What does a monthly close for a therapy practice include?

Days 1 to 5: gather

Nothing reconciles until the inputs are complete, and most late closes are late because of this step, not the accounting:

• The month's bank and credit-card activity, with the statement period closed
• Billing totals from your practice system - SimplePractice, Jane, TherapyNotes, or similar - in totals form
• Payroll runs, contractor payments, and payroll-tax debits
• Card-processor payouts and their fee lines
• A short note on anything unusual: a refund, a held payout, a large one-off purchase, a personal charge that slipped in

That last item is the one clients skip and the one that saves the most time. Two sentences about an odd month removes an hour of guesswork.

Days 6 to 10: classify and reconcile

• Match deposits to collected fees, and explain anything that does not match
• Categorize every transaction to a chart of accounts built for a practice, not a generic one
• Reconcile each bank and card account to its statement
• Move personal spending out of the business accounts, or flag it to you for repayment
• Record processor fees as expenses and payroll liabilities as liabilities
• Confirm last month's open items cleared, so nothing ages quietly

Categorization is the step people picture when they think of bookkeeping. It is the least important part of the close and the easiest to automate badly. The reconciliation underneath it is what makes the reports true.

Days 11 to 15: review and report

• Profit and loss against the prior month, with variances that matter explained
• Balance sheet: cash, receivables, payroll liabilities, owner equity and draws
• Cash-flow statement, so collections and profit are not confused with each other
• Flagged anomalies - a margin shift, a duplicate payment, a collections dip by clinician
• A plain-English summary: how the practice is doing, what changed, what I want to ask you

Statements delivered by a non-licensed preparer carry the disclosure legend New York requires, stating plainly that they were prepared and not audited or reviewed. Yours will, every month. The Group Practice Pack sample shows what the reporting looks like for a multi-provider practice.

What "reconciled" actually means

Reconciled means the ending balance in your books equals the ending balance on the bank statement, and every difference between the two has an explanation you could show a lender without embarrassment. Not "it's close", not "we looked at it".

This is why I do not treat a $42 unexplained difference as noise. One unexplained difference is not a rounding problem; it is the first sign of something structural, and the only cheap moment to find it is the month it appears.

The four patterns that make a close hard

1. Personal spending in the business account. It is the most common cause of a close that never quite balances. Every personal charge has to be found, classified, and either repaid or treated as a distribution.

2. Stacked unreconciled months. Two months behind is twice the work, and six is a project. Catch-up work is quoted flat and done once, and it is almost always cheaper than the months of guessing that preceded it.

3. No owner pay on the books. When the owner pays themselves informally, the practice looks more profitable than it is and the owner looks more expensive than they are. Owner pay and draws belong on the page.

4. No tax reserve. A reserve is a transfer to savings on a schedule, not an expense and not a surprise. Practices that set one aside on every deposit do not spend February recovering from January.

What lands in your inbox on day 15

Statements, reconciliation notes, flagged items, and a short summary in plain English - plus any questions I need you to answer about the month. The same package, the same date, every month, so you can plan around it.

If you would rather not run this yourself, that is the engagement: what it costs, and how the money side gets recorded in a cash-pay or superbill practice.

The close, answered.