Bookkeeping and Tax for Nashville Medical Practices
Bookkeeping, payroll, and tax for independent medical practices, med spas, and direct care clinics in Nashville. Handled remotely by enrolled agents who know healthcare.
Independent Practices in a Healthcare City
Nashville is often called the healthcare business capital of the country. HCA Healthcare and hundreds of other healthcare companies are based here, and Vanderbilt University Medical Center anchors Midtown. Many of the city’s physicians, nurses, and clinicians trained or worked inside those large systems. A growing number are now leaving to open practices of their own. Physician groups in Brentwood, med spas in Green Hills and The Gulch, direct care clinics in East Nashville and across Middle Tennessee.
When you leave a large system, you also leave behind its billing office, HR department, and finance team. That is the gap we fill. Baker’s has done bookkeeping and tax work out of Lenexa, Kansas since 1995, and our remote division provides healthcare bookkeeping services to independent practices nationwide, Nashville included. Our Chief Information Officer, Marc Eastin, is a practicing neurosurgeon who also owns a business, so we understand how little time a doctor has left over for the books.
No State Income Tax, Still a Tax Bill
No State Income Tax, Still a Tax Bill
Tennessee doesn’t tax your wages or personal income, which is a real advantage for practice owners. The federal bill is still the big one. Our tax planning looks at business structure, owner pay, retirement contributions, and the timing of equipment purchases so you keep more of what the practice earns.
Franchise and Excise Tax
Franchise and Excise Tax
Most LLCs, professional corporations, and S corporations in Tennessee owe franchise and excise tax, with excise charged at 6.5% of net earnings. An S corporation election that saves on federal payroll taxes doesn’t avoid it. We factor that into structure decisions and keep your books ready for the filing.
Sales Tax on Retail Products
Sales Tax on Retail Products
Patient care isn’t taxed, but the skincare, supplements, and eyewear on your shelf are. Tennessee has one of the highest combined sales tax rates in the country, so small mistakes add up. We track what you sell and file on time in every state where you have sales.
Staffing in a Crowded Market
Staffing in a Crowded Market
With so many healthcare employers in town, good front desk staff, medical assistants, nurses, and injectors have options. We run staff and provider payroll through Gusto, and Marcella’s years in recruiting and HR help practices write competitive offers and onboard new hires properly.
Nashville Practices We Work With
The independent side of Nashville healthcare covers a lot of ground. Surgeons who own the building their practice sits in. Nurse injectors running a busy med spa. Family physicians who traded a hospital schedule for a membership model. Therapy groups that have grown from two clinicians to ten. These practices are big enough to need real financial support but rarely have anyone on staff to handle it.
Your books are handled by a team of enrolled agents who learn how your practice runs, not a call center that reassigns you every month. We close the books monthly, send a one-page summary you can read in a few minutes, and for practices that bill insurance, we check that what your billing system says was collected actually made it to the bank.
Physician and Surgical Practices
Physician and Surgical Practices
Primary care, specialty, and surgical groups with one to ten providers. We compare insurance collections against bank deposits, calculate provider pay from the compensation agreements you already have, and keep separate books when the building is held in its own entity.
Med Spas and Aesthetic Clinics
Med Spas and Aesthetic Clinics
Cash-pay practices where the numbers can look better than they are. We show profit per treatment after product cost and commissions, and we track prepaid packages and memberships so revenue isn’t counted before the service is delivered.
Direct Care and Concierge Practices
Direct Care and Concierge Practices
Physicians who leave a hospital system to open a direct primary care or concierge practice are often running a business for the first time. We set up the structure, books, and payroll before you open, then track membership revenue and retail sales month to month.
Behavioral Health Groups
Behavioral Health Groups
Therapy, counseling, and psychiatry groups paying clinicians by the session. We calculate clinician pay each pay run based on your existing agreements so people are paid correctly and on time. Marcella’s master’s in clinical psychology means she understands how these practices actually operate.
Common Questions About This Area
Do you have an office in Nashville?
No. Our office is in Lenexa, Kansas, where the firm has been since 1995. Our remote division was built for practices in other states, and we already have clients in Tennessee. Books live in QuickBooks Online, payroll runs through Gusto, and we meet by video whenever you want to talk.
Tennessee has no state income tax. Do I still need tax planning?
Usually, yes. Practice owners tend to be high earners, and the federal bill is the large one. Tennessee also charges franchise and excise tax on most LLCs and corporations, including S corporations, so the right structure for a Nashville practice can look different than it would in other states.
Do you work with med spas?
Yes. We track profit per treatment after product cost and injector commissions, keep prepaid packages and memberships off the revenue line until the service is delivered, and file sales tax on retail skincare. If your med spa is split into a management company and a medical entity, we keep separate books for each.
I'm leaving a hospital job to open my own practice. When should I call?
Before you open, if possible. New practice setup covers business structure, books, payroll, and software so everything is in place on day one. If you've already opened, we start where you are and get things organized.
What does monthly bookkeeping cost?
Monthly bookkeeping runs $500 to $1,500 per month depending on volume and complexity. If your books are behind, catch-up is billed at 75% of the monthly fee for each month we bring current. Payroll, tax returns, and other services are priced separately.
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