Bookkeeping for Healthcare Practices and Fractional CFO
Bookkeeping for healthcare practices means accurate records of what the practice earns, a clear view of money still owed by patients and payers, control of overhead and a cash plan for hiring, equipment and growth. This page sets out those needs and how the three English Oak services map to them.
What does a healthcare practice need from its finance function?
Practices are small businesses with unusual revenue timing. Care is delivered first, and payment follows from patients, insurers or other payers, sometimes much later and sometimes for less than was billed. Cash received is therefore a poor guide to what the practice has earned.
A good finance function keeps three things apart: what was billed, what was collected, and what is still outstanding. Monthly bookkeeping records revenue and receivables and reconciles the bank accounts. Clinical billing and coding are separate work, usually handled by your billing team or system.
How does a practice keep overhead under control?
Payroll for clinical and administrative staff, rent, equipment leases, supplies and software make up most of a practice's costs. Many of them are fixed, so a slow month hurts quickly.
The month-end close is where overhead gets reviewed. A fractional controller oversees that close, compares actual results with budget and looks at margin and profitability. Internal controls matter here too: who can approve payments, who reconciles accounts, and who sees what.
What does fractional CFO support look like for a practice?
The CFO questions in a practice tend to be about growth. Should we add a provider? Is a second location affordable? What does a new piece of equipment do to cash over the next year? Do we want to bring in a partner or prepare for a sale one day?
A fractional CFO works on forecasting, scenario planning, budgeting and KPIs, plus financing support and exit or acquisition preparation. A forecast lets you test those choices on paper first. See our guides to building a financial forecast and scenario analysis. Any decision about investing in the practice is a business decision; we do not give investment advice.
Why does cash planning matter so much?
In a practice, cash planning matters because payer delays and fixed payroll collide. A short-term cash forecast, such as a rolling weekly view, shows when receipts are expected against when bills and payroll fall due, and flags gaps while there is still time to act. It also helps when a new hire or a lease commitment is being weighed, because you can see the effect on cash month by month.
How do Record it, Control it and Drive it map to a practice?
| Need | Service | What it covers |
|---|---|---|
| Revenue and expenses recorded, accounts reconciled | Record it (bookkeeping) | Monthly coding, AP and AR, statements |
| Reliable monthly close, overhead reviewed | Control it (controller) | Close oversight, budget vs actual, internal controls |
| Growth, financing and exit planning | Drive it (CFO) | Forecasting, scenarios, funding readiness |
Starting prices are $500 a month for bookkeeping, $1,500 for a controller and $2,500 for a CFO, each a custom fixed monthly fee. See pricing and what we do.
What do we not do?
We do not prepare tax returns, audit or give investment advice, and we work alongside your CPA or tax professional. English Oak has not published industry-specific results or client claims for healthcare. This page describes what practices generally need. You may also want to read about professional services firms, e-commerce and the full industries list.
Need this done for you? See our Fractional CFO & Advisory service, or pricing. English Oak Financial does not prepare tax returns, perform audits or give investment advice. This guide is general information, not tax, legal or investment advice.
Related pages
Common questions
What does a fractional CFO do for a healthcare practice?
In general terms, a fractional CFO builds forecasts and budgets, plans cash, models decisions such as adding a provider or location, and prepares financing or exit materials. It is part-time, not a full-time hire.
Can a bookkeeper handle a practice's books?
A bookkeeper can record transactions, reconcile accounts and keep payables and receivables current. Billing and coding for patient claims is usually a separate function. Our bookkeeping service covers the accounting side.
When is a fractional CFO not worth it for a practice?
A fractional CFO becomes relevant when the practice is weighing real decisions such as growth, borrowing or a sale.
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