Medical and dental practices run on insurance reimbursement, expensive equipment and a payroll mix that regulators look at closely. The accounting problems are specific, and generic small business advice gets them wrong.
Fixed fees, quoted in writing. Florida licensed CPA.
None of these show up in a general small business playbook.
You produce a service, you bill it, the payer adjusts it, and eventually some of it arrives. On cash basis books your best production month can look like your worst month.
Health is a specified service trade or business under Section 199A. Above the income thresholds, the 20 percent qualified business income deduction phases out entirely for practice owners.
Associates, hygienists, per-diem coverage and contracted specialists are frequently paid as 1099 contractors when the facts point to employee treatment. This is one of the more commonly examined issues in practice settings, and the assessment includes back payroll taxes and penalties.
Solo providers through multi-location groups.
Revenue recognized when earned, contractual adjustments booked properly, and a receivables aging that tells you which payers are slow and which claims are dying.
W-2 versus 1099 for associates and clinical staff, reviewed against the actual facts rather than what is convenient. Fixing this before an examination is far cheaper than after.
Chairs, imaging, lasers and leasehold improvements timed against Section 179 limits and bonus depreciation. If you own the building, a cost segregation study is often worth running.
For a high-earning owner whose QBI deduction is limited, a defined benefit or cash balance plan can shelter far more than a 401(k) alone. This is frequently the single largest deduction available to a practice owner.
PA and PLLC structure, S corporation elections, reasonable compensation for owner-providers, and the accounting behind an associate buy-in or a partner buy-out.
Consolidated financials with location-level contribution, so you can see which office carries the group and which one is being subsidized.
Connected properly, so your books close on live data instead of month-old statements. Where we hold a certification, we say so.
General information, not advice for your situation. Outcomes depend on facts we would need to review with you.
“For the first time, I feel like I actually understand my business finances. Philip does not just prepare our taxes, he helps us make better decisions throughout the year.”
Both. Dental, medical, veterinary, physical therapy, behavioral health and similar owner-operated practices share the same core structure: insurance or payer reimbursement, significant equipment, a licensed provider as owner, and clinical staff. The specifics of the fee schedule differ, the accounting problems do not.
It is the first thing we look at, and the honest answer is that many practice owners have a number that was set once and never revisited. Reasonable compensation should reflect what the clinical and management work you personally perform would cost to replace, supported by data. Too low invites reclassification of distributions as wages plus penalties. Too high costs you unnecessary payroll tax.
It depends on the purchase price of the building or the size of the buildout and how long you intend to hold it. For an owned facility with a significant clinical buildout, it frequently is. For a modest leasehold improvement in a space you may exit in three years, often not. We look at the numbers before recommending a study, and we do not take a percentage of the result.
Possibly. The determination turns on behavioral control, financial control and the nature of the relationship, not on what the agreement says or what is customary in your area. If you set the schedule, provide the equipment and the space, and the person works only for you, the facts generally point to employee treatment. It is worth reviewing before someone else does.
Our pricing is published. Answer a few questions in the quote tool and a real starting figure appears on screen. A fixed fee is confirmed in writing after we review your situation.
Most firms make you book a call before they will name a price. Answer a few questions and get a real starting number in about two minutes.
