5.0 out of 5 based on 41 reviews
Dental Practice Accounting for Dental and Medical Practices
Know where the money is going, which parts of the practice are most profitable, and what is holding margins back.
★★★★★“Since adding Alex with Stronghold Accounting for our bookkeeping, it has truly been a Godsend for our business. Alex cleaned up a difficult QuickBooks transition and became a game changer for our month-to-month bookkeeping.”Patty LeslieTampa
★★★★★“I like that you're helping me strategize, not just giving me numbers. There were still blind spots that you've been able to uncover for me. I didn't think that was possible.”JoelService-business owner
★★★★★“Alex and his team helped bring the books current and continue to provide monthly support while helping plan for growth.”Dr. MaloneLake Mary
★★★★★“Alex is sharp, detail-oriented, and genuinely passionate about his work. He explains the numbers clearly and helps business owners gain more control over their finances.”Baxter McCoyOrlando
★★★★★“Since adding Alex with Stronghold Accounting for our bookkeeping, it has truly been a Godsend for our business. Alex cleaned up a difficult QuickBooks transition and became a game changer for our month-to-month bookkeeping.”Patty LeslieTampa
★★★★★“I like that you're helping me strategize, not just giving me numbers. There were still blind spots that you've been able to uncover for me. I didn't think that was possible.”JoelService-business owner
★★★★★“Alex and his team helped bring the books current and continue to provide monthly support while helping plan for growth.”Dr. MaloneLake Mary
★★★★★“Alex is sharp, detail-oriented, and genuinely passionate about his work. He explains the numbers clearly and helps business owners gain more control over their finances.”Baxter McCoyOrlando
★★★★★“Since adding Alex with Stronghold Accounting for our bookkeeping, it has truly been a Godsend for our business. Alex cleaned up a difficult QuickBooks transition and became a game changer for our month-to-month bookkeeping.”Patty LeslieTampa
★★★★★“I like that you're helping me strategize, not just giving me numbers. There were still blind spots that you've been able to uncover for me. I didn't think that was possible.”JoelService-business owner
★★★★★“Alex and his team helped bring the books current and continue to provide monthly support while helping plan for growth.”Dr. MaloneLake Mary
★★★★★“Alex is sharp, detail-oriented, and genuinely passionate about his work. He explains the numbers clearly and helps business owners gain more control over their finances.”Baxter McCoyOrlando
What makes practice accounting different
The gap between production and collection. A practice bills $80,000 of work in a month and collects closer to $55,000 of it, weeks later, once insurance pays its share and patient balances come in. Owners run the business on the $80,000. Only the $55,000 pays the wages.
Production versus collectionA medical practice accountant or dental CPA who only produces a P&L is reporting on the wrong number. An accountant for doctors and an accountant for dentists face the same core issue: production is not collection, and the practice management system reports one while the accounting system should be recording the other. Bookkeeping for therapists follows the same pattern at smaller ticket sizes and higher volume.
The problems that only happen at practices
01Production treated as revenueProduction is what was done. Collection is what arrived. The difference is contractual adjustments, insurance write-offs and unpaid patient balances, and in some practices it is a third of the headline figure. Practice management software reports production. The accounting system should be recording collections.
02Insurance receivables aging quietlyClaims denied, resubmitted, partially paid or never chased. Without aging by payer, a practice cannot tell whether a slow month was a demand problem or a billing one.
03Practice management software that never reaches the ledgerDentrix, Open Dental or Athenahealth on one side, QuickBooks on the other, and a monthly deposit total connecting them. All the useful detail is on the wrong side of that gap.
04Associate and hygienist compensation on productionPay tied to production while the practice collects less than it produces means the practice absorbs the shortfall. Whether the arrangement is on production or collection is one of the highest-value questions in a practice’s P&L.
05Equipment financed and treated as an expenseA $90,000 chair or imaging system on a five-year note is an asset and a liability, with interest and depreciation, not a monthly cost line. Practices with several financed assets often have a balance sheet that bears little relation to reality.
06Owner compensation muddled with practice profitVery common in single-owner practices. Without separating the salary for clinical work from the return on owning the business, the owner cannot tell whether the practice is worth owning or is simply a job with overheads.
07Therapy and counselling practices with a different shapeSmaller ticket, higher volume, heavier insurance panel work and frequent no-shows. Same underlying problem: what was billed and what arrived are not the same number.
What we handle for practices
The problem
What we do
Collections
Collections tracked against production, with the gap reported monthly
Insurance receivables
Insurance receivables aged by payer, so slow payers are visible
Practice management
Practice management software reconciled to the ledger, not connected by a deposit total
Provider compensation
Associate and hygienist compensation modelled on production or collection, whichever the contract says
Equipment finance
Equipment finance recorded properly, with the asset, the liability, the interest and the depreciation split out
Owner compensation
Owner compensation separated from practice profit
Chart of accounts
Chart of accounts built for practice reporting: supplies, lab, staff, facility, as percentages of collections
Multi-location reporting
Multi-location or multi-provider reporting where relevant
CPA analysis
CPA analysis of the monthly close
Practice benchmarks
50-65%+Target gross margin
15-25%+Target net margin
50-65%Target operating expenses as a share of collections, excluding owner or provider compensation where appropriate
Under 40 daysTarget receivables
Software we work in
QuickBooks Online for the general ledger, with experience working from PatientNow and other practice-management reports. We work from the reports your practice management system already produces. Nobody needs to re-key anything.
How it works
STEP 1Collections baseline first. What is being produced against what is arriving, and where the gap sits.
STEP 2Chart of accounts rebuilt for practice reporting, expressed as percentages of collections.
STEP 3Foundation Buildout, particularly around equipment finance and owner draws. The typical timeline is 2-4 weeks.
STEP 4Monthly close, with a collections report alongside the P&L.
Proof
$784KAccounting misstatements identified and corrected, multi-location healthcare business
4 weeksTo reliable financial statements, after rebuilding nearly two years of activity
What it costsPricing is custom and flat-rate. The quote reflects company size, industry, headcount, bank and credit-card accounts, locations, entity count, transaction volume, and any cleanup required.
For a multi-location healthcare business, Stronghold identified and corrected more than $784,000 in accounting misstatements, rebuilt nearly two years of activity, and delivered reliable financial statements in about four weeks.Multi-location healthcare business
Services practices usually need
See more services for practices
Common questions
Practice questions
Do you work with dental practices specifically, or medical generally?
Both, plus therapy and counselling practices. The mechanics are shared: production against collection, insurance timing, and provider compensation. The benchmarks differ by practice type and we use the right ones.
Are you a dental CPA?
Stronghold is a CPA-led accounting team that works with dental and medical practices. A CPA analyzes the close and the story behind the numbers.
Do you work with therapy and counselling practices?
Yes. Bookkeeping for therapists follows the same production-against-collection pattern at smaller ticket sizes, with heavier insurance panel work and no-show rates that materially affect revenue.
Can you work with our practice-management software?
Yes. Stronghold works from the reports it produces and reconciles them to QuickBooks Online; PatientNow is among the systems the team has used.
How do you handle insurance receivables?
Aged by payer and reported monthly, so a collections problem is visible as a collections problem rather than a bad month.
Should our associates be paid on production or collection?
It depends what the agreement says, and the two produce materially different outcomes when collection rates are below par. It is worth modelling before renewing a contract.
Do you handle HIPAA-covered data?
Stronghold can enter into a Business Associate Agreement when work requires access to PHI, limits access to what is necessary, and uses aggregated financial information whenever practical.
Do you prepare our practice tax return?
Stronghold handles proactive tax planning and works with an integrated tax-preparation partner for filing. We coordinate the year-end handoff so the books, planning, and return preparation stay connected.