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Outsourced Bookkeeping for Medical & Dental Practices — EOB Reconciled, Per-Provider P&L, HIPAA-Aware
Stop guessing what your insurance collections ratio is. ProAxis is a Bergen County, NJ CPA-led bookkeeping team serving medical and dental practices across NJ, NY & PA. We reconcile every ERA / EOB to the bank, run per-provider profitability, manage multi-provider payroll, and keep your equipment depreciation schedule audit-ready — all in a HIPAA-aware workflow.
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What best describes you?
What does medical & dental practice bookkeeping include?
For medical and dental practices in NJ, NY, and PA, ProAxis Tax & Accounting Services runs CPA-supervised books. The books are reconciled to insurance remittances as well as the bank:
- Fixed monthly fees — solo practitioners typically $700–$1,200/month, 3–4 provider practices $1,200–$2,500/month (published ranges, not an offer)
- EOB/ERA reconciliation so collections match deposits
- Per-provider production and profitability reporting
- Payroll coordination, including NJ associate classification (the ABC test)
- Equipment depreciation and Section 179 tracking
- Lender-ready month-end close for expansions and buy-ins
Pricing follows the published ranges in the bookkeeping cost guide. Tax-side context lives on the healthcare CPA page; comparing specialists? See the best dental CPA firms in NJ.
Sound Familiar?
The 6 Bookkeeping Problems Every Tri-State Practice Has
Most practice businesses we onboard arrive with one or more of these problems. Here’s how a CPA-led bookkeeping team helps address them.
Insurance ERAs and EOBs hit the bank in lump sums and your books just show one big deposit. Nobody knows which procedures actually got paid.
How we fix it
We perform insurance ERA / EOB reconciliation — matching each deposit to the underlying claims, write-offs, and patient responsibility — so your collections ratio, write-off %, and per-payer profitability are visible monthly.
You have 3 associate dentists / providers and you can't tell which ones are profitable after their pay, lab fees, and supply consumption.
How we fix it
We track per-provider P&L: production, collections, comp/benefits, lab fees by case, and direct supply allocation. You see who's accretive and who's not.
Your tax preparer keeps asking for a clean fixed-asset schedule and you've got equipment purchases buried in 'Office Supplies'.
How we fix it
We maintain a medical-equipment fixed-asset register for chairs, imaging, lasers, and IT. Proper Section 179 / bonus depreciation election tracking captures the accelerated depreciation available to the practice.
Patient PHI is showing up in QuickBooks memo fields and you're not sure if you're HIPAA-compliant.
How we fix it
We configure HIPAA-aware bookkeeping workflows: no PHI in QBO memos, BAA-covered tooling for any patient-identifiable docs, and clean separation between practice management and accounting systems.
Multi-provider payroll is a nightmare — W-2 hygienists, 1099 associate dentists, productivity bonuses, and CME stipends all mixed together.
How we fix it
We run provider compensation correctly: W-2 vs. 1099 worker classification, productivity bonus accruals, fringe benefit reporting, and proper expense reimbursement under accountable plans.
Lab fees, supplies, and contract labor are eating your margin and nobody can explain why.
How we fix it
We classify variable cost-of-services by procedure category and generate monthly trend reports, flagging supply or lab-fee creep before it eats another quarter.
What’s Included
What's Included in Practice Bookkeeping
Insurance ERA / EOB Reconciliation
Match each insurance deposit to claims, write-offs, and patient responsibility. Monthly collections ratio reporting.
Per-Provider P&L Tracking
Production, collections, lab fees, and direct supply costs allocated per associate or location.
Medical Equipment Depreciation
Sec. 179 + bonus depreciation strategy for chairs, imaging, lasers, sterilization. Year-end planning included.
HIPAA-Aware Workflow Setup
Clean separation between PMS / EHR and accounting. No PHI in QBO. BAA-covered document tooling.
Multi-Provider Payroll
W-2 staff, 1099 associates, productivity bonuses, retirement contributions, fringe benefits.
Practice-Loan Amortization
Practice acquisition loan or equipment financing tracked with proper interest / principal split each month.
401(k) / SEP-IRA Coordination
Employer contribution calculations, year-end true-up, coordination with TPA.
Monthly Financial Package
P&L vs. budget, balance sheet, AR aging by payer, and a 25-minute CPA consultation call.
Tax-Ready Year-End Close
Books closed, depreciation booked, accruals trued up — ready for the practice's tax return.
Why ProAxis
Why Tri-State Practices Switch to ProAxis
We Speak Practice Management AND Accounting
We reconcile Dentrix and Open Dental day-sheets directly to the bank deposit — work many general bookkeepers don't take on. We've worked with the major PMS/EHR systems — Dentrix, Eaglesoft, Open Dental, athenahealth, AdvancedMD, Kareo — and we know how the production/collections/adjustments flow into accounting.
Tax Strategy Built Into the Books
Equipment depreciation, S-Corp owner reasonable comp, retirement plan contributions, and entity structure decisions are made all year — not in March. We coordinate practice tax planning with bookkeeping monthly, so April is no surprise.
IRS Tax Resolution Filings Handled In-House
Practices generate IRS letters — payroll-tax notices, 1099 misclassification challenges, S-Corp reasonable-comp examinations. We prepare the written responses and filings for you to sign and submit, and we work under Form 8821 to pull transcripts and read your notices. ProAxis does not represent taxpayers before the IRS; an examination that requires representation is referred to a licensed representative.
100% Virtual, HIPAA-Aware
Secure portal for any document containing PHI, BAA in place where needed, encrypted transmission, no patient identifiers in QBO.
Practice Bookkeeping — Frequently Asked Questions
Do you reconcile insurance EOBs and ERAs to bank deposits?
