Healthcare Accounting Services
Accounting outsourcing for medical practices and healthcare providers, built around insurance reimbursement cycles and payer mix — not generic small business bookkeeping.
What tends to make Healthcare accounting different
Medical practice accounting has a structural difference from most small businesses: revenue doesn't arrive as a simple invoice-and-payment cycle, it comes through insurance reimbursements that are billed at one amount, adjusted, and paid at another, often weeks or months later. Standard bookkeeping approaches struggle with this. We reconcile reimbursements against billed claims, track payer mix, and structure a chart of accounts that reflects how a practice actually generates revenue.
The parts of the workflow that can be delegated
The right scope depends on your systems, team and review process. These are practical areas where additional capacity can be useful without taking control away from your team.
Insurance reimbursement reconciliation against billed claims
Payer mix reporting (insurance vs. self-pay revenue breakdown)
Chart of accounts structured for clinical revenue, ancillary services, and overhead
Consolidated reporting across multiple providers or locations
Support for practice management and profitability analysis
Agreed data scope and access responsibilities
Four Things That Go Wrong in Healthcare Books
Not because anyone was careless. Because each one is a convention a generalist bookkeeper has no particular reason to know, and the accounts look reasonable while it is wrong.
Billed is not collectible, and neither is revenue
Where third-party payers are involved, the amount billed, the amount allowed and the amount eventually received are three different numbers, separated by weeks. Books that recognise the billed amount and then write the difference off later show revenue that never existed followed by an expense that is really a pricing adjustment. Recording the contractual adjustment as it is known keeps the receivable meaningful.
Aged receivables that are aged for different reasons
A balance sitting at 90 days because a claim was denied is a completely different problem from one sitting there because a patient has not paid, and both look identical on a standard aging report. Splitting the receivable by who owes it — payer versus patient — is what turns the aging into something anyone can act on.
Deposits and prepayments treated as income
Money taken before a service is delivered is a liability until it is. Where that is booked straight to revenue, income is overstated in one period and the obligation is invisible in the next. It is a small discipline that materially changes what a month looks like.
Payroll that carries most of the cost and none of the detail
In most practices staffing is the largest line, and a single lump posting tells you nothing about which service line, location or shift pattern is consuming it. Recording payroll at the detail the reporting needs is a setup decision, and it is difficult to reconstruct afterwards.
What We Would Put Right First
Before anything is optimised, these have to be true. Most of them are setup decisions that are cheap now and expensive to retrofit.
- Contractual adjustments recorded as they become known, not written off later
- Receivables split by payer versus patient responsibility
- Prepayments and deposits carried as liabilities until earned
- Payroll recorded at the detail the reporting actually needs
- Bank, merchant and clearing accounts reconciled monthly
Explore the workflows that connect to this one
Frequently Asked Questions
Do you reconcile insurance reimbursements against billed claims?
Payer reimbursements and adjustments can be reconciled against billed claims, which is a different process than standard accounts receivable and needs its own workflow.
Can you report on payer mix (insurance vs. self-pay revenue)?
Revenue can be reported by payer type so you can see how your patient mix is affecting collections and cash flow, not just a single revenue total.
Do you use a chart of accounts specific to medical practices?
The chart of accounts can be structured around how medical practices actually operate — separating clinical revenue, ancillary services, and practice overhead clearly.
Do you handle multi-provider or multi-location practices?
Consolidated reporting can cover multiple providers or office locations, with location-level detail retained where the source records support it.
Is patient billing data handled securely?
The scope should use de-identified or aggregated financial information wherever it can meet the reporting need. Before any patient-level information is shared, the practice must determine whether it contains protected health information (PHI) and whether the service makes Accounstone a HIPAA business associate. PHI must not be provided unless the required written business associate agreement and applicable safeguards are in place and confirmed by the parties. Accounstone does not claim HIPAA certification.
What records help reconcile insurance reimbursements?
Useful source records can include billed-claim summaries, remittance advice or explanation-of-benefits data made available by the practice, deposit details and the accounting ledger. The workflow reconciles the financial information supplied; medical coding, claim submission and payer appeals remain with the practice or its billing specialists.
Can accounting reports be prepared by provider or location?
Yes, where the source records and chart of accounts support that view. The scope should define provider and location dimensions, allocation rules, report periods and who reviews the result so aggregated and location-level reporting reconcile to the same underlying ledger.
How are payer adjustments or unexplained deposit differences handled?
The reconciliation should identify the billed amount, remittance or adjustment information available, deposit and resulting difference, then list anything unexplained for the designated practice or billing contact. Accounting preparation should not infer a clinical or claims decision from a difference in the deposit.
Do you provide medical billing, claims submission or coding?
This page covers accounting and bookkeeping workflows such as reimbursement reconciliation, payer-level reporting and practice financial records. Medical coding, claims submission, denial appeals and patient-collection operations are outside the stated accounting scope unless a specific separate service is confirmed.
Can you support month-end close for a multi-location practice?
Where the practice’s accounting records and allocation rules allow it, close support can organize reconciliations, location-level schedules, expense allocations and financial reports for review. The practice or its accounting professional confirms accounting policy choices and approves any judgment-based adjustments.
Talk to Us About Healthcare Accounting
A free consultation, and a call that costs nothing. Tell us how healthcare work is handled today and where the recurring load is landing on the wrong people.
Need support with Healthcare accounting?
Tell us how the work is handled today and where additional capacity would make the biggest difference.