Medical practices & clinics
Books and taxes for independent urgent care clinics.
Dozens of small insurance payouts, cash-pay walk-ins, weekend shift differentials, and the x-ray machine that cost as much as a truck. 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
February came in at $24,600. Flu volume was heavy, and the new digital x-ray unit landed this month, so I logged it as equipment, not supplies.
- Availity batch depositInsurance visit reimbursements
- Square terminal, front deskCash-pay visits
- Konica Minolta lease, x-rayImaging equipment
- Quidel rapid test kitsPoint-of-care test supplies
- Weekend PA staffing agencyClinical staffing
Why your books are different
An urgent care clinic's books go wrong under the volume, not despite it.
You are not billing one price for one kind of visit. You are billing dozens of payers a day at different contracted rates, plus a flat cash-pay rate for the uninsured, on top of a fleet of shift-differential staff. A generalist averages all of it together and the true cost of staying open nights and weekends disappears.
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1
Small insurance payouts arrive in a wave
A single day of forty visits can generate forty separate insurance payouts over the following weeks, each discounted differently by the payer. Booked as one lump deposit, you lose the ability to see which payers are actually worth staying in-network with.
What we doBooks insurance deposits as they land and keeps them apart from cash-pay revenue, so the payer mix stays visible instead of blending into one number. -
2
Cash-pay and insurance rates get averaged together
An uninsured walk-in pays your flat self-pay rate, while an insured visit nets a contracted, usually lower, amount. Blend the two and you cannot tell if cash-pay volume is actually carrying the month.
What we doKeeps cash-pay visits in their own line, separate from insurance reimbursements, so each revenue source shows its real weight. -
3
Shift differentials hide inside one payroll number
Paying extra for nights, weekends, and holiday coverage is what keeps an urgent care open when a regular office is closed, but if it all runs through one payroll line you cannot see what staying open those hours actually costs.
What we doKeeps base clinical wages and shift differential pay visible against each other, so the cost of extended hours is a number, not a guess. -
4
Imaging and lab equipment gets filed as a supply run
A digital x-ray unit or an on-site lab analyzer can cost tens of thousands of dollars. Filed as supplies, it wrecks the month it was bought and hides what it is really worth over years.
What we doFlags a big equipment purchase the day it lands, logs it as equipment, and lets the accountant decide how it gets written off. -
5
Employer contract revenue blends with walk-in visits
Local employers who send workers in for drug screens or minor injury care often pay on a net-30 invoice, a different rhythm than walk-in cash or insurance deposits, and easy to lose track of.
What we doKeeps employer contract revenue in its own line, so a slow-paying employer account shows up instead of hiding inside daily visit totals.
Your categories
The categories Gus keeps for an independent urgent care clinic.
Set up once for how patients pay and what the clinic spends. You never pick a category. He does, and an accountant checks it.
Money in
- Insurance visit reimbursementsBatch deposits from payers, often arriving through a clearinghouse such as Availity.
- Cash-pay visitsThe flat self-pay rate charged to uninsured walk-ins.
- Employer contract revenueDrug screens and minor injury visits billed to local employers on invoice.
- Occupational referral visitsPhysicals or screenings referred in from a local employer or staffing agency.
Money out
- Clinical staffingPhysicians, PAs, and nurse practitioners, including per-diem and weekend coverage.
- Imaging equipmentX-ray units and related service contracts, logged so they get written off right.
- Point-of-care test suppliesRapid flu, strep, and similar test kits from suppliers such as Quidel.
- Front desk and check-in staffKept apart from clinical wages so labor cost stays visible by role.
- Rent and utilities for extended hoursThe lease and utility cost of staying open nights and weekends.
- Malpractice insuranceCoverage for the practicing providers, billed annually or quarterly.
- Card processing feesWhat the terminal or processor keeps on cash-pay and copay transactions.
- Marketing and signageLocal advertising and wayfinding that drives walk-in volume.
What we watch for you
- Cash-pay share
How much of each month comes from self-pay walk-ins versus insurance deposits, tracked from what actually lands.
- Shift differential cost
What extended and weekend hours cost against the visits they bring in, worth knowing before changing hours.
- Employer contract balance
How much employer invoice revenue is outstanding, based on what has actually been deposited so far.
- The set-aside
What you will owe, tracked every month, so April is a number you already knew.
Ask Gus
Things urgent care 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 book each deposit as it lands and tag it by payer, so the wave evens out over the month instead of looking like random money.
Usually it can. I logged it as equipment, not supplies, and flagged it so the accountant makes the call with your whole year in view.
I keep that revenue in its own line since it lands on a different schedule than walk-in cash. Whether to take on more employer contracts is a call for you, not me.
The tax side
The tax side of an independent urgent care clinic.
Most of what matters here is equipment timing, worker classification for per-diem coverage, and 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.
- Imaging and lab equipmentX-ray units and lab analyzers can usually be written off the year you buy them, with 100 percent bonus depreciation available for property acquired after January 19, 2025.
- Per-diem and locum coverageA provider who covers a shift occasionally, sets their own terms, 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.
- 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.
- Employee or contractor for regular PAsA PA or nurse practitioner who works your posted schedule under your supervision is usually an employee, even if paid per shift. Per-diem alone does not make someone a contractor.
Deductions independent urgent care clinics miss
Your bookkeeper knows what to look for in your statements. You never have to.
- Point-of-care test kits
- Imaging equipment maintenance
- Malpractice premiums
- Practice management software
- Card processing fees
- Shift differential pay
- Uniforms and scrubs
- Biohazard disposal
- Signage and local marketing
- License and certification renewals
- Answering service
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 urgent care year, kept every month.
Flu season and summer sports injuries do not run on the same schedule as your taxes. 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 per-diem provider'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 whether a heavy flu season or a quiet summer changed the number.
- October
Before flu season
Before the winter surge, 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 independent urgent care 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 independent urgent care owners ask first.
Do you verify insurance eligibility or handle claims?
No. Gus does not handle insurance billing, medical coding, or claims of any kind. Your billing software or biller still does that. Gus works from what actually lands in your bank account.
I run two locations. Can the books stay separate?
Yes, where the bank data allows it. Gus tags income and cost by location so a slow site does not hide inside a strong one.
How do you handle the rapid test kits we go through constantly?
They stay in their own supply line so a bulk order does not make one month look thin and the next look great by comparison.
We pay some PAs per diem and others on staff. Does that matter for taxes?
It can. A per-diem provider who sets their own terms and bills you directly is often a contractor, while one working your posted schedule is usually an employee regardless of how they are paid. Gus flags the setup and the accountant confirms it.
Do employer drug screen contracts count differently than regular visits?
They land on a different payment schedule, usually net 30 instead of at the visit, so Gus keeps that revenue in its own line to keep the timing clear.
My books are a mess from opening fast. Is that fixable?
Yes. Send the bank statements you have. Gus sorts them, the accountant checks them, and most owners know where they stand inside a week.
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