Medical practices & clinics
Books and taxes for podiatrists.
Routine diabetic foot care, custom orthotics, therapeutic shoe fittings, and surgical cases split between the office and the surgery center. 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
May came in at $23,600. Two surgical cases paid out from the surgery center separately from the office visit deposits, so I kept those lines apart.
- Availity batch depositInsurance visit reimbursements
- Surgery center facility payoutSurgical case reimbursements
- Custom orthotic lab, Langer BiomechanicsOrthotic lab costs
- Diabetic shoe distributorTherapeutic shoe inventory
- Clinical staff payrollClinical wages
Why your books are different
A podiatry practice's books go wrong in the same four places.
You are seeing frequent, low-dollar routine care visits, dispensing custom devices with their own lab cost, and running surgical cases that pay out from two different sources. A generalist blends it all and you cannot see which part of the practice is actually carrying it.
-
1
Custom orthotics have a lab cost hiding in the fee
A custom orthotic pair dispensed in-office is billed to the patient or insurance, but a chunk of that goes straight to the orthotic lab that molded and built it. Booked as one number, the real markup disappears.
What we doKeeps what the patient or payer paid for orthotics apart from the lab cost that built them, so the true margin on dispensing is visible. -
2
Surgical cases pay out from two places at once
A surgical case often generates a professional fee from the payer and a separate facility payout from the surgery center or hospital, landing in the bank on different days for the same procedure.
What we doMatches both payments back to the same case so a surgical month reads as complete, not as two unrelated deposits. -
3
Diabetic shoe fittings are a recurring benefit, not a one-off sale
Medicare's therapeutic shoe benefit for diabetic patients recurs on its own schedule each year, and treated as a one-time retail sale, it is easy to lose track of who is due for a refit.
What we doKeeps therapeutic shoe revenue in its own line so the recurring nature of the benefit stays visible month to month. -
4
Routine diabetic foot care blends into surgical revenue
Frequent, low-dollar nail and callus care visits for diabetic patients bring in steady but small amounts, and blended with high-dollar surgical revenue, they make the routine side of the practice invisible.
What we doKeeps routine care visits in their own line, separate from procedures and surgery, so the steady base of the practice stays visible.
Your categories
The categories Gus keeps for a podiatry practice.
Set up once for how visits, devices, and surgical cases get paid. You never pick a category. He does, and an accountant checks it.
Money in
- Insurance visit reimbursementsDeposits from payers for office visits and routine care.
- Surgical case reimbursementsProfessional fees for surgical procedures, kept apart from facility payouts.
- Orthotic and device dispensing feesWhat patients or payers pay for custom orthotics and braces.
- Therapeutic shoe fitting revenueThe diabetic shoe benefit, billed on its own recurring schedule.
Money out
- Orthotic lab costsWhat labs such as Langer Biomechanics charge to build custom devices.
- Therapeutic shoe inventoryDiabetic shoes and inserts purchased from an approved distributor.
- Clinical wagesMedical assistants and clinical staff, kept apart from provider compensation.
- Surgical suppliesSterile instruments and supplies used for in-office procedures.
- Rent and utilitiesThe office and procedure room space.
- Malpractice insuranceAnnual or quarterly premiums, often higher given surgical scope.
- Practice management softwareScheduling, charting, and billing tools.
What we watch for you
- Orthotic margin
What dispensing custom devices brings in against what the lab charges to build them.
- Routine care share
How much of each month is steady routine visits versus procedures and surgery.
- Surgical case completion
Whether both the professional and facility payouts for a case have actually landed.
- The set-aside
What you will owe, tracked every month, so April is a number you already knew.
Ask Gus
Things podiatrists 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.
Because a good chunk of each fee goes straight to the orthotic lab. I keep what you collected apart from the lab cost, so the real margin shows up instead of the whole fee looking like profit.
Probably not. Surgery centers and payers often pay the facility fee and the professional fee separately, sometimes weeks apart. I'll match the second payment to the case once it lands.
That call is above my pay grade since it involves patient scheduling, but I keep the revenue from shoe fittings visible on its own so you can see the pattern of how often it recurs.
The tax side
The tax side of a podiatry practice.
Most of what matters here is separating device and inventory costs from service 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 outA podiatry 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.
- Surgical and procedure equipmentIn-office surgical equipment and procedure tools can usually be written off the year you buy them, with 100 percent bonus depreciation available for property acquired after January 19, 2025.
- Orthotic and shoe inventoryThe cost of custom orthotics and therapeutic shoes is generally tracked as the cost of what you sell, separate from your other operating expenses, which affects how your margin reads on the return.
- Contract or covering podiatristsA podiatrist 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 podiatrists miss
Your bookkeeper knows what to look for in your statements. You never have to.
- Orthotic lab fees
- Surgical instruments and supplies
- Malpractice premiums
- Practice management software
- CME courses and travel
- License and board renewal fees
- Therapeutic shoe inventory
- Scrubs and clinical apparel
- Biohazard disposal
- Marketing and referral outreach
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
A podiatry year, kept every month.
Surgical cases, routine care, and device dispensing 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 a surgical case or two still settling.
- 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 surgical volume or device dispensing changed the number.
- October
Before year end
Gus looks at equipment worth buying and anything worth doing before December, while therapeutic shoe fittings often pick up.
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 podiatrists. 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 podiatrists ask first.
Do you bill insurance for visits or surgical cases?
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 handle the lab cost on custom orthotics?
Gus keeps what you collected apart from what the orthotic lab charged to build the device, so the real margin on dispensing shows up instead of the whole fee looking like profit.
A surgical case paid out in two separate deposits. Is that normal?
Yes, professional fees and facility fees from a surgery center or hospital often land separately, sometimes weeks apart. Gus matches them back to the same case as they land.
Does the diabetic therapeutic shoe benefit need its own category?
Yes, since it recurs on its own annual schedule rather than being a one-time sale. Gus keeps it visible on its own so the pattern is clear.
My routine diabetic foot care visits are steady but small. Do they matter to the books?
They matter a lot. Gus keeps them in their own line so the steady base of the practice doesn't disappear next to bigger surgical numbers.
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.
More in medical practices & clinics
We keep books for the business next door too.
- Compounding pharmacies
- Durable medical equipment (DME) suppliers
- Elective 3D/4D ultrasound studios
- Independent pharmacies
- Medical billing companies
- Mobile nursing & concierge nurse services
- Mobile phlebotomy services
- Mobile x-ray & ultrasound services
- Occupational health & DOT physical clinics
- Orthotics & prosthetics providers
- Sleep clinics
- Wound care clinics
- Allergy clinics
- Audiology & hearing aid centers
- Concierge medicine practices
- Direct primary care (DPC) practices
- Independent eyewear boutiques
- Naturopathic doctors
- Occupational therapy practices
- Pediatric therapy clinics
- Speech therapy practices
- Sports medicine clinics
- Tattoo removal clinics
- Fertility clinics
- Functional medicine practices
- Independent urgent care clinics
- Optometrists
- Pain management clinics
- Private practice physical therapy
- Regenerative medicine clinics
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