Outsourced Accounting & Tax for Healthcare & Life Sciences
The U.S. healthcare RCM market is a $172 billion industry – and 60% of it is already outsourced. Our teams arrive trained on healthcare's regulatory landscape before day one.
Healthcare clients are the hardest to staff for. And the costliest to lose.
87% of CFOs report a consistent accounting talent deficit, and the U.S. accountant workforce shrank 10% since 2019. Meanwhile, 90% of medical groups report rising operating costs with labor consuming 84% of expenses.
Can't Find Healthcare Accountants
56% of CPA firms now outsource to fill the gap. U.S. specialists with HIPAA training, medical billing skills, and payer reconciliation experience command $85K+ salaries – when you can find them at all.
Partner Time Trapped in Review
Accounting turnover averages 15–22% annually, spiking 40–60% post-busy-season. A 50-person firm loses $400–600K/year in replacement costs. Partners stay buried in QC loops instead of advisory.
Compliance Risk with Generic Offshore
The average healthcare data breach costs $9.77 million – $408 per record. In 2024, 725 large breaches were reported, and 55% of HIPAA penalties hit small practices.
Turning Away Healthcare Clients
72% of small hospital CFOs see outsourcing as their top strategy. 93% of larger hospitals plan to supplement with it. The demand is massive – but without capacity, you're declining work.
Healthcare accounting, executed at scale
Every service below is delivered with healthcare-specific SOPs, compliance-aware workflows, and multi-layer QC.
Medical Bookkeeping
HIPAA-aware bookkeeping for hospitals, clinics, and physician practices. 49–80% of medical bills contain errors – our multi-layer QC eliminates them.
- Daily transaction recording
- Insurance receivables tracking
- Multi-location GL management
Revenue Cycle Support
Claim denial rates hit 11.8% in 2024, yet 86% are avoidable. Each costs $57 to rework. We catch errors before they become denials.
- Billing-to-collection reconciliation
- Payer adjustment analysis
- Denial management support
Financial Reporting
Hospital margins sit at just 1.5% – every dollar of accuracy matters. Board-ready packages with full multi-entity visibility.
- Monthly financial packages
- Multi-entity consolidation
- Department-level P&L
Tax Preparation
Healthcare entity returns covering exempt organizations, physician groups, and multi-state practices.
- 990 nonprofit hospital returns
- 1120/1065 physician groups
- Multi-state compliance
Audit & Compliance Support
Medicare has a 7.38% improper payment rate. Denials up 16% since 2018. Workpapers and cost reports that hold up under scrutiny.
- Audit-ready workpaper prep
- Cost report assembly
- Compliance documentation
Payroll & HR Support
Multi-location payroll processing, physician compensation allocation, and benefits reconciliation.
- Multi-location payroll
- Physician comp allocation
- Benefits reconciliation
What makes medical practice accounting different
Healthcare accounting has its own rhythm because the money does not arrive when the service does. These four points cover most of it.
Revenue cycle and the payer mix
A practice rarely collects what it bills. Insurance contracts, allowed amounts, write-offs, and patient balances mean charges and actual collections diverge sharply. The books have to reflect net realizable revenue, not gross charges, or the financials are fiction.
Reimbursement timing and AR aging
Payments from insurers lag weeks or months, and denials restart the clock. Healthcare AR aging behaves differently than other industries, so cash forecasting and revenue recognition have to account for the delay between service and deposit.
Cash vs. accrual, and physician compensation
Many practices run cash-basis for taxes but need accrual to see true performance, and partner or physician compensation often hinges on productivity formulas that the books have to support cleanly.
Where accounting meets compliance
Healthcare carries data-handling obligations around protected information, and facilities may face cost-reporting requirements. We keep the financial records clean and the access controlled. Confirm specific reimbursement and compliance rules for your specialty and state.
We work inside your software
Our teams train on your tech stack during onboarding – no migration needed.
QuickBooks Online
Certified TeamQuickBooks Desktop
Certified Team
Xero
Certified Team
Sage Intacct
Certified TeamAthenahealth
Trained TeamNetSuite
Trained Team
Epic / Cerner
Trained Team+ Any Other
We'll TrainHealthcare expertise built into every layer
We don't rotate generic accountants into your healthcare engagements. Here's how we train and how we protect.
