Mental & behavioral health
Books and taxes for psychiatry practices.
A UnitedHealthcare batch for short med management visits, a nurse practitioner's W-2 pay, a pharmacy prior-authorization call nobody bills for, and a private-pay intake. 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
March came in at $19,000. Your nurse practitioner's first full month of visits landed as its own line, so you can see what she brings in against her pay.
- UnitedHealthcare batchMed management visits
- Intake private payPrivate pay visits
- NP payrollClinician wages
- Billing service feeBilling and clearinghouse
- Malpractice premiumInsurance
Why your books are different
A psychiatry practice's books go wrong around short visits and one-off costs.
A generalist sees a deposit and a payroll run. Your practice runs quick fifteen-minute med management visits at one rate and longer intakes at another, pays a nurse practitioner or physician assistant, and eats time on prior authorizations nobody bills for. When the books flatten all of that, you cannot see what actually drives the month.
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1
Med management visits and intakes get mixed together
A short medication check and a ninety-minute new-patient intake bill at very different rates, and mixed into one revenue line, you cannot tell whether the practice needs more new patients or more return visits.
What we doKeeps med management visits and intake visits in their own lines so you can see which kind of visit is actually driving revenue. -
2
A nurse practitioner or PA's production disappears into total revenue
When a psychiatrist adds a nurse practitioner or physician assistant to see patients, their visits and their pay often get lumped into the practice's general numbers, so nobody can tell if the hire is paying for itself.
What we doKeeps each clinician's wages against the revenue their visits bring in, so the math on adding staff is visible, not a guess. -
3
Prior authorization time never shows up as a real cost
Staff hours spent on medication prior authorizations are real, recurring labor that never gets billed to anyone, and if that time is not accounted for somewhere, the true cost of running the practice looks lower than it is.
What we doFlags administrative staff wages as their own line, separate from clinical pay, so the full cost of running the practice is visible. -
4
Insurance batches lag behind quick visits
Med management visits are quick and frequent, so a single insurance batch can cover dozens of short visits weeks after they happened, making a busy month look thin on paper.
What we doBooks the batch as income the day it lands and keeps a rough visit count against it, so a lagging deposit does not read as a slow month.
Your categories
The categories Gus keeps for a psychiatry practice.
Set up once for how the practice gets paid and what it spends. Nobody hand-sorts a category. Gus does, and an accountant checks it.
Money in
- Med management visitsShort medication check-ins, billed and tracked apart from intakes.
- Intake and evaluation visitsLonger new-patient visits, billed at their own rate.
- Private pay visitsOut-of-network patients paying by card, ACH, or check.
- TMS or other add-on servicesIf the practice also runs TMS or ketamine visits, kept in their own line.
Money out
- Clinician wagesW-2 pay for the psychiatrist, nurse practitioner, or physician assistant.
- Administrative staff wagesFront desk and prior-authorization staff, kept apart from clinical pay.
- Billing and clearinghouseFees paid to submit and track insurance claims.
- Malpractice insuranceCoverage for every prescribing clinician.
- EHR and e-prescribing softwarePractice management, charting, and e-prescribing subscription fees.
- Office rentClinic space, whether a single office or a multi-room suite.
What we watch for you
- Visit mix
Med management versus intake revenue, so you can see which visit type is driving the month.
- Clinician pay share
Wages against total collections, especially once a nurse practitioner or PA joins.
- Insurance lag
Weeks between visits and a batch deposit, so a busy month does not read as slow.
- The set-aside
What the practice will owe, tracked every month, so April is a number already known.
Ask Gus
Things psychiatry practice 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.
Her visits brought in more than her pay and benefits cost this month, for the first time. I keep that comparison running so you can see it change month to month.
It covers about forty med management visits at the contracted rate, which lines up with your calendar. Short visits pay less per visit, so a busy week can still look like this.
That is a real decision with real cost trade-offs on both sides. I can show you what the current service costs against what it collects, and the accountant can help you weigh a change.
The tax side
The tax side of a psychiatry practice.
Most of what goes wrong here is labels: clinician pay mixed with admin pay, and visit types blended together so the return misses what it should catch.
What your return has to get right
Your accountant signs it, so it gets done right the first time.
- Worker classification for clinical staffA nurse practitioner or physician assistant who works set hours on the practice's schedule is almost always an employee, not a contractor. Getting this wrong on a prescribing clinician is expensive if it gets flagged.
- Contractor 1099sAny biller, consultant, or locum clinician paid $2,000 or more in 2026 who is not on payroll gets a 1099-NEC by January 31. Gus keeps that list all year.
- The pass-through deductionMost practice owners can deduct up to 20 percent of business profit before it is taxed, though this often shrinks for a personal-service business like psychiatry at higher income.
- Equipment for add-on servicesIf the practice adds TMS or infusion equipment, it can usually be written off in the year it is bought, with 100 percent bonus depreciation available for property acquired after January 19, 2025.
Deductions psychiatry practices miss
Your bookkeeper knows what to look for in your statements. You never have to.
- Malpractice insurance premium
- State medical license renewal
- DEA registration renewal
- Continuing medical education
- EHR and e-prescribing software
- Billing service or clearinghouse fees
- Office or suite rent
- Front desk staff wages
- Professional liability tail coverage
- Medical association dues
- Waiting room furnishings
- Business phone and fax line
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 psychiatry practice year, kept every month.
Visit volume dips in January as patient deductibles reset, then steadies through the year. Gus keeps the practice ahead of both the calendar and the deadlines. 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, DEA and license renewal dates are on the radar, and the monthly set-aside is planned.
- April
Filed. Done.
The business return is filed and signed. No surprise bill, because the set-aside has been running since January.
- July
Halfway check
Where the practice stands, what it will owe, and whether a new hire this spring changed the number.
- October
Before year-end
Gus looks at any equipment purchases and moves worth making before December, alongside DEA renewal timing.
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 psychiatry 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 psychiatry practice owners ask first.
Can Gus separate med management visits from intake visits?
Yes. They are booked in their own lines so you can see which kind of visit is actually driving your revenue each month.
We just hired a nurse practitioner. Can the books show if she is worth it?
Gus tracks her wages against the revenue her visits bring in, so you can see the comparison directly instead of guessing from a lump total.
Does Gus handle prior authorizations or insurance appeals?
No. That stays with your clinical and billing staff. Gus books what lands in your account and keeps staff time visible as a real cost, but does not work with insurers directly.
My billing service takes a cut before the deposit lands. Does that get tracked?
Yes. Gus books the full visit value as revenue and the billing service's cut as its own cost, so you can see what it actually charges you.
We are considering adding TMS. Would that change our books much?
It would add its own revenue and equipment lines, and Gus sets those up the same way he does for the rest of the practice. The equipment write-off is a question for the accountant once you are close to buying.
Our books have never separated clinical pay from front desk pay. Can that be fixed?
Yes. Gus can rebuild recent months with that split and keep it going forward, so you can finally see what clinical staff cost against what admin staff cost.
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