Medical practices & clinics
Books and taxes for occupational therapy practices.
Insurance visits, school district contracts on their own payment calendar, custom splints, and sensory gym equipment. 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 $14,300. The Riverside district's fall invoice finally paid out, so I booked it the month it landed, not the month the sessions happened.
- Riverside school districtSchool contract revenue
- Availity batch depositInsurance visit reimbursements
- North Coast Medical splintsSplint and adaptive supplies
- Sensory gym equipment leaseTreatment equipment
- Clinical staff payrollClinical wages
Why your books are different
An occupational therapy practice's books go wrong in the same four places.
You are billing insurance for some sessions, invoicing a school district for others, and selling custom splints and adaptive equipment on top of it. A generalist treats all of that as one revenue stream, and a slow-paying district contract looks like a bad month instead of just a late one.
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1
School district contracts pay on their own calendar
A district often invoices monthly or quarterly and pays on its own fiscal schedule, sometimes 60 or 90 days after the sessions happened. Blended with insurance and cash revenue, a normal delay looks like a bad month.
What we doKeeps school contract revenue in its own line, booked the month it actually lands, so a district's slow payment cycle doesn't read as a drop in business. -
2
Splints and adaptive equipment blend into visit fees
A custom thermoplastic splint or an adaptive utensil set has its own material cost, separate from the therapy session itself. Blended together, you cannot tell if selling equipment is actually worth the time it takes.
What we doKeeps splint and adaptive equipment sales apart from session revenue, with the material cost tracked against it, so the real margin is visible. -
3
Missed pediatric sessions create uneven cash flow
Pediatric sensory therapy depends on a parent showing up consistently, and missed sessions with no-show fees create gaps that look like the practice is losing patients rather than just losing scheduled hours.
What we doKeeps no-show and cancellation fees in their own line, so a scheduling gap and a real drop in patients don't look the same on paper. -
4
Sensory gym equipment reads as a supply run
Swings, crash pads, and therapy equipment for a sensory gym can add up to real money fast. Filed as supplies, a big purchase wrecks the month it happened and hides what the equipment is 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.
Your categories
The categories Gus keeps for an occupational therapy practice.
Set up once for how you get paid and what the practice spends. You never pick a category. He does, and an accountant checks it.
Money in
- Insurance visit reimbursementsDeposits from payers for authorized therapy sessions.
- School contract revenueInvoiced sessions billed to a school district on its own payment schedule.
- Cash-pay sessionsFamilies paying directly, common for services insurance does not cover.
- Splint and adaptive equipment salesCustom splints, adaptive utensils, and similar items sold to patients.
Money out
- Clinical wagesOTs and OT assistants, kept apart from contract therapist pay.
- Splint and adaptive suppliesThermoplastic material and adaptive equipment from suppliers such as North Coast Medical.
- Treatment equipmentSensory gym equipment, swings, and therapy tools, logged so they get written off right.
- Rent and utilitiesThe clinic space, including a sensory gym if one is on site.
- Malpractice insuranceAnnual or quarterly premiums for the practicing therapists.
- Continuing education and specialty certificationsTraining such as certified hand therapist or sensory integration coursework.
- Practice management softwareScheduling, documentation, and billing tools.
What we watch for you
- District contract lag
How long a school district takes to pay after sessions happen, tracked from what has actually landed.
- Equipment sale margin
What splints and adaptive equipment bring in against what they cost, kept apart from session revenue.
- No-show rate
How much of scheduled revenue is lost to missed sessions, tracked from cancellation fees and gaps.
- The set-aside
What you will owe, tracked every month, so April is a number you already knew.
Ask Gus
Things occupational therapy 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.
Districts often run 60 to 90 days behind on their own schedule. I keep that revenue in its own line so a normal delay doesn't read as a drop in business.
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.
That depends on your state and how the splint is classified. I keep splint sales in their own line so the accountant can confirm what applies to you.
The tax side
The tax side of an occupational therapy practice.
Most of what matters here is treatment equipment timing, worker classification for contract therapists, 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.
- Treatment equipment purchasesSensory gym equipment and larger therapy tools can usually be written off the year you buy them, with 100 percent bonus depreciation available for property acquired after January 19, 2025.
- The pass-through deduction phases outAn occupational therapy 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.
- Contract therapists across districtsA therapist who works multiple school districts on their own schedule and bills you or the district directly is often a contractor and gets a 1099-NEC if you pay them $2,000 or more in 2026, due January 31.
- Employee or contractor for clinic staffA therapist who works your clinic's posted schedule under your supervision is usually an employee, even if some of their time is billed to a school contract.
Deductions occupational therapy practices miss
Your bookkeeper knows what to look for in your statements. You never have to.
- Splint and adaptive supplies
- Sensory gym equipment maintenance
- Malpractice premiums
- Continuing education and specialty certifications
- Practice management software
- License renewal fees
- Adaptive equipment samples
- Scrubs and clinical apparel
- Referral and outreach marketing
- Answering and scheduling 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 occupational therapy year, kept every month.
School contracts run on a district calendar, insurance runs on its own, and your taxes run on a third. Your team keeps you ahead of all three. 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 contract therapist'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 summer session gaps or new district contracts changed the number.
- October
Before year end
Gus looks at equipment worth buying and anything worth doing before December, while fall district invoices are still working through the system.
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 occupational therapy 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 occupational therapy owners ask first.
Do you bill insurance or school districts directly?
No. Gus does not handle insurance billing, medical coding, claims, or district invoicing. Your practice management software or billing service still does that. Gus works from what actually lands in your bank account.
Our school district contracts pay months after the sessions happen. Does that mess up the books?
No. Gus books that revenue the month it actually lands, so a normal district payment delay doesn't read as a slow month for the practice.
We sell custom splints and adaptive equipment. Does that need its own bookkeeping?
Yes, and Gus already keeps it in its own line, apart from session revenue, so you can see whether selling equipment is actually worth the time.
Some of our therapists work across three different districts. How does that affect pay?
A therapist setting their own schedule across districts and billing directly is often a contractor, while one working your clinic's schedule is usually an employee. Gus flags the setup for the accountant to confirm.
Missed pediatric sessions create gaps in our schedule. Does that show up as a problem in the books?
Gus keeps no-show and cancellation fees in their own line, so a scheduling gap reads as exactly that, not as a real drop in patients.
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