Medical practices & clinics
Books and taxes for speech therapy practices.
In-person sessions, teletherapy, school district invoices, and communication device funding that can take months to clear. 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
November came in at $11,700. A communication device funding claim from Medicaid finally cleared after a five-month wait, so I booked it the month it landed.
- Availity batch depositInsurance visit reimbursements
- TheraPlatform teletherapy feesTeletherapy software
- Lincoln school districtSchool contract revenue
- AAC device funding claimDevice funding revenue
- Clinical staff payrollClinical wages
Why your books are different
A speech therapy practice's books go wrong in the same four places.
You run in-person sessions, teletherapy, school contracts, and sometimes device funding, all with different payers and different timelines. A generalist treats it as one revenue stream, and a slow device claim or a district's payment cycle looks like a bad month instead of just a late one.
-
1
Communication device funding clears months later
A funding claim for an augmentative communication device can take months to clear through Medicaid or a private payer, arriving well after the evaluation and trial period happened.
What we doBooks device funding revenue the month it actually lands, so a slow claim doesn't get mistaken for a drop in regular session volume. -
2
Teletherapy and in-person sessions blend together
A teletherapy session costs less to deliver than an in-person one, no room, no drive time, but if both land in the same revenue line you cannot tell which model is actually more profitable.
What we doKeeps teletherapy and in-person session revenue apart, with the teletherapy software fee tracked against it, so the real margin on each is visible. -
3
School contracts pay on the district's own calendar
A district often invoices monthly and pays 60 to 90 days later on its own fiscal schedule, a normal delay that can look like a business problem if it is blended with other revenue.
What we doKeeps school contract revenue in its own line, booked when it actually lands, so a district's slow payment cycle doesn't read as a drop in business. -
4
Group and individual sessions get billed as one rate
A group articulation session brings in a different amount per child than a one-on-one session, and blending the two hides which format is actually worth scheduling more of.
What we doKeeps group and individual session revenue apart, so you can see which format is actually carrying the schedule.
Your categories
The categories Gus keeps for a speech therapy practice.
Set up once for how you get paid and what the practice spends. You never pick a category. He does, and an accountant checks it.
Money in
- Insurance visit reimbursementsDeposits from payers for authorized in-person and teletherapy sessions.
- School contract revenueInvoiced sessions billed to a school district on its own payment schedule.
- Device funding revenueClaims for augmentative and alternative communication devices, booked when they clear.
- Cash-pay sessionsFamilies paying directly for services insurance does not cover.
Money out
- Clinical wagesSLPs and clinical fellows, kept apart from contract therapist pay.
- Teletherapy softwareVideo and scheduling tools such as TheraPlatform used to deliver and bill remote sessions.
- Therapy materials and assessmentsStandardized assessments, workbooks, and articulation materials.
- Rent and utilitiesClinic space, kept separate from teletherapy's lower overhead.
- Malpractice insuranceAnnual or quarterly premiums for the practicing clinicians.
- Continuing educationCertification maintenance and specialty training such as feeding therapy courses.
- Practice management softwareScheduling, documentation, and billing tools.
What we watch for you
- Device funding lag
How long a communication device claim takes to clear, tracked from what has actually landed.
- Teletherapy share
How much of each month is teletherapy versus in-person, since the cost to deliver each is different.
- District contract lag
How long a school district takes to pay after sessions happen, tracked from actual deposits.
- The set-aside
What you will owe, tracked every month, so April is a number you already knew.
Ask Gus
Things speech 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.
Yes, it counts the month the payment actually lands, not the month of the evaluation. I booked it here so the timing stays honest.
I keep the revenue from each apart, with the teletherapy software fee tracked against it, so you can see the real margin for yourself.
If she bills you directly and sets her own hours, that usually points to a contractor, and she gets a 1099-NEC if you pay her $2,000 or more this year. I flagged it for the accountant to confirm.
The tax side
The tax side of a speech therapy practice.
Most of what matters here is timing device funding and school contract 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 speech 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.
- Device funding revenue timingA communication device claim is income the year the payment is actually received, even if the evaluation and trial happened the year before. Keeping the date clear helps the accountant report it correctly.
- Contract and fellow therapist payA clinical fellow or contract therapist who 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.
- Assessment materials and small equipmentStandardized assessments and small clinical equipment are generally deductible the year they are bought, while larger equipment purchases may be handled as a capital expense.
Deductions speech therapy practices miss
Your bookkeeper knows what to look for in your statements. You never have to.
- Standardized assessments
- Teletherapy software fees
- Malpractice premiums
- Continuing education and certification
- Therapy materials and workbooks
- License renewal fees
- Practice management software
- Feeding and articulation supplies
- Scheduling and answering service
- Referral and outreach marketing
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 speech therapy year, kept every month.
School contracts run on a district calendar, device claims run on their own, and your taxes run on a third. 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, any contract therapist's 1099 is ready, and you get a monthly set-aside so April is already handled.
- 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 summer caseload gaps or a cleared device claim changed the number.
- October
Before year end
Gus looks at anything worth doing before December, while fall school district invoices are still working through the system.
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 speech therapy 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 speech therapy owners ask first.
Do you bill insurance or handle device funding claims?
No. Gus does not handle insurance billing, medical coding, device funding claims, or district invoicing. Your practice management software or billing service still does that. Gus works from what actually lands in your bank account.
Our AAC device claims take months to clear. Does that mess up the books?
No. Gus books that revenue the month it actually lands, so a slow claim doesn't get mistaken for a drop in regular caseload.
Is it worth tracking teletherapy separately from in-person sessions?
Yes, and Gus already does it. The cost to deliver each is different, so keeping them apart shows you the real margin on both.
Our school district contract pays 90 days after invoicing. Is that normal?
It is common. Gus books that revenue when it lands and keeps it apart from other income, so the delay doesn't read as a drop in business.
Some of our clinicians are clinical fellows supervised remotely. Does that change how they're paid?
It depends on whether they set their own schedule and bill you directly, which points toward a contractor, or work your practice's schedule under supervision, which usually points toward an employee. Gus flags the setup for the accountant.
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