Medical practices & clinics
Books and taxes for optometrists.
Vision plan allowances, medical eye exams billed differently than routine ones, an optical shop up front, and contact lens orders by the case. 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
August came in at $20,600. Back-to-school eye exams were heavy, and a vision plan frame allowance covered part of a big eyewear order, so I split what the plan paid from what the patient paid out of pocket.
- VSP allowance batchVision plan reimbursements
- Availity medical exam depositMedical exam reimbursements
- Frame and lens orderEyewear inventory
- Annual contact lens supply orderContact lens sales
- Optical shop staff payrollOptical shop wages
Why your books are different
An optometry practice's books go wrong where the exam meets the optical shop.
A routine vision exam gets paid by a vision plan, a medical eye problem gets billed to medical insurance, and the optical shop up front runs on retail margin entirely its own. A generalist blends all three into one number and loses track of which part of the practice actually pays the bills.
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1
Vision plans and medical insurance pay completely differently
A routine annual exam billed to a vision plan such as VSP or EyeMed pays a flat, contracted amount, while a medical eye problem like conjunctivitis or a foreign body billed to medical insurance pays on a different schedule entirely, and blended together you cannot see which exam type is more common or more valuable.
What we doKeeps vision plan reimbursements and medical exam reimbursements in separate lines, so the split between routine and medical visits stays visible. -
2
A frame allowance splits one purchase into two payers
A vision plan often covers a flat dollar allowance toward frames, with the patient paying the difference out of pocket, so a single eyewear sale can involve two different payments landing separately.
What we doTracks the plan's allowance and the patient's out-of-pocket portion as parts of the same sale, so a frame purchase reads as one transaction instead of two unrelated deposits. -
3
The optical shop runs on retail margin, not exam margin
Frames, lenses, and contacts sold at the optical counter carry a retail markup that has nothing to do with what an exam brings in, and blended together you cannot tell whether the shop or the exam room is actually carrying the practice.
What we doKeeps optical shop sales and their inventory cost apart from exam revenue, so retail margin is visible on its own. -
4
Annual contact lens orders land as one big deposit
A patient ordering a full year's supply of contact lenses pays it all at once, which can make one month look unusually strong compared to months without a big annual order.
What we doKeeps contact lens sales in their own line, so a large annual order reads as exactly that, not as ongoing monthly growth.
Your categories
The categories Gus keeps for an optometry practice.
Set up once for how exams, the optical shop, and contact lenses all get paid. You never pick a category. He does, and an accountant checks it.
Money in
- Vision plan reimbursementsAllowances from vision plans such as VSP or EyeMed for routine exams and eyewear.
- Medical exam reimbursementsDeposits from medical insurance for eye conditions and medical visits.
- Eyewear salesFrames and lenses sold, with plan allowance and patient payment tracked together.
- Contact lens salesOngoing and annual supply orders, kept apart from eyewear.
Money out
- Eyewear inventoryFrames and lens blanks purchased from suppliers and labs.
- Contact lens inventoryStock ordered from manufacturers to fulfill patient orders.
- Optical shop wagesOpticians and retail staff, kept apart from clinical wages.
- Clinical wagesOptometric technicians and clinical staff supporting exams.
- Exam equipmentRetinal cameras and diagnostic equipment, logged so they get written off right.
- Malpractice insuranceAnnual or quarterly premiums for the practicing optometrists.
- Rent and utilitiesSpace for both the exam lanes and the optical shop.
What we watch for you
- Exam type mix
How much of each month is routine vision plan exams versus medical visits.
- Optical shop margin
What eyewear and contact lens sales bring in against their inventory cost.
- Frame allowance capture
How much of each eyewear sale comes from the plan allowance versus the patient's own payment.
- The set-aside
What you will owe, tracked every month, so April is a number you already knew.
Ask Gus
Things optometrists 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 keep vision plan reimbursements and medical exam reimbursements in separate lines, so you can see that split directly instead of guessing from the total.
Both amounts get tracked as parts of the same eyewear sale, so it reads as one transaction, not two separate, confusing deposits.
I keep shop sales and inventory cost apart from exam revenue, so the real margin on the shop is a number you can look at directly.
The tax side
The tax side of an optometry practice.
Most of what matters here is separating retail inventory from exam revenue 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 outAn optometry 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.
- Eyewear and contact lens inventoryFrames, lenses, and contact lens stock held for resale are generally tracked as inventory, with their cost recognized as items sell rather than when they're purchased.
- Diagnostic equipment purchasesRetinal cameras and other diagnostic equipment can usually be written off the year you buy them, with 100 percent bonus depreciation available for property acquired after January 19, 2025.
- Contract or covering optometristsAn optometrist covering your practice occasionally who 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.
Deductions optometry practices miss
Your bookkeeper knows what to look for in your statements. You never have to.
- Eyewear and lens inventory
- Contact lens inventory
- Diagnostic equipment maintenance
- Malpractice premiums
- CME courses and travel
- License renewal fees
- Optical shop fixtures and displays
- Practice management software
- Marketing for new patients
- Frame samples and displays
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 optometry year, kept every month.
Back-to-school exams, holiday eyewear sales, and vision plan cycles each run 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 the optical shop and exam room on different rhythms.
- 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 back-to-school exams and eyewear sales matched last year's pattern.
- October
Before year end
Gus looks at equipment worth buying and anything worth doing before December, as patients often use remaining vision benefits before they reset.
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 optometry 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 optometrists ask first.
Do you bill vision plans or medical insurance for us?
No. Gus does not handle insurance billing, medical coding, or claims of any kind. Your practice management software or billing service still does that. Gus works from what actually lands in your bank account.
How do you tell the difference between a routine exam and a medical visit in the books?
By which payer the deposit came from. Vision plan allowances and medical insurance reimbursements are kept in separate lines from the start.
A vision plan allowance and a patient's out-of-pocket payment come in separately for the same glasses. Does that get confusing?
Gus tracks both as parts of the same eyewear sale, so it reads as one transaction rather than two unrelated deposits.
Is it worth knowing whether the optical shop or the exam room brings in more?
Most owners find it useful. Gus keeps shop sales and their inventory cost apart from exam revenue, so the real split is visible.
A patient ordered a full year of contact lenses in one order. Does that skew the month?
Gus keeps contact lens sales in their own line, so a large annual order reads as exactly what it is, not as a sudden jump in monthly growth.
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