Medical practices & clinics
Books and taxes for orthotics and prosthetics providers.
A device cast one month and delivered weeks later, components that cost more than a car, and repair revenue that keeps coming long after the sale. 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 $29,700. A microprocessor knee component landed for a case cast back in June, so I tied that cost to the original patient case, not this month's random expenses.
- Availity batch deposit, device deliveryDevice reimbursements
- Ossur component orderComponent and material costs
- Repair and adjustment feesRepair and maintenance revenue
- Casting and fitting feesCash-pay fitting revenue
- Fabrication technician payrollFabrication wages
Why your books are different
An O&P practice's books go wrong across the weeks between casting and delivery.
You measure or cast a patient one month, order components that can cost as much as a car, and deliver and bill the finished device weeks later. A generalist books everything the day money moves and completely loses the thread connecting a cost to the case it belongs to.
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1
Casting and delivery happen in different months
A patient is often cast or measured well before a custom device is fabricated and delivered, and the billing happens at delivery, not at the initial visit, which can make a busy casting month look quiet if delivery revenue doesn't land until later.
What we doTracks device revenue against when it's actually billed at delivery, while keeping the visit and casting activity visible too, so the lag doesn't read as a slow patch. -
2
High-cost components are a case cost, not general supplies
A microprocessor knee or a custom socket component can cost tens of thousands of dollars, and if that cost isn't tied to the specific case it was ordered for, it swamps every other number in a general supply category.
What we doKeeps component and material costs tied to the case they belong to, so one expensive component doesn't distort the whole supply picture. -
3
Repair revenue gets lost next to new device sales
Adjustments, repairs, and replacement parts for existing devices bring in steady revenue long after the original sale, but it's easy to blend that in with new device billing and lose track of how much repeat business the practice actually generates.
What we doKeeps repair and adjustment revenue in its own line, separate from new device sales, so the ongoing relationship with existing patients stays visible. -
4
Warranty-covered parts get billed like a regular sale
Some replacement parts are covered under a manufacturer's warranty at no cost to the patient, while others are billable, and if those two get mixed together, revenue and cost both read wrong.
What we doKeeps warranty-covered replacements separate from billable repairs, so revenue reflects only what was actually charged.
Your categories
The categories Gus keeps for an O&P practice.
Set up once for how casting, delivery, and repairs all get paid. You never pick a category. He does, and an accountant checks it.
Money in
- Device reimbursementsInsurance payments for delivered orthotic and prosthetic devices.
- Cash-pay fitting revenueCasting, fitting, and evaluation fees paid directly.
- Repair and maintenance revenueAdjustments and repairs on existing devices.
- Warranty service revenueAny billable portion of warranty-related service.
Money out
- Component and material costsHigh-cost parts from manufacturers such as Ossur or Ottobock, tied to specific cases.
- Fabrication wagesTechnicians who cast, fabricate, and fit devices.
- Clinical wagesCertified orthotists and prosthetists, kept apart from fabrication staff.
- Rent and utilitiesFitting rooms and fabrication lab space.
- Malpractice or liability insuranceCoverage for the practicing clinicians.
- Fabrication equipmentCasting and fabrication tools, logged so they get written off right.
- Practice management softwareScheduling, order tracking, and billing tools.
What we watch for you
- Casting-to-delivery lag
How long it typically takes between casting a patient and billing the delivered device.
- Component cost per case
What high-cost components run against what the case actually reimburses.
- Repair revenue trend
How much steady repair and adjustment revenue is coming from existing patients over time.
- The set-aside
What you will owe, tracked every month, so April is a number you already knew.
Ask Gus
Things O&P providers 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.
That's normal here. Devices bill at delivery, which can be weeks after casting. I track both so the lag reads as a pattern, not a slow month.
I keep it tied to the specific case it was ordered for, so it shows up as that case's real cost instead of blowing up your general supply category.
I keep repair and adjustment revenue in its own line, so you can see that trend directly instead of it blending into new device sales.
The tax side
The tax side of an O&P practice.
Most of what matters here is tying component costs to the right case 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 O&P 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.
- High-cost component trackingComponents and materials are generally deductible as the cost of the specific case they were used for, which affects how margin reads on the return when a component is unusually expensive.
- Fabrication equipment purchasesCasting and fabrication equipment can usually be written off the year you buy it, with 100 percent bonus depreciation available for property acquired after January 19, 2025.
- Contract or covering cliniciansAn orthotist or prosthetist 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 orthotics and prosthetics providers miss
Your bookkeeper knows what to look for in your statements. You never have to.
- Component and material costs
- Fabrication equipment maintenance
- Malpractice or liability premiums
- Continuing education and certification
- Practice management software
- License renewal fees
- Casting and fitting supplies
- Scrubs and clinical apparel
- Marketing and referral outreach
- Shipping for components and devices
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 O&P practice year, kept every month.
Casting, fabrication, and delivery each run weeks apart, and repair revenue trickles in on its own schedule. Your taxes run on a fixed one. 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, and you get a monthly set-aside so April is already handled, even with devices still in fabrication.
- 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 device deliveries or repair volume changed the number.
- October
Before year end
Gus looks at equipment worth buying and anything worth doing before December, as patients often use remaining insurance 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 orthotics and prosthetics providers. 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 O&P providers ask first.
Do you handle insurance billing or prior authorizations for devices?
No. Gus does not handle insurance billing, medical coding, authorizations, 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.
Casting happens one month and delivery happens the next. Does that confuse the books?
No. Gus tracks both the casting activity and the delivery billing, so the normal lag between them reads as a pattern rather than a mystery.
How do you handle really expensive components tied to one specific patient?
They're tracked against that specific case, so a costly component reads as that case's real cost instead of distorting your general supply numbers.
Is repair revenue worth tracking separately from new device sales?
Yes, and Gus already does it. It shows you how much steady repeat business is coming from patients you've already fitted.
Some replacement parts are covered under warranty and some aren't. Does that matter for the books?
Yes. Gus keeps warranty-covered replacements separate from billable repairs, so your revenue reflects only what was actually charged.
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