- A chart of accounts is the list of buckets your money moves through. Get it wrong and every report you read afterward is wrong with it.
- DPC revenue is recurring dues, not billed encounters. Your chart has to separate dues from enrollment fees, and separate both from ancillary revenue.
- Dues collected for care you have not delivered yet are a liability, not revenue. This is the single most common error we correct.
- Keep direct cost of care apart from operating expenses. Without that split you cannot calculate a gross margin, and you cannot tell whether another member makes you money.
- Record revenue gross and processor fees separately. Booking only the deposit hides both your real top line and your real cost of collecting it.
- Our template ships with 122 accounts across eight groups. Delete what you do not need. Fewer accounts you actually use beats more accounts you do not.
Why a generic chart of accounts fails a DPC practice
Almost every small business chart of accounts is built on one assumption: you do work, you send an invoice, you get paid. Revenue is earned when the job is done.
Direct Primary Care breaks that assumption on the first day. Money arrives as recurring membership dues, usually charged monthly through a platform, sometimes prepaid for a full year. The care gets delivered later, across the following twelve months, in amounts nobody can predict in advance.
Drop that into a standard chart of accounts and everything lands in one account called Sales. You lose the ability to answer basic questions. How much of my revenue is recurring. What did enrollment fees contribute. Am I making money on the dispensary or subsidizing it. What happens to my January if I sell more annual plans.
Your CPA runs into the same wall at year end. Books that need rebuilding before a return can be filed cost you money twice, once in their time and once in the answer quality you get back.
The eight groups, and what each is for
The structure below is what we build for the practices we work with. The numbering is a convention, not a rule. Consistency matters more than the specific digits.
Assets
What the practice owns. Bank accounts, receivables, prepaid costs, equipment. This is also where payment processor clearing lives, which matters more in DPC than in most businesses.
Liabilities
What the practice owes. Vendors, credit cards, payroll withholdings, loans. Deferred membership revenue belongs here, and it is the account most practices are missing entirely.
Equity
Owner capital in, owner draws out, and accumulated results. Keeping draws separate from payroll matters if you are taxed as an S corporation.
Income
Where the chart earns its keep. Split recurring dues from enrollment fees, and both from medications, labs, imaging, and employer contracts. Refunds and chargebacks get their own contra accounts rather than being netted out.
Direct cost of care
Costs that rise and fall with the care you deliver. Medications dispensed, outside labs and imaging, clinical supplies, contracted clinical providers. Keeping these out of operating expenses is what makes a gross margin meaningful.
Operating expenses
The cost of running the business regardless of panel size. Rent, software, insurance, marketing, administrative payroll. If your panel doubled, most of these would barely move.
Other income
Money that arrives outside normal operations. Interest, referral payments, card rewards. Separated so it never inflates your operating picture.
Other expense
Depreciation, amortization, interest paid, penalties, and gains or losses on disposing of an asset. Non operating by design.
The two accounts most practices get wrong
Deferred membership revenue
A member pays 1,200 dollars in January for the year. You have not earned 1,200 dollars in January. You have earned 100 dollars, and you owe eleven more months of care. The remaining 1,100 dollars is a liability.
Booked correctly, the cash lands in the bank, revenue releases monthly out of the deferred account, and your Profit and Loss shows a steady recurring line. Booked incorrectly, your best month is January every single year, your margins are meaningless, and any comparison between months tells you nothing.
This also affects what you can see about your own business. Practices that book annual plans as immediate revenue tend to overestimate how much they can spend in the first quarter and get surprised later.
Payment processor clearing
Membership platforms and card processors pay out net. They subtract their fees, refunds, and failed charges, then deposit what is left. If you record only the deposit that hits your bank, two things disappear. Your revenue is understated by the amount of the fees, and the fees themselves become invisible.
Record revenue at gross, put the fees in their own expense account, and let the timing difference sit in a clearing account. On a recurring membership model, that fee number is worth watching every month. It scales directly with your panel.
Importing into QuickBooks Online
The CSV version uses US QuickBooks Online Type and Detail Type values and is formatted for direct import. Four things to know before you run it.
- Import parent accounts before subaccounts. The file is already ordered that way, so do not sort it before importing.
- Subaccounts use the Parent:Child naming format. That colon is what tells QuickBooks where the account nests.
- Delete rows you do not need first. It is far easier to remove accounts in the spreadsheet than to deactivate them later.
- If you are importing into a file that already has data, test in a sample company first. Merging into an existing chart takes more care than starting fresh.
The XLSX version exists for that editing step. Open it, cut what does not apply to your practice, rename anything that does not match how you talk about your own business, then save as CSV and import.
A note on the tax related accounts
The template includes an accountable plan account and a short term owner residence rent account. They are there so you have somewhere to book arrangements your CPA has already advised. Their presence is bookkeeping structure, not a recommendation that you use them.
We do not prepare or file taxes and we do not give tax advice. It is hard to do two things really well, so we do bookkeeping and partner with CPAs who are strong at tax. Account structure does affect how a return gets prepared, so share your chart with your CPA and let them confirm it fits your entity before you rely on it.
Questions we get about this
How many accounts should I actually have?
Fewer than the template ships with. We include 122 so most practices find what they need, and we expect you to delete. A solo practice with one bank account and no dispensary might end up around forty. More accounts than you use makes categorization harder, not easier, because every transaction becomes a decision.
Do I need account numbers at all?
No, and QuickBooks Online has them switched off by default. They help once you pass a few dozen accounts because they force a stable order and make conversations faster. If you turn them on, be consistent from the start.
What if I use Kick or something other than QuickBooks?
The PDF and XLSX are platform neutral, so the structure carries over anywhere. Only the CSV is formatted specifically for QuickBooks Online import.
Can I change the account names?
Yes, and you should. Name accounts the way you already talk about your practice. A chart of accounts you have to translate in your head is one you will categorize inconsistently.
Do you prepare or file tax returns?
No, and that is on purpose. We do world class bookkeeping and partner with CPAs who are world class at tax. Your books arrive clean enough to file straight from, and if you need a CPA we are glad to introduce you to one we trust.
Want this set up correctly the first time?
We work only with Direct Primary Care practices. If you would rather have the chart built, the history cleaned up, and the monthly close handled by someone who already understands membership revenue, that is the whole job.
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