Yes. This is one of the highest-value bookkeeping tasks for any insurance-heavy practice. Each insurance deposit (Delta Dental, MetLife, Aetna, Cigna, BCBS, etc.) is matched to the underlying claims. That includes proper recording of contractual write-offs, patient responsibility, and the actual deposit amount. Without this, your collections ratio is unknown and your AR is unreliable. We deliver monthly reports showing collections by payer, write-off percentages, and AR aging.
Can you separate per-provider profitability for an associate-driven practice?
Yes. We track production, collections, direct lab fees, and a reasonable share of supplies and overhead per provider. The result is a per-associate P&L that lets you see which providers are net profitable after their compensation arrangement. That per-associate view supports compensation negotiations and partnership decisions, and shows when an associate's economics aren't working.
Are you HIPAA-aware? How do you handle patient information?
We do not put patient identifiers (names, DOB, insurance ID, account numbers) in QuickBooks. Reconciliations reference internal practice-management IDs only. Any document containing PHI moves through a BAA-covered secure portal, never email. We don't replace your HIPAA compliance program, but our workflows are designed to minimize new privacy exposure.
We have W-2 staff and 1099 associate doctors. Can you handle the mixed payroll?
Yes. We coordinate W-2 payroll with your payroll provider (Gusto, ADP, Paychex, Intuit Online Payroll) and process 1099 associate compensation with productivity-based calculations. We also handle fringe benefits, accountable-plan expense reimbursements, and year-end W-2 / 1099 issuance. We work with you upfront on worker classification — IRS Form SS-8 factors and the dental-practice-specific treatment guidance. This reduces the risk of associate reclassification later.
Can you implement Section 179 and bonus depreciation on equipment we bought this year?
Yes. Medical and dental practices are equipment-intensive — chairs, panoramic imaging, intraoral scanners, CBCT, lasers, autoclaves, IT infrastructure. We maintain a fixed-asset register, calculate the Section 179 expense election within annual limits, and apply bonus depreciation where applicable. We also coordinate with year-end tax planning. That way you make the buy/lease and timing decisions before December 31, not in March.
What does monthly practice bookkeeping cost?
Pricing depends on practice size, number of providers, transaction volume, payer mix, and whether we're handling payroll. A solo practitioner running ~$1M in collections typically runs $700–$1,200/month. A 3–4 provider practice runs $1,200–$2,500/month. If the practice's books are behind, catch-up work is quoted as a separate project. After a free discovery call, we give you a fixed monthly fee.
We already have a bookkeeper — how does the transition work?
ProAxis begins with a free scoping call and a read-only review of your current file. Before any work starts, your monthly fee goes into a written engagement letter. We connect bank feeds, fix what needs fixing, and take over the monthly close. That includes the tie-out of Dentrix or Open Dental day-sheets to bank deposits. Anything with PHI travels through the BAA-covered portal during the switch. Your outgoing bookkeeper only needs to hand over file access — we handle the rest.
Ready to Know Your Real Collections Ratio?
Free 30-minute review of your practice's books and insurance reconciliation process. We'll tell you exactly what's broken and what fixing it looks like — no obligation.
Serving medical and dental practices across New York, New Jersey & Pennsylvania — 100% virtual.
How Does ERA/EOB Reconciliation Actually Work?
Every insurance payment starts as a remittance. The payer sends an ERA (electronic remittance advice) or a paper EOB. That document lists each claim, what the payer allowed, what it paid, and what it wrote down.
Reconciliation means posting those payments against the original claims — not just recording a deposit. Each claim line splits three ways:
- Cash collected — what the payer actually paid.
- Contractual adjustment — the gap between your fee and the payer's allowed amount.
- Patient responsibility — the balance that shifts to the patient.
That split matters. Contractual adjustments are not lost revenue; they were never collectible under your payer contracts. Mixing them into collections inflates the top line and hides your real collections ratio.
Then comes the bank side. Payers batch payments, so one ACH deposit often covers dozens of claims across several dates of service. Card deposits from patient payments often arrive net of processing fees. Each deposit must tie back to specific remittances, line by line. When a deposit and its remittance disagree, the gap has a cause: a takeback, a denial, or a posting error. Reconciliation shows which one.
Per-provider P&L depends on the same discipline. Revenue must map to the provider whose production generated the claim, not to whoever's name is on the deposit. Without production-based mapping, associate profitability is a guess. Three breakdowns show up most often:
- Unposted adjustments. Payments post, write-downs don't, and AR balloons with amounts no one will ever collect.
- Patient-responsibility balances aging silently. The payer's share posts; the patient's share sits unbilled or unworked for months.
- Deposits booked straight to revenue. The bank feed becomes the books, with no adjustment split — so income is misstated either way.
A disciplined month-end close catches all three. Five checks, every month:
- Tie every practice-management batch to a posted bank deposit.
- Post and review all contractual adjustments, grouped by payer.
- Age patient-responsibility AR and work the stale balances.
- Map revenue and direct costs to each provider by production.
- Compare the collections ratio to prior months and explain any swing.
Last reviewed: 2026-07-11
More ProAxis Resources for Medical & Dental Practices
- Healthcare Industry CPA Hub →
- Physician Tax Planning Deep Dive →
- Curated Resource Hub for Medical & Dental Practices →
- ProAxis Pricing →
- Bookkeeping Cost Calculator → Quick monthly-fee estimate
- Catch-Up Bookkeeping Calculator → One-time project cost if you're months behind
- 1099 Associates: the NJ ABC Test → Why most 1099 associates are really W-2
- S-Corp Reasonable Salary Guide → The 60/40 myth and the 2026 math
Content last updated: August 23, 2026. Figures reflect the law in effect when written; see the Disclaimer.