Mental & behavioral health
Books and taxes for intensive outpatient programs.
A per-diem insurance payment for a client's three-day-a-week program, group facilitator pay for evening sessions, van costs for client transportation, and a snack order for group nights. 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 $17,000. Two new clients started mid-month, so per-diem billing ramped up gradually instead of jumping all at once.
- Insurance program-day batchProgram day billing
- Group facilitator payrollClinical staff wages
- Client van lease paymentTransportation costs
- Group night snack orderProgram supplies
- Client self-pay balancePrivate pay
Why your books are different
An IOP's books go wrong around program days and group staffing.
A generalist sees a deposit and a payroll run. Your program bills insurance per program day rather than per session, staffs evening or multi-hour groups differently than individual therapy, and often covers client transportation. When the books flatten all of that, a ramping census looks like an inconsistent one.
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1
Per-diem billing does not line up neatly with the calendar
Insurance pays a set rate per program day attended, not per client per month, so a client who starts mid-month or misses a few days makes revenue swing in ways that look confusing without knowing the attendance behind it.
What we doBooks per-diem deposits as they land and keeps a note on the payer and rough attendance pattern, so a swing reads as an attendance issue, not a mystery. -
2
Group facilitator pay does not scale down when groups run smaller
A facilitator running an evening group is paid for the shift whether five clients or twelve show up, so a light group night can look like a labor cost problem when it is really just lower attendance that week.
What we doKeeps facilitator wages in their own line against program day billing, so cost against attendance stays visible together. -
3
Client transportation costs get buried in general vehicle expenses
A program running a van to pick up and drop off clients has real, recurring costs in lease payments, fuel, and maintenance that are part of delivering the program, not just a general business vehicle expense.
What we doKeeps transportation costs in their own line so the real cost of getting clients to the program is visible. -
4
A ramping census looks like inconsistent revenue
New clients starting at different points in the month means program day billing often ramps up gradually rather than jumping all at once, and read the wrong way, that ramp can look like unreliable demand.
What we doFlags a gradual ramp as new clients starting mid-month, so the month reads as growth, not inconsistency.
Your categories
The categories Gus keeps for an intensive outpatient 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
- Program day billingInsurance per-diem payments for each day a client attends the program.
- Assessment and intake billingInitial evaluations billed apart from ongoing program days.
- Private payClients or families paying directly for days insurance does not cover.
- Aftercare or step-down billingReduced-frequency sessions for clients stepping down from full IOP.
Money out
- Clinical staff wagesGroup facilitators and individual therapists, kept apart from administrative pay.
- Transportation costsVan lease, fuel, and maintenance for client pickup and drop-off.
- Program suppliesGroup materials, snacks, and handouts for program nights.
- Facility costsRent, utilities, and maintenance for the group and program space.
- Malpractice insuranceCoverage for clinical staff running the program.
- Billing and clearinghouseFees paid to submit and track insurance authorizations and per-diem claims.
What we watch for you
- Census trend
How many clients are active in the program, tracked against billing, so a revenue swing reads as an attendance change.
- Facilitator cost per group
Staff wages against program day billing, so labor cost against attendance stays visible.
- Transportation cost per client
Van and fuel costs against active caseload, so the real cost of transport is visible.
- The set-aside
What the program will owe, tracked every month, so April is a number already known.
Ask Gus
Things IOP 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. Two new clients started mid-month, so per-diem billing built up gradually as they attended more days. I flagged it as a ramp, not a problem.
It is a normal part of running scheduled groups. I keep facilitator wages against program day billing so you can see the relationship over time, not just react to one light night.
I keep it as its own transportation line since it is part of delivering the program, not a general vehicle expense. That way you can see what getting clients here and back actually costs.
The tax side
The tax side of an intensive outpatient program.
Most of what goes wrong here is timing and labor visibility, since per-diem billing does not track neatly with the calendar and staffing is scheduled, not variable.
What your return has to get right
Your accountant signs it, so it gets done right the first time.
- Worker classification for group facilitatorsA facilitator who runs your scheduled groups using your curriculum is almost always an employee, not a contractor. Getting this wrong on scheduled staff gets expensive if it gets flagged.
- Vehicle and mileage costsA program-owned van used for client transportation is generally deducted through actual costs like lease, fuel, and maintenance, tracked separately from an employee's personal mileage.
- Contractor 1099sA per-diem group facilitator, a consulting medical director, or any other contractor paid $2,000 or more in 2026 who is not on payroll gets a 1099-NEC by January 31.
- The pass-through deductionUp to 20 percent of the program's profit can often come off the owner's taxable income, though the benefit tends to shrink once earnings climb past the threshold for a clinical, personal-service business.
Deductions intensive outpatient programs miss
Your bookkeeper knows what to look for in your statements. You never have to.
- Van lease and fuel costs
- Vehicle maintenance and insurance
- Malpractice insurance premium
- Group program materials and handouts
- Facility rent for group space
- Billing and clearinghouse fees
- Staff continuing education
- Background check fees for new hires
- Program snacks and supplies
- Business insurance beyond malpractice
- Medical director fees
- Professional association dues
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 IOP's year, kept every month.
Census can ramp and dip based on referral timing more than the season itself. 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 typical census patterns.
- 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 this year changed the number.
- October
Before year-end
Gus looks at any staffing, transportation, 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 intensive outpatient 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 IOP owners ask first.
Can Gus track our census alongside our per-diem billing?
Gus books your program day revenue and can keep a rough attendance note alongside it if you share census data, so a revenue swing reads as an attendance change, not a mystery.
Our facilitators are paid a flat rate per group regardless of attendance. Does that complicate the books?
No. Gus keeps facilitator wages in their own line against program day billing, so you can see the relationship between staffing cost and attendance over time.
Does Gus handle our insurance per-diem authorizations?
No. That stays with your clinical and billing staff. Gus books what actually lands in your account and keeps staff and transportation costs visible, but does not manage authorizations directly.
We run a van for client transportation. How should that be tracked?
It is kept in its own transportation category, separate from general expenses, so you can see what it costs to get clients to and from the program.
Our census ramps up slowly whenever we get new referrals. Is that normal?
Yes. Gus flags a gradual ramp as new clients starting mid-month rather than a decline, so a growing program does not read as an inconsistent one.
Our books have never separated program day billing from private pay. Can that be fixed?
Yes. Gus can go back through your deposit history, sort program day billing from private pay month by month, and keep the two separate from now on.
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