Compliance Mapping
We study the healthcare regulatory landscape in scope – HIPAA, Medicare/Medicaid, state licensing – before onboarding begins. Denial rates are up 16% since 2018.
Sector-Trained Teams
Our accountants receive healthcare-specific training covering medical terminology, revenue cycle logic, and payer structures.
Custom Healthcare SOPs
Every engagement gets healthcare-tuned workflows for data handling, PHI protection, and industry-specific reconciliation logic.
Industry QC Checklists
94% of business spreadsheets contain errors. In healthcare, coding errors trigger 25% of audit reviews. Our QC catches them before you see them.
HIPAA-Aware Protocols
HIPAA penalties can exceed $1.9M per violation annually, and 55% of penalties hit small practices. All team members trained on PHI handling and breach procedures.
SOC 2 + Zero Local Storage
Role-based access, encrypted connections, VPN-secured environments. No client data stored on local devices – ever.
NDA & BAA Ready
Every engagement backed by non-disclosure and Business Associate Agreements as required under HIPAA.
Monitoring & Verification
Continuous audit logging, session monitoring, and background-verified staff with per-engagement access controls.
Your healthcare team in 3 weeks
A structured onboarding process built for healthcare's unique requirements.
Healthcare Discovery
We map the healthcare workflows in scope, compliance needs, and software stack.
Team Selection
Accountants with healthcare vertical training, medical billing familiarity, and PHI awareness.
SOP & Compliance Setup
Healthcare-specific SOPs, PHI protocols, and QC checklists documented and trained.
Pilot & Scale
Start with a small batch – see the quality and compliance before scaling capacity.
Every healthcare deliverable clears four stages of review
A resume tells you nothing about whether a payer reconciliation will hold up. The review does. Nothing reaches your partner until it has passed all four layers.
Stage 1, Preparer
The healthcare-trained accountant records transactions, reconciles the payer mix, and builds structured workpapers against your SOPs. Net realizable revenue, not gross charges.
Stage 2, Senior Review
A senior checks the AR aging logic, allowed-amount write-offs, and physician compensation allocations against the engagement standards before anything moves forward.
Stage 3, Quality Review
An independent quality pass tests reconciliations, multi-entity eliminations, and cost-report schedules against our healthcare QC checklists. This is where coding and reconciliation errors get caught.
Stage 4, Final Review
A final reviewer confirms the deliverable is board-ready and audit-defensible before it reaches your desk. Your partner reviews finished work, not first drafts.
U.S. healthcare hire vs. Accountably
90% of medical groups report rising costs, with labor at 84% of expenses. A U.S. healthcare accountant costs $100–130K fully loaded. Here's the comparison:
| Feature | U.S. Healthcare Hire | Accountably |
|---|---|---|
| Annual Cost per Staff | $100–130K (loaded) | $28–36K |
| Healthcare-Specific Training | 3–6 months ramp-up | Pre-trained, 3 weeks |
| HIPAA-Aware Protocols | Varies by hire | Built into delivery |
| Multi-Layer QC | Partner review only | 4-tier QC before you see it |
| Backup Coverage | None | Always-on backup |
| Seasonal Scaling | Hire/fire cycle | Scale up or down in days |
| Annual Savings (per staff) | – | $65–95K+ |
A 3-person healthcare team = $195–285K+ in annual savings. That's capacity freed for advisory, not overhead.
What you keep, what we carry
Your name signs the return and the financial statements. We never touch that line. Here is exactly where the work divides on a healthcare engagement.
What you keep
The judgment calls that belong to the firm whose name is on the work.
- The signature on returns and financial statements
- Final judgment on revenue recognition and cost-report positions
- Partner-level calls on physician compensation and entity structure
- The client relationship and advisory conversations
What we carry
The preparation and review that frees your partners to stay in judgment.
- Preparation of bookkeeping, reconciliations, and returns
- Structured, audit-defensible workpapers for the payer mix and AR aging
- The four-stage review before anything reaches your desk
- Continuity and shadowing during any rolloff so the workflow never drops
The person designing your healthcare team has signed the return
Accountably was founded and is run by a Washington-licensed CPA with 7+ years inside US firms, from PwC, to a real-estate tax practice, to a full-service firm, rising reviewer to manager to advisory. We are accountants who learned staffing, not staffers who learned accounting.
A reviewer designed the review
The multi-layer review on your engagement was built by someone who sat the review cycle and felt April, not by a sales team. That is why net realizable revenue and cost-report accuracy are checked, not assumed.
Proof before your name is on the line
A partner's name is on every return, so trust has to be proven before the name is on the line, not claimed with SOPs. We engineer the proof into the work. Don't trust us. Test us.
20+ firms, 30+ placements since 2022
One regional CPA firm scaled to 12 placements: 3x return volume, 60% less partner review time, and roughly $420K saved a year, with zero in-house hires.
The 30-day fit guarantee
Start with one to three people and scale as trust builds. Not the right fit in the first 30 days and we replace them free. On rolloff, we shadow and hand over so the workflow never takes a hit.
Real results from healthcare-focused firms
MedBridge CPA Group scales healthcare practice by 60%
Serving 35+ healthcare clients across Texas and Oklahoma, MedBridge was turning away hospital system clients during audit season. Within 6 months of partnering with Accountably, they expanded capacity while cutting delivery costs.
"Our biggest fear was data sensitivity with healthcare clients. Accountably's HIPAA-aware protocols gave us the confidence to move forward. Six months in, not a single compliance issue."
What healthcare-focused firms say
From physician practices to hospital systems – firms trust us with their most sensitive clients.
"We handle 40+ physician groups. Accountably's team understands medical billing reconciliation better than our previous two offshore providers combined."
Michael Torres, CPA
Managing Partner, Torres & Associates
"The PHI handling protocols sold us. We had two providers before who couldn't satisfy our compliance officer. Accountably passed the audit review on the first attempt."
Jennifer Park
Director of Operations, Westfield Health CPA
"We went from turning away hospital system clients to actively pursuing them. Accountably gave us the capacity and confidence to grow our healthcare niche."
Robert Chen, CPA
Partner, Pinnacle Healthcare Advisors
Healthcare-specific questions
Common questions from healthcare organizations and the firms that serve them.
How do you handle HIPAA compliance for offshore work?
With healthcare breaches averaging $9.77 million and 725 reported in 2024, we take this seriously. All team members are trained on PHI handling. We use encrypted environments with zero local storage, role-based access, and Business Associate Agreements.
Do your teams understand medical billing and revenue cycle?
Yes. With denials at 11.8% and 86% avoidable, accuracy is critical. Our healthcare-track accountants train specifically on billing reconciliation, payer adjustments, denial management, and receivables tracking.
Can you handle multi-entity healthcare organizations?
Absolutely. We support hospital systems with multiple physician groups, clinics, and ancillary services – each with separate books. Our teams handle eliminations, consolidated reporting, and department-level P&L.
What about Medicare and Medicaid cost reporting?
With a 7.38% Medicare improper payment rate, cost report accuracy is non-negotiable. We handle assembly, schedule prep, and documentation. Final review stays with your U.S. team.
What if I've had a bad offshore experience before?
Most bad experiences come from generic staff with no healthcare training. Our 30-day pilot guarantee lets you test risk-free – a free replacement if quality, compliance, or communication doesn't meet your standards.
What healthcare software do you work with?
We train on whatever your clients use – Epic, Cerner, Athenahealth, AdvancedMD, and more. On the accounting side: QuickBooks, Xero, Sage Intacct, NetSuite, and all major tax platforms.
Start with a 40-hour proof pilot
Before you commit a live client file, grade real work. We take a fixed 40-hour block of your own healthcare workload, prepare it on your SOPs, and run it through the full four-stage review. You hold the finished workpapers next to what your team would have produced.
Your work, not a sample
Reconciliations, payer-mix workpapers, or cost-report schedules from your actual healthcare engagements. A fixed 40-hour block, scoped with you up front.
Put through full review
The pilot clears all four review stages, the same way live work does. You see the quality and the structure of the workpapers, not a polished demo.
You grade it, then decide
If the work earns the handoff, scale from one to three people. If it does not, you have lost no client file and proven the fit on your own terms.
Scale healthcare accounting and tax without the risk
Get a tailored assessment for your healthcare work. We'll show you exactly what we can handle, how we'd fit into your workflow, and what results to expect. Proof before your name is on the line. Don't trust us. Test us.