Medical practice accounting · Insurance reconciliation · HIPAA-aware · Clinical payroll
Healthcare accounting where accuracy and confidentiality aren’t optional — they’re the minimum standard.
Medical practices operate at the intersection of healthcare regulations, insurance billing complexity, and standard business accounting. Pair HIPAA-aware bookkeeping with clinical payroll, practice-level reporting, or a dedicated staff engagement that treats patient data with the discretion the law requires.
What we handle
Healthcare accounting specifics — handled correctly.
Insurance receivables reconciliation
Reconciliation of insurance payments against claims submitted. ERA and EOB matching. denied claim tracking. contractual adjustment posting. the most complex AR function in any medical practice.
Clinical staff payroll
Payroll for physicians, nurses, medical assistants, and administrative staff. malpractice insurance deductions, CME reimbursements, and on-call pay differentials handled correctly.
Practice-level financial reporting
Physician-level P&L, production vs collection analysis, payer mix reporting, and overhead ratio benchmarking. the management reports that let practice owners understand their financial performance.
HIPAA-aware data handling
Our engagement with healthcare clients is designed to minimise contact with protected health information. financial data is handled through HIPAA-aware workflows and our confidentiality standards apply in full.
Accounts payable management
Medical supply vendor AP, equipment lease payments, lab service invoices, and facility costs. full AP cycle management with payment approval workflows maintained.
Tax preparation support
Schedule C or entity return preparation support for physician-owned practices. self-employment tax calculations, QBI deduction analysis, and retirement contribution planning support for your CPA's review.
What makes healthcare different
The accounting complexity that general bookkeepers get wrong in medical practices.
Healthcare accounting has specific features that don’t exist in other industries. an accountant who treats a medical practice like a professional services firm will produce inaccurate financials — not because they’re incompetent, but because they don’t know what they don’t know.
Contractual adjustments are not bad debt
When an insurer pays less than the billed amount, the difference is a contractual adjustment — not an uncollectable receivable. posting it as bad debt produces overstated revenue and inflated AR that misleads the practice owner about their true financial position.
Patient co-pays and insurance payments reconcile differently
A visit generates two payment streams — the patient co-pay at point of service and the insurance payment arriving weeks later. both need to reconcile against the original claim. most general bookkeepers match only the cash received.
Physician compensation structures are highly specific
Physicians are often paid on production, collection, or a combination of both — not a fixed salary. the payroll calculation requires access to production data from the practice management system, not just the payroll platform.
Practice types we serve
Primary care
Family & internal medicine
High-volume, multi-payer practices with complex insurance reconciliation and patient co-pay management.
Specialty
Specialist practices
Cardiology, orthopaedics, dermatology, and other specialties with procedure-based billing and equipment-heavy balance sheets.
Dental
Dental practices
Insurance billing, patient financing reconciliation, and equipment depreciation specific to dental practice accounting.
Mental health
Therapy & counselling
Insurance credentialing complexity, session-based billing, and the specific payer mix challenges of mental health practices.
Group
Multi-physician groups
Physician-level production tracking, cost allocation between partners, and consolidated group reporting.
Ancillary
Labs, imaging & pharmacy
High-transaction ancillary services with specific billing, inventory, and compliance reporting requirements.
Other industries
Healthcare clients need accountants who know the difference between a contractual adjustment and bad debt.
Book a call and tell us about your healthcare client base. We'll confirm exactly what's in scope and what the first month looks like.
Book a discovery callOr email us directly at accounting@nimblechapps.finance — no forms, no bots.
