Industry · Healthcare accounting
Healthcare accounting that tracks what you collect, not just what you bill.
Practices rarely collect what they charge — contractual adjustments, write-offs, and patient balances stand between billed and banked. TechBrot’s team, led by a Certified QuickBooks ProAdvisor, reconcile payer deposits, track revenue per provider and location, handle payroll and patient refunds, and keep protected health information out of the books — so your numbers reflect reality. Independent firm, not affiliated with Intuit Inc.
Healthcare bookkeeping breaks in ways ordinary bookkeeping doesn’t: a practice almost never collects what it bills, so gross charges, contractual adjustments, write-offs, patient responsibility, and net collections are all different numbers — and revenue is only real once it’s in the bank. Add per-provider and per-location performance, clinical payroll, patient credit balances that must be refunded, and the need to keep protected health information out of the accounting records, and generic bookkeeping falls short. TechBrot’s team, led by a Certified QuickBooks ProAdvisor, reconcile payer deposits to your own QuickBooks file from financial summaries, track billed-versus-collected revenue by provider and location, handle payroll and refunds, and deliver financials your CPA can file from. We are not a medical billing or coding company.
Maintained by TechBrot Inc., an independent firm — not affiliated with Intuit Inc. Bookkeeping and ProAdvisor scope only; does not file income taxes, provide medical billing or coding, or certify HIPAA compliance — coordinates with your CPA, billing company, and counsel.
Healthcare accounting, in five questions.
Why is healthcare bookkeeping harder?
Practices rarely collect what they bill. Gross charges, contractual adjustments, write-offs, patient responsibility, and net collections are all different numbers, and revenue is only real once collected — plus per-provider and per-location performance, clinical payroll, and patient credit balances that have to be refunded. Bookkeeping that records only the deposit misses all of it.
Do you reconcile insurance and payer deposits?
Yes. Payer deposits are reconciled to your QuickBooks file from remittance and deposit summaries, separating gross charges, contractual adjustments, patient payments, and net collections — so you see billed versus collected, not one lump deposit. We work from financial summaries, never PHI.
Can you track per-provider or per-location profit?
Yes. We configure QuickBooks — typically with Classes or location tracking — so each provider and location has its own profit and loss alongside a consolidated practice view, which is what compensation, hiring, and payer-mix decisions actually need.
How do you handle HIPAA and patient data?
Accounting doesn’t require protected health information. We work from financial summaries — deposit reports and remittance totals — and keep PHI out of the books. We are not a medical billing or coding company and do not certify HIPAA compliance; that stays with your practice and its counsel.
What does it cost?
A fixed monthly fee against a written scope — driven by the number of providers and locations, payer and payroll complexity, and reporting needs. No hourly billing. TechBrot does not file income taxes; we coordinate with your CPA or EA. See pricing.
Healthcare accounting, plainly.
Healthcare books break in ways ordinary bookkeeping doesn’t: a practice almost never collects what it bills, so gross charges, insurance contractual adjustments, write-offs, patient responsibility, and net collections are all different numbers — and revenue is only real once it’s in the bank. A claim is billed at the practice’s standard rate, the payer allows a lower contracted amount, the difference is a contractual write-off (not a loss to chase), part is the patient’s responsibility, and only the deposit that lands is collected revenue. Record the lump deposit as income and the whole picture — your real collection rate, which payers underpay, what’s still outstanding — disappears.
Add per-provider and per-location performance, payroll for clinical and administrative staff, patient credit balances that must be refunded rather than absorbed, and the need to keep protected health information out of the accounting records, and generic bookkeeping that only tracks company-wide income and expense falls short. TechBrot’s team, led by a Certified QuickBooks ProAdvisor, reconcile payer deposits to your own QuickBooks file from financial summaries, track billed-versus-collected revenue by provider and location, handle payroll and refunds, and deliver financials your CPA can file from. We are not a medical billing or coding company, and accounting never requires PHI. For practices ready to act on the numbers, advisory adds the judgment layer on top. Independent firm led by a Certified QuickBooks ProAdvisor — not affiliated with Intuit Inc.
Three places practices lose the numbers.
Nearly every messy practice file fails in the same three areas. Knowing which one you’re in tells us where to start.
Billed treated as collected.
Gross charges get booked as income while contractual adjustments and write-offs are ignored, so revenue looks far larger than what hits the bank and you can’t see your real collection rate. The fix is payer deposits reconciled to QuickBooks with gross charges, adjustments, patient payments, and net collections separated — revenue recognized on what’s actually collected. If your books show charges rather than collections, your profit is fiction and your taxes may be overstated. Fixable from financial summaries, no PHI required.
No per-provider or location view.
Income and cost sit in one practice-wide ledger, so you can’t tell which providers, locations, or service lines carry the practice — or how the payer mix affects each. The fix is provider- and location-level tracking in QuickBooks, using Classes or location tracking, so profitability and payer mix are visible and decision-ready. Compensation and hiring decisions made without per-provider numbers are guesses; real data changes them.
Credit balances and PHI mishandled.
Patient overpayments get booked as income instead of refundable liabilities, and protected health information ends up in accounting records where it shouldn’t be — both create real exposure. The fix is patient credit balances booked as liabilities so refunds are tracked, and a clean process that keeps the books built from financial summaries, never PHI. We keep the records and the data handling right; HIPAA-compliance certification and income-tax filing stay with your counsel and CPA, and we coordinate cleanly.
Healthcare accounting, done by an expert.
Every engagement is scoped to your providers, locations, and systems, delivered in your own QuickBooks file by a named Certified ProAdvisor.
Payer deposit reconciliation
Payer and patient deposits reconciled to QuickBooks from remittance and deposit summaries — gross charges, contractual adjustments, patient payments, and net collections separated — so billed-versus-collected and your true collection rate are visible.
Per-provider & location books
Income and cost tracked by provider and location with QuickBooks Classes or location tracking, so each has a real P&L alongside a consolidated view of the whole practice — the visibility behind compensation and growth decisions.
Payroll & provider compensation
Payroll for clinical and administrative staff integrated with the books, with provider-compensation tracking and clean W-2-versus-1099 treatment where per-diem or locum providers work alongside employed clinicians.
Practice-book cleanup
Behind or built on charges-as-income? We reclassify to collection-based revenue, rebuild patient credit balances as liabilities, and reconcile each account to a known-good baseline — then keep it clean.
QuickBooks setup for practices
A healthcare chart of accounts, provider and location structure, and the right connections from your practice-management, billing, and payment systems into QuickBooks — built so payer deposits reconcile from day one.
Practice advisory
As the practice grows, fractional CFO advisory on provider profitability, payer mix, staffing against revenue, and cash flow — the judgment layer above the books, where the value now lives.
Connected to how you run the practice.
- QuickBooks Online — the practice ledger payer deposits reconcile into
- athenahealth — deposits and adjustments exported to QuickBooks
- Tebra (Kareo) — practice-management payments matched to deposits
- SimplePractice — behavioral-health billing reconciled
- Jane — clinic deposits and patient payments reconciled
- DrChrono — EHR and billing reconciled to the books
- AdvancedMD — remittance and deposit summaries to QuickBooks
- Stripe & Square — patient copays and card payments
On a different EHR or practice-management system? We reconcile from financial summaries — deposit and remittance reports — not protected health information, so if your system exports deposits and adjustments to QuickBooks we can build the workflow around it. Ask on a discovery call.
From billed-not-banked to collection-based books.
Every healthcare engagement follows the same four-phase rhythm — built so your books are accurate before anyone tries to advise on them.
Discovery
A 30-minute call to map your providers, locations, billing and payment systems, payer mix, and where the books are breaking. No pitch.
Cleanup & setup
If needed, a cleanup to move from charges to collection-based revenue, plus QuickBooks setup with provider and location structure and reconciliation workflows.
Monthly reconciliation
Payer deposits and accounts reconciled monthly, with per-provider performance, payroll, and patient refunds maintained and contractual adjustments separated from real revenue.
Reporting & advisory
A monthly package with per-provider and per-location margin and collection-rate reporting, plus advisory as the practice grows.
The five numbers a practice charge becomes.
A single claim moves through five different figures before it’s real revenue. Bookkeeping that records only the deposit — or only the charge — misses where the money actually went.
| Figure | What it is | Where it belongs in the books |
|---|---|---|
| Gross charge | The practice’s standard billed rate for the service, before any payer contract applies. | A reference figure, not revenue — never the number that should hit your income. |
| Contractual adjustment | The difference between the gross charge and the rate the payer has contracted to allow. | A write-off against the charge, separated out — not a bad debt to chase and not a loss. |
| Allowed amount | What the payer contract actually permits for the service — charge minus the contractual adjustment. | The basis for what should ultimately be collected between payer and patient. |
| Patient responsibility | Copay, coinsurance, or deductible the patient owes out of the allowed amount. | Receivable from the patient until paid; tracked separately from payer A/R. |
| Net collections | The deposits that actually land — payer remittances plus patient payments. | The only figure that is real revenue. Credit balances booked as refundable liabilities, not income. |
The KPI and reporting layer: what the numbers are actually for.
Reconciled books answer “is this right?” A KPI layer answers “what is happening, and is it getting worse?” These are the practice KPIs worth reading month to month — each computed from the ledger and the remittance data, so they can be read independently of the party being measured. Every one of them is only as good as the bookkeeping decision listed beside it.
| Measure | What it tells you | What the books have to produce |
|---|---|---|
| Net collection rate | What the practice collected against what the payer contracts actually allowed — not against gross charges, which overstates the shortfall. | Allowed amounts separated from contractual adjustments, and patient responsibility tracked apart from payer receivables. |
| Days in accounts receivable | How long money sits between service and deposit — the earliest visible sign that claims are stalling. | A/R aged by payer and by date of service, with credit balances excluded so they do not net away real ageing. |
| Denial and rework rate | The share of claims denied, and how much of the collected money required a second submission to arrive. | Denials and resubmissions recorded as events, not absorbed silently into the next remittance. |
| Payer concentration | How much of the practice depends on any single payer — the exposure that matters if one contract changes. | Deposits attributed by payer every month, not just at year end. |
| Provider contribution | What each provider collects against the direct cost of keeping them working — compensation, support staff, space, and supplies. | Revenue and direct costs both tagged by provider, which is a chart-of-accounts decision made before the fact. |
| Cost per encounter | Total operating cost divided by visits — the figure that shows whether volume growth is actually paying for itself. | A clean operating-expense base and a visit count the practice agrees on and computes the same way each month. |
The reason to compute these from the books rather than take them from a billing report is that a billing company’s performance report is a self-assessment. That is not an accusation — a vendor’s dashboard is built to show its own work, and it usually shows it fairly. But denial rate, days in A/R, and net collection rate are the measures of that work, and a practice that reads them only from the party doing the work has no independent check. Computing them from deposits, remittances, and the ledger gives a second read from a different source. Where the two agree, the practice can stop wondering. Where they diverge, the divergence is the finding.
Reporting to a board, an MSO, or a lender.
Once a practice answers to someone outside it — a board, a management company, or a bank — the monthly close stops being an internal record and becomes a document other people make decisions from. Four things make that package land.
A package that arrives the same way every month
Balance sheet, income statement, and cash-flow statement on a fixed calendar, with the prior period and the year-to-date beside them. Boards and lenders read pattern before they read magnitude, so the format staying constant matters as much as the numbers being right — a package that changes shape each month cannot be read as a trend.
Covenant calculations shown, not just asserted
If a practice loan carries a debt-service coverage or a fixed-charge covenant, the lender wants the ratio and the figures it was built from. Computing it the way the credit agreement defines it — which is often not the way the P&L presents it — and showing the workings is what turns a covenant certificate into something the bank can accept without a follow-up.
Payer concentration and A/R quality stated up front
Both a board and a lender will eventually ask what share of revenue rides on one payer and how much of the receivable is genuinely collectible. Putting the payer split and the aged A/R in the package as a standing schedule answers it before it is asked, and stops the answer from being assembled under time pressure.
Provider and location detail behind the summary
The consolidated statement is what gets discussed; the per-provider and per-location detail is what the discussion turns to within about ten minutes. Producing both together, from the same ledger, is the difference between a reporting pack and a summary someone then has to go behind.
On benchmarks, plainly. This page does not publish industry benchmark figures for days in A/R, net collection rate, or cost per encounter. Published sets exist, but they vary by specialty, region, payer mix, and the methodology used to build them, and quoting a single number as though it applied to every practice would be a claim we have not verified and cannot support. What we benchmark against is the practice’s own trend and its own payer contracts — a rate that is drifting against last quarter, or a payer paying below its contracted allowed amount, is a finding a general number cannot give you. Where a specialty association publishes a comparison set the practice trusts, we will report against it; that is the practice’s choice of source, not ours. Fractional CFO and reporting scope →
Clean books are the start. A stronger practice is the point.
Once payer deposits reconcile and your collection-based numbers are real, the question changes from “are the books right?” to “what do we do about them?” Which providers and service lines to grow, how the payer mix is shaping margin, whether a provider or location is carrying the practice or dragging it, when to add staff or space, how to structure compensation — the decisions that separate practices that thrive from those that just stay full.
That’s where healthcare advisory comes in: a Certified ProAdvisor who knows your numbers turning them into provider-profitability, payer-mix, and growth decisions through cash-flow forecasting and fractional CFO work. As automation commoditizes basic bookkeeping, this judgment layer is where the value — and the margin — now lives. Explore fractional CFO & advisory →
Maintained under a Certified ProAdvisor.
This page reflects how TechBrot actually handles healthcare engagements. It is maintained by TechBrot Inc., a Delaware-incorporated independent bookkeeping and advisory firm, and kept current on payer-deposit reconciliation, collection-based revenue, and per-provider tracking. Where our approach or scope changes, this page is updated. We are not a medical billing or coding company and do not certify HIPAA compliance; income-tax filing and entity matters stay with your CPA and counsel.
Certifications
Active Intuit Certified QuickBooks ProAdvisor — Online (L2) and Payroll
Scope
Payer reconciliation, collection-based revenue, per-provider books, payroll, patient refunds · built from financial summaries, not PHI · income-tax filing coordinated with your CPA/EA
Engagement
Fixed-fee, written scope before work · delivered in your own QuickBooks file
Independence
Independent bookkeeping and advisory firm led by a Certified QuickBooks ProAdvisor · Not affiliated with Intuit Inc. · Not a medical billing, coding, or HIPAA-certification company
Healthcare accounting questions.
Why is healthcare accounting different from regular bookkeeping?
Do you reconcile insurance and payer deposits to QuickBooks?
Can you track profitability per provider or per location?
Do you handle payroll, provider compensation, and patient refunds?
How do you handle HIPAA and patient data?
What does healthcare bookkeeping cost?
Do you offer advice, or just bookkeeping?
Do you produce a KPI dashboard for the practice?
Can you produce reporting for a board, an MSO, or a lender?
Ready when you are
Get practice books that match what you collect.
Book a 30-minute discovery call. We’ll review your providers, payer mix, where the books are breaking, and the right next step — with a written fixed-fee scope within 3 business days. No pitch.