Who We Help · Therapists · Bookkeeping
Therapist bookkeeping: one calendar, three payers, clean books
Therapy revenue looks simple — sessions on a calendar — until you notice the money arrives three different ways: private clients paying at booking, insurers reimbursing direct-billed claims, and EAP networks remitting weeks later at contracted rates. We keep books that track each payer stream on its own, reconcile Jane or Owl Practice to the bank, and wind down the GST/HST accounts the 2024 exemption made obsolete.
By the AnalytIQ Accounting team · Last reviewed: August 12, 2026
Three payers, three payment patterns
A single revenue line called "therapy income" hides the fact that your practice runs three different collection cycles at once, each with its own timing, rate, and reconciliation problem. Splitting them is what makes the books useful:
| Payer | How the money arrives | What the books must do |
|---|---|---|
| Private-pay | Card on file at booking, or e-transfer after the session | Tie payment batches to bank deposits net of processor fees |
| Insurer direct-billed | Insurer portion on its own schedule; client copay at the session | Split each invoice, carry the insurer receivable, match remittances |
| EAP contracts | Bulk remittances weeks later, at contracted rates below your fee | Book revenue at the contract rate; age the receivable by network |
The payer split also produces the number the revenue line never shows: your effective rate per session by channel, which is the raw material for the mix decisions on our therapist CFO page.
Jane and Owl are the sub-ledger, not the books
Practice management systems like Jane and Owl Practice know your appointments, invoices, and payments — but they know nothing about your rent, your liability insurance, your software stack, or what actually cleared the bank. We treat the system as a revenue sub-ledger and reconcile it outward on a regular cycle: payment reports to processor payouts, payouts to bank deposits net of fees, and invoiced-but-unpaid balances to a receivable that gets reviewed rather than forgotten. No-show and late-cancellation fees get their own account, because they are real revenue with no session behind them and they distort per-session math when blended in. E-transfers are the perennial loose end — they arrive under cryptic sender names with no invoice number, so we match them weekly while memories are fresh.
The expense side has its own niche shape: clinical supervision, college and association dues, liability insurance, EMR and telehealth subscriptions, and continuing education all recur on their own cycles. A therapist who sublets the office to another clinician on off days also has rental income that deserves its own account rather than a seat inside session revenue. Categorized consistently, these produce the overhead-per-session number that fee decisions depend on.
Sliding scale is a subsidy — record it like one
When a reduced-fee client pays eighty dollars against a two-hundred-dollar fee, booking eighty as the whole story erases information you need. We record the full fee and the reduction as a separate discount line, which keeps three things visible: the true size of your sliding-scale subsidy each month, the integrity of your standard fee in the data, and the capacity cost of each subsidized slot when you plan the caseload. Pro bono sessions get logged the same way at a full discount — they are scheduled capacity, and the books should admit it.
The 2024 GST/HST exemption cleanup
Since June 20, 2024, psychotherapy and counselling therapy services are GST/HST-exempt — psychologists were already exempt as listed health practitioners, so the change mainly lands on registered psychotherapists and counselling therapists who had been charging tax. Exempt is not zero-rated: you stop charging HST, and you also stop claiming input tax credits on rent, software, and supervision costs, so your expenses now cost their sticker price.
For practitioners who were registered, there is real cleanup: invoice templates and fee listings purged of HST, a decision on cancelling the registration, the final GST34 return, and care around deregistration itself, which can trigger adjustments on assets you previously claimed ITCs on. We handle that wind-down deliberately so the account closes clean instead of leaking assessments later.
USD sessions and year-end readiness
Telehealth clients in the US pay in US dollars, and each receipt needs conversion at transaction-date rates before it lands on your T2125 or your professional corporation's T2 — while the W-8BEN requests and sourcing questions those clients bring live on our cross-border tax page for therapists. Books split by payer, reconciled to Jane, and cleaned of stale HST accounts make year-end filing an assembly job rather than an investigation — which is the point of doing them monthly.
Each month closes with a short package: revenue by payer, receivables aged by insurer and EAP network, discount totals, and overhead per delivered session. Those four reports answer most of the questions a practice owner actually asks, and they keep earned-but-unpaid money from silently aging into money nobody chases.
Common questions.
Do I still need to think about GST/HST if therapy is now exempt?
Yes, once. If you were registered before June 2024 the account needs a proper wind-down — final return, deregistration decision, and possible adjustments on assets with claimed ITCs. After that, exempt means no tax charged and no ITCs recovered.
Can my books just mirror what Jane shows?
No — Jane is the revenue sub-ledger. The books add what it cannot see: bank reality, processor fees, expenses, and receivables from insurers and EAP networks that pay long after the session.
How should I record sliding-scale sessions?
Book the full fee and the reduction as a separate discount line. That preserves your fee data and shows the real monthly cost of your sliding-scale commitment, instead of quietly deflating revenue.
Related reading
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