Medical practices & clinics
Books and taxes for sleep clinics.
Overnight sleep studies, CPAP machines rented toward ownership, mask and filter resupply, and techs paid to stay up all night. 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
February came in at $18,400. Overnight tech coverage ran three extra shifts for a full lab, so I kept that against study volume instead of folding it into regular payroll.
- Availity batch depositSleep study reimbursements
- CPAP rental month 4 of 13CPAP rental revenue
- ResMed equipment orderCPAP and supply inventory
- Mask and filter resupply batchResupply revenue
- Overnight tech payrollOvernight staffing
Why your books are different
A sleep clinic's books go wrong overnight, literally.
You are running a facility that stays open through the night, renting equipment toward eventual ownership over more than a year, and mailing resupply orders on a recurring basis. A generalist treats all of that like a normal daytime office and misses where the real cost and the real pattern sit.
-
1
CPAP rentals trickle in over more than a year
A CPAP machine is often rented to the patient for around 13 months before ownership transfers, with a partial payment landing each month rather than one sale, and a generalist can lose track of where a patient is in that cycle.
What we doBooks each month's CPAP rental payment as its own line, tied to the patient's rental period, so the slow build toward a completed sale stays visible. -
2
Overnight staffing is a cost no daytime practice carries
Running an overnight sleep lab means paying techs to stay awake and monitor patients through the night, a real and substantial cost that has no equivalent in a typical medical office and gets lost if it's buried in general payroll.
What we doKeeps overnight staffing costs in their own line, tracked against study volume, so the true cost of running the lab overnight is visible. -
3
Resupply orders create small, steady, easy-to-miss revenue
Masks, tubing, and filters mailed on a recurring schedule bring in small amounts often, and if they're lumped into equipment sales, the steady recurring base of the business disappears next to bigger, less frequent numbers.
What we doKeeps resupply revenue in its own line, separate from CPAP equipment sales, so the recurring base of the business stays visible. -
4
Study facility fees and interpretation fees pay out separately
A sleep study often generates a facility fee for the lab itself and a separate professional fee for the physician who interprets the results, landing in the bank on different days for the same patient's study.
What we doMatches both payments back to the same study so a study month reads as complete, not as two unrelated deposits.
Your categories
The categories Gus keeps for a sleep clinic.
Set up once for how studies, CPAP rentals, and resupply orders all get paid. You never pick a category. He does, and an accountant checks it.
Money in
- Sleep study reimbursementsFacility and interpretation fees for in-lab and home sleep studies.
- CPAP rental revenueMonthly rental payments during the path toward equipment ownership.
- Resupply revenueRecurring mask, tubing, and filter orders shipped to patients.
- Cash-pay consultation feesFollow-up visits paid directly by the patient.
Money out
- CPAP and supply inventoryEquipment and resupply stock from suppliers such as ResMed or Philips Respironics.
- Overnight staffingSleep techs monitoring patients through the night, kept apart from daytime staff.
- Lab facility costsRent and utilities for a space built to house overnight patients.
- Malpractice insuranceAnnual or quarterly premiums for the interpreting physicians.
- Equipment maintenanceServicing for polysomnography and monitoring equipment.
- Practice management softwareScheduling, charting, and billing tools.
- Shipping and fulfillment costsGetting resupply orders out to patients on schedule.
What we watch for you
- CPAP rentals in progress
How many patients are mid-rental toward ownership, tracked from monthly payments received.
- Overnight staffing cost per study
What it costs to staff the lab overnight against how many studies were run.
- Resupply revenue trend
How the recurring resupply base is growing or shrinking month to month.
- The set-aside
What you will owe, tracked every month, so April is a number you already knew.
Ask Gus
Things sleep clinic 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.
I book each month's rental payment tied to that patient's rental period, so you can see where anyone stands without digging back through old records.
I track it against how many studies were run that month, so you can see whether the cost lines up with volume or whether something's off.
Yes, they stay in their own line since they're small and recurring, while a new machine sale or rental is a bigger, less frequent number. Keeping them apart shows the real shape of the business.
The tax side
The tax side of a sleep clinic.
Most of what matters here is timing CPAP rental revenue correctly 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 sleep clinic 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.
- CPAP and lab equipment purchasesPolysomnography and CPAP equipment can usually be written off the year you buy them, with 100 percent bonus depreciation available for property acquired after January 19, 2025.
- CPAP rental revenue timingMonthly rental payments are income as they're received over the rental period, rather than all at once, which keeps the return matched to when the cash actually arrives.
- Overnight and per-diem techsA sleep tech who covers occasional overnight 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.
Deductions sleep clinics miss
Your bookkeeper knows what to look for in your statements. You never have to.
- CPAP and supply inventory
- Lab equipment maintenance
- Overnight staffing costs
- Malpractice premiums
- Practice management software
- Shipping and fulfillment for resupply
- CME and board certification renewal
- Scrubs and clinical apparel
- Patient education materials
- 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 sleep clinic year, kept every month.
CPAP rentals run on a 13-month cycle of their own, resupply runs on its own schedule, and 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 CPAP rentals still in progress.
- 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 study volume or CPAP rentals changed the number.
- October
Before year end
Gus looks at equipment worth buying and anything worth doing before December, as colder months often bring more sleep study referrals.
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 sleep 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 sleep clinic owners ask first.
Do you bill insurance for sleep studies or CPAP equipment?
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 track a CPAP that's still in its rental period?
Each month's rental payment is booked tied to that patient's rental cycle, so you can see where any patient stands in the path toward ownership.
Overnight staffing is our biggest cost most months. Can that be tracked separately?
Yes, and Gus already keeps it apart from daytime payroll, tracked against study volume, so the real cost of running the lab overnight is visible.
A sleep study facility fee and the physician's interpretation fee paid out on different days. Is that normal?
Yes, that's common. Gus matches both payments back to the same study as they land, so the study reads as complete once both arrive.
Does resupply revenue need its own category from CPAP equipment sales?
Yes. Resupply orders are smaller and recur often, while equipment sales are bigger and less frequent. Keeping them apart shows the real shape of the business.
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