Speech Therapy
Financial clarity for speech therapy practices.
Speech therapy practices serve school contracts, private pay, telehealth, and insurance — often all at once. Each revenue line has different timing, different costs, and different tax treatment. We make sure none of it falls through the cracks.
The Reality
What speech therapy owners struggle with.
Multiple revenue lines, none of which behave like the others
School contracts pay quarterly on net-60. Private pay collects same-day. Insurance runs 30–90 day cycles. Medicaid early intervention runs longer. A speech therapy practice that does all four is running four different businesses inside one P&L — and most QuickBooks setups never separate them properly.
SLP staffing classification
1099 vs W-2 for SLPs is increasingly settled — and increasingly enforced. Practices that grew up on a 1099 model are sitting on real reclassification exposure. We help owners model the cost of conversion and the structure that makes it work.
Telehealth across state lines
Telehealth speech therapy hit critical mass post-2020 and has not slowed. Once a practice serves clients in multiple states, payroll, income tax nexus, and SLP licensing all expand. The financial side has to be set up for it.
Pediatric and adult clients have different financial patterns
Pediatric work is heavily school-contract and Medicaid early intervention. Adult work is more often private pay or commercial insurance. The economics, the timing, and the tax handling differ in ways generic accounting does not capture.
Our Approach
How we serve speech therapy owners.
Bookkeeping built for payer separation
School contracts, private pay, commercial insurance, Medicaid, and early intervention each get their own line. Aging by payer. Margin by payer. The view the owner needs to actually run the practice.
Multi-state tax coordination for telehealth
Service location tracked alongside revenue. Nexus risk surfaced before it becomes a state notice. Estimated payment coordination across states. Coordinated with healthcare counsel on SLP licensing.
Group practice entity strategy
Multi-provider, multi-location, or owner-split practices need different entity structures than single-owner solos. We model after-tax economics and recommend the cleanest fit given the actual operational reality.
SLP staffing strategy
Modeling 1099 vs W-2 conversion costs. Compensation structures for staff SLPs. Owner draw planning. The financial side of building a practice that retains good clinicians.
Frequently Asked
Questions speech therapy owners ask.
How should we handle revenue from school contracts vs private pay?
Separate income accounts for each — school contracts, private pay, commercial insurance, Medicaid, and any others — with classes for the underlying service line. Aging reports by payer. Margin per payer surfaced in monthly reporting. Without this structure the owner cannot see which contracts are actually profitable.
Can my SLPs be 1099 contractors, or do they need to be W-2?
In most current speech therapy practices the IRS and state agencies treat staff SLPs as W-2 employees. The control, scheduling, and supervisory structure typically fails the contractor tests. We model the cost of a clean conversion and help structure the comp model to make the math work for the practice.
What is the tax treatment for telehealth services across state lines?
Once you have meaningful service delivery in another state, income tax nexus and possibly payroll tax come into play. We track service location alongside revenue so nexus risk surfaces in real time. SLP licensing in each state is a separate matter handled by your healthcare counsel.
How do I track Medicaid early intervention reimbursements?
Early intervention has its own reimbursement timeline, documentation requirements, and per-state rate structure. We treat it as a distinct payer line in the chart of accounts, with aging reports tuned to the slower collection cycle and reconciliation against state payment portals.
When does it make sense to spin off a group practice into its own entity?
Usually when the practice grows beyond a single owner-clinician model — multi-provider, multi-location, or with ownership splits. The decision involves entity tax structure, professional licensing rules, and operational separation of solo work from the group. We model the after-tax outcome and coordinate with healthcare counsel on the structure.
Talk to a CPA who knows speech therapy.
We work with a small portfolio of speech therapy practices. If we are a fit for yours, the strategy call is the next step.