How Medical Practices Can Maximize Efficiency and Profitability Through Smart Accounting – Presti & Naegele

Why Medical Practices Need Specialized Accounting Support

A medical practice isn’t just another business. Between insurance reimbursement delays, high overhead costs, and shifting healthcare policies, the financial operations of a practice are uniquely complex.

Standard bookkeeping approaches often fall short. For example:

• Expenses like lab equipment, continuing education, and specialized software require specific categorization.
• Cash flow is irregular — driven by patient co-pays, delayed insurance payments, and Medicare/Medicaid rules.
• Staffing involves a mix of employees, part-time specialists, and independent contