attempt packages, tracked against any refund guarantee.
- Cryopreservation storage revenueAnnual embryo, egg, or sperm storage fees.
Money out
- Donor and third-party costsDonor egg, sperm, and surrogacy agency payments passed through on behalf of patients.
- Lab and embryology suppliesCulture media, incubator supplies, and lab consumables.
- Clinical wagesPhysicians, embryologists, and nursing staff.
- Storage facility costsCryopreservation tank maintenance and monitoring.
- Malpractice insuranceAnnual or quarterly premiums, often higher given the scope of care.
- Lab equipmentIncubators and embryology equipment, logged so they get written off right.
- Practice management softwareScheduling, charting, and billing tools.
What we watch for you
- Package refund exposure
How much multi-cycle package revenue could still be refunded based on outstanding guarantees.
- Storage revenue trend
How the recurring storage fee base is growing as more patients complete active treatment.
- Insurance versus cash-pay mix
How much revenue comes from insurance versus direct patient payment, since it varies so much by state.
- The set-aside
What you will owe, tracked every month, so April is a number you already knew.
Ask Gus
Things fertility 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.
I track it against the original package revenue rather than the current month, so the refund reads honestly instead of looking like a sudden drop in this month's income.
No, I keep donor and third-party pass-through costs in their own line, separate from your actual clinical revenue, so it doesn't distort your real margin.
They're smaller individually, but I keep that revenue visible on its own so the recurring base isn't lost next to bigger cycle numbers.
The tax side
The tax side of a fertility clinic.
Most of what matters here is tracking package refund exposure and third-party pass-through 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 outA fertility 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.
- Multi-cycle package revenue and refundsPackage revenue is generally income when received, but a later refund reduces income in the period it's paid, which is why keeping packages tracked against their guarantees matters for an accurate return.
- Donor and third-party pass-through costsMoney passed through to a donor or surrogacy agency on a patient's behalf is generally not your income or your expense, since it belongs to the patient's arrangement, not your clinical services.
- Lab and embryology equipmentIncubators and embryology lab equipment can usually be written off the year you buy them, with 100 percent bonus depreciation available for property acquired after January 19, 2025.
Deductions fertility clinics miss
Your bookkeeper knows what to look for in your statements. You never have to.
- Lab and embryology supplies
- Cryopreservation storage costs
- Malpractice premiums
- Lab equipment maintenance
- CME courses and travel
- Board certification renewal
- Practice management software
- Scrubs and clinical apparel
- Patient education materials
- Biohazard disposal
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 fertility clinic year, kept every month.
Cycle packages, storage fees, and insurance mixes 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 multi-cycle packages still in progress.
- 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 package refunds or storage revenue changed the number.
- October
Before year end
Gus looks at equipment worth buying and anything worth doing before December, while many patients plan new cycles for the year ahead.
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 fertility 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 fertility clinic owners ask first.
Do you bill insurance or handle state coverage mandates?
No. Gus does not handle insurance billing, medical coding, or claims of any kind, and he doesn't track state coverage mandate compliance. Your practice management software or billing service still does that. Gus works from what actually lands in your bank account.
How do you handle a refund on a multi-cycle package?
It gets tracked against the original package revenue rather than the current month, so a refund reads as exactly that instead of looking like a drop in current business.
Do donor egg and surrogacy payments count as our income since they move through our account?
No, Gus keeps those pass-through costs in their own line, separate from your actual clinical revenue, since that money belongs to the patient's arrangement, not your services.
Is embryo storage revenue worth tracking separately from cycle fees?
Yes, it's a much smaller but steadier recurring stream, and Gus keeps it visible on its own so it doesn't disappear next to larger cycle package numbers.
Our patient mix shifted after we started seeing patients from a state with mandated coverage. Does that change the books?
It can shift how much revenue comes from insurance versus direct payment. Gus builds categories around how your patients actually pay rather than assuming one mix.
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