Medical & Dental Practice Bookkeeping

Our current practice clients include a multi-provider dental group, primary care, an ophthalmology practice doing laser cataract surgery, emergency physicians working as independent contractors across hospital contracts, and psychiatry. That range matters less than the model — a cash-pay psychiatry practice and a multi-provider dental group need the books built completely differently, and we build to the model rather than to the specialty label.

No. Coding, claim submission, denial appeals, and payer disputes stay with your biller or coding staff. What we do is reconcile the financial results of that work — matching remittances to deposits, separating contractual adjustments from write-offs, and surfacing denials that quietly became permanent write-offs. Practices often find that reconciliation is what finally tells them whether their billing is working.

Yes, we'll sign your Business Associate Agreement, and we operate under one where our work touches protected health information. We also try to limit that exposure structurally: bookkeeping runs on financial data, so we request summary and financial-level reports rather than chart detail, scope system access to the financial modules, and exchange documents through a secure portal instead of email.

Yes — multi-entity structures are routine for us and one of the main reasons practices come to us. Each entity gets its own reconciled set of books, intercompany due-to and due-from accounts get reconciled monthly rather than accumulating, management fees and related-party rent get recorded on both sides, and you get both consolidated and standalone reporting. Unreconciled intercompany accounts are the most common mess we inherit from previous bookkeepers.

Yes, and it's usually the most useful number a practice has never seen. It requires collections attributed to the provider who produced them and the fully burdened cost of that provider — salary or formula pay plus payroll taxes, benefits, malpractice, CE, and retirement contributions. Once it exists, most owners find the spread between their strongest and weakest provider is wider than they assumed.

Yes. The hard part isn't the payroll run, it's that the formula depends on collections that aren't final for weeks. We reconcile the collection figures first so the calculation runs on numbers that hold up, then process pay on your schedule. We handle mixed rosters too — employed providers, contracted providers, and locums coverage in the same practice.

No. Whatever you chart and bill in, we work from what it produces. The common failure isn't the software — it's that nobody checks whether the PM system's financial reports and the general ledger agree, so unapplied payments, duplicate postings, and stale credit balances quietly accumulate. That reconciliation is part of what we do every month.

If you're operating through an entity, probably yes — just at a smaller scale. Contract income should be reconciled against every 1099 you receive rather than assumed correct, tracked by hospital or group, and kept cleanly separate from personal spending. Malpractice, licensing, CME, and travel need to be captured as they happen. The main deliverable is clean quarterly figures your CPA can plan estimates from.

No, and solo practices are often where the books slip furthest, because there's nobody whose job it is. We scope the engagement to the practice — cash pay and sliding scale tracked properly, out-of-network claims and patient balances followed, telehealth platform fees reconciled, no-show fee revenue captured. Small doesn't mean simple, but it does mean the price should reflect it.

No to both. Bulverde Business Solutions provides bookkeeping, payroll, and financial operations services — not CPA, tax, or attest services. We're not a CPA firm and we don't prepare returns. We keep the books accurate all year, assemble a year-end package your CPA can work straight from, and coordinate with them directly. Most CPAs are relieved to get clean books instead of a shoebox in March.

Normal, and it's how a lot of practice engagements start. We do a diagnostic review first, give you a written scope and a fixed price before any work begins, then bring the history current before running forward. With practices the usual finds are unreconciled deposits going back months, intercompany accounts nobody ever cleared, and equipment loans booked as expense. See our catch-up and cleanup service.

A flat monthly price, quoted after we look at your transaction volume, provider and staff count, number of entities and locations, payer mix complexity, and whether payroll and AP/AR are in scope. Entity count and payer complexity are the main drivers on a practice engagement. We don't bill hourly and we don't meter phone calls — a client who won't call because the clock is running is a client we can't help.