Medical practices & clinics
Books and taxes for physical therapy practices.
Insurance visits, cash-pay plans of care, deductibles that reset every January, and PTs paid on productivity. 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
January came in at $18,500. Patient responsibility is running high while deductibles reset, but I kept those front-desk collections in their own line so it doesn't look like insurance suddenly paid less.
- Availity batch depositInsurance visit reimbursements
- Cash plan of care, WhitfieldCash-pay plans of care
- Chattanooga e-stim unitsTreatment equipment
- PT productivity payrollClinical wages
- Suite rent, unit 12Rent
Why your books are different
A physical therapy clinic's books go wrong in the same four places.
You are not billing one visit at one rate. A plan of care mixes insurance-authorized visits, patient responsibility that shifts through the year, and cash-pay patients who skip insurance entirely. A generalist blends it all and you cannot see what a plan of care is actually worth.
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1
January's deductible reset hides as a bad month
Every January, patients owe more out of pocket until their deductible is met, so front-desk collections climb while insurance reimbursement per visit drops. Blended together, it looks like a slow month instead of a normal shift in who is paying what.
What we doKeeps patient-collected amounts separate from insurance deposits, so the January shift shows up as a pattern, not a mystery. -
2
PT productivity pay hides inside one payroll line
Many clinics pay PTs a base plus a bonus tied to visits or units completed. Run through one generic payroll category, you cannot see labor cost against what each provider actually brought in.
What we doKeeps base wages and productivity pay visible against each other, so labor cost against visit revenue is a real number, not a guess. -
3
Cash-pay plans of care blend with insurance visits
A patient who pays out of pocket for a full plan of care, often to skip a high deductible, pays a different rate than an insurance-authorized visit. Blended together, you cannot tell which model is actually better for the clinic.
What we doKeeps cash-pay plans of care in their own line, separate from insurance visits, so each revenue source shows its true rate. -
4
Treatment equipment reads as a supply run
E-stim units, ultrasound machines, and an anti-gravity treadmill can add up to real money fast. Filed as supplies, a 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 a physical therapy clinic.
Set up once for how patients pay and what the clinic spends. You never pick a category. He does, and an accountant checks it.
Money in
- Insurance visit reimbursementsDeposits from payers for authorized plan of care visits.
- Patient responsibility collectionsCopays, coinsurance, and deductible amounts collected at the front desk.
- Cash-pay plans of carePatients who pay directly and skip insurance for the full course of care.
- Home visit feesMobile or in-home therapy visits, kept apart from in-clinic care.
Money out
- Clinical wagesBase pay for PTs and PTAs, kept apart from productivity bonuses.
- Treatment equipmentE-stim units, ultrasound machines, and treadmills, logged so they get written off right.
- Rent and utilitiesThe lease for treatment rooms and the waiting area.
- Malpractice insuranceAnnual or quarterly premiums for the practicing therapists.
- Practice management and billing softwareScheduling, documentation, and claims transmission tools.
- Continuing education and certificationsSpecialty certifications such as dry needling or manual therapy training.
- Marketing and physician outreachLocal marketing and relationship building with referring physicians.
What we watch for you
- Patient collection share
How much of each month comes from patients directly versus insurance, especially early in the year.
- Productivity pay ratio
What productivity bonuses cost against visit revenue, tracked apart from base clinical wages.
- Cash-pay plan revenue
How much came from cash-pay plans of care versus insurance-authorized visits.
- The set-aside
What you will owe, tracked every month, so April is a number you already knew.
Ask Gus
Things physical 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.
Deductibles reset, so patients owe more up front while insurance pays out less per visit. I keep those two collected apart, and the pattern usually clears by spring.
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.
It stays payroll, but I keep the base pay and the bonus in separate lines so you can see labor cost against what each therapist brings in.
The tax side
The tax side of a physical therapy clinic.
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 purchasesE-stim units, ultrasound machines, and larger equipment like treadmills 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 outA physical 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 or per-diem therapistsA PT who covers occasional shifts, sets their own terms, and 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.
- Employee or contractor for regular staffA therapist who works your posted schedule under your clinic's supervision is usually an employee, even if part of their pay is tied to productivity.
Deductions private practice physical therapy clinics miss
Your bookkeeper knows what to look for in your statements. You never have to.
- Treatment equipment maintenance
- Continuing education and certifications
- Malpractice premiums
- Practice management software
- Manual therapy and modality supplies
- License renewal fees
- Referral and physician outreach marketing
- Scrubs and clinical apparel
- Rehab bands and small equipment
- 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
A physical therapy year, kept every month.
Deductibles reset every January and patient volume shifts through the year. 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 as deductible resets shift the payer mix.
- 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 patient collections and insurance mix evened out as expected.
- October
Before year end
Gus looks at equipment worth buying and anything worth doing before December, while deductibles are easing and volume often steadies.
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 private practice physical therapy clinics. 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 physical therapy owners ask first.
Do you handle insurance authorizations or visit limits?
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.
Why does patient collection revenue climb every January?
Deductibles reset at the start of the year, so patients owe more before insurance starts covering a larger share. Gus keeps that pattern visible instead of letting it read as a slow month.
We offer cash-pay plans of care for patients who want to skip insurance. Does that complicate things?
No, Gus keeps cash-pay plans in their own line, separate from insurance visits, so you can see which model is actually working better for the clinic.
How do you handle PT pay that includes a productivity bonus?
It stays part of payroll, but Gus keeps base wages and bonus pay in separate lines so labor cost against visit revenue is a real number.
Do I need to send 1099s to therapists who cover occasional shifts?
If they set their own terms, bill you directly, and you pay them $2,000 or more in 2026, usually yes, by January 31. Gus keeps that list as the year goes.
My books are behind from focusing on patients instead of paperwork. Is that fixable?
Yes. Send the bank statements you have. Gus sorts them, the accountant checks them, and most owners know where they stand inside a week.
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