Bookkeeping and Tax for Houston Medical Practices
Monthly bookkeeping, payroll, and tax for Houston physician practices, med spas, and direct care clinics. Handled remotely by enrolled agents who learn your practice.
Bookkeeping for Houston Practices
Few cities have as much healthcare concentrated in one place as Houston. The Texas Medical Center is the largest medical complex in the world, and it trains and employs thousands of physicians, nurses, and clinicians. Many of them eventually leave to open practices of their own in Bellaire, Memorial, the Heights, Sugar Land, Katy, and The Woodlands. They arrive knowing medicine very well and the business side much less.
Baker’s Bookkeeping & Tax Services has handled bookkeeping, payroll, and tax work since 1995 from our home in Lenexa, Kansas. Our remote division now provides healthcare bookkeeping services to independent practices nationwide, including a growing number in the Houston area. Your account is handled by enrolled agents who take the time to learn how your practice earns and spends money.
Monthly Bookkeeping
Monthly Bookkeeping
Books closed every month in QuickBooks Online with a one-page summary you can read in a few minutes. For practices that bill insurance, we compare what your billing system says was collected against what actually reached the bank. If your books are behind, we bring them current first.
Payroll
Payroll
Front desk staff, medical assistants, nurses, and providers paid on time through Gusto. Tax deposits, quarterly filings, and W-2s are taken care of. If you have providers or remote staff outside Texas, multi-state payroll is covered as well.
Tax Planning in Texas
Tax Planning in Texas
Texas has no state personal income tax, which puts nearly all of a practice owner’s income tax bill on the federal return. We build a yearly plan around entity structure, owner salary, retirement contributions, and the timing of large equipment purchases. We also keep track of the Texas franchise tax report for LLCs and corporations.
Opening a Practice
Opening a Practice
Physicians leaving hospital systems to start direct primary care or concierge practices, and nurses opening their first med spa, often start with us here. Our new practice setup covers business structure, books, payroll, and software so everything works on the day you see your first patient.
Houston Practices We Work With
The Medical Center gets most of the attention, but Houston’s independent practices are spread across the entire metro. The city is one of the five largest markets in the country for medical spas and aesthetic clinics, and it has more direct primary care practices than any other city in Texas. It also has a deep base of independent physician and specialty groups, many of which have been operating for decades.
Most of the practices we work with have between one and ten providers. Our Chief Information Officer, Marc Eastin, is a practicing neurosurgeon who also owns a business, so we understand what it means to see patients all day and then face the books at night. Our work is built around taking that second part off your plate.
Physician and Specialty Practices
Physician and Specialty Practices
Primary care, surgical specialties, dermatology, pain management, and urgent care. We calculate partner and provider pay each month from production reports, following the compensation agreements you already have. When the doctors also own the building, we keep separate books for the practice and the real estate entity.
Med Spas and Aesthetic Clinics
Med Spas and Aesthetic Clinics
Cash-pay businesses with prepaid packages, memberships, and injector commissions. We track packages until the treatment is delivered so revenue isn’t overstated, and we show profit per treatment after product cost. Texas limits who can own a medical practice, so many med spas run a management company and a physician-owned entity, each with its own books.
Direct Primary Care and Concierge
Direct Primary Care and Concierge
Membership practices run by doctors who left employment to work for themselves. We track monthly membership revenue, file sales tax on supplements and other retail products, and plan ahead for the federal tax bill that comes with owning a profitable practice.
Behavioral Health Groups
Behavioral Health Groups
Therapy, counseling, psychology, and psychiatry groups. Paying clinicians correctly under session-based agreements is the hardest money problem for these owners, and we calculate it every pay run using the agreements you provide. Our President, Marcella Nichols, holds a master’s in clinical psychology and understands how these practices operate.
Common Questions About This Area
You're based in Kansas. Can you work with a Houston practice?
Yes. Our remote division was built to serve practice owners across the country, and the firm already has clients in nearly every state. We work in QuickBooks Online and Gusto, share documents online, and meet by video when there is something worth talking through. Most Houston clients never need us in the room.
Texas has no state income tax. Do I still need tax planning?
Yes. Without a state income tax, almost all of a practice owner's income tax lands on the federal return, and that is where structure, owner salary, retirement contributions, and equipment timing make the biggest difference. Texas still has a franchise tax report for LLCs and corporations and sales tax on retail products, and we keep track of both.
What does monthly bookkeeping cost?
Monthly bookkeeping runs between $500 and $1,500 a month depending on transaction volume and how many entities you have. If your books are behind when we start, each month of catch-up is billed at 75% of the monthly fee. We give you an exact quote after looking at your practice.
I'm leaving a hospital job at the Medical Center to open my own practice. When should I call?
Before you sign a lease or see your first patient, if you can. Choosing the right business structure and setting up books and payroll from the start is much easier than fixing them later. If you are still employed and earn side income from locums, expert witness work, or a medical directorship, we handle that too.
Who actually works on my account?
A team of credentialed enrolled agents who learn how your practice runs. You are not routed through a call center. The same people who keep your books also handle your tax return and respond to any IRS or state notices on your behalf.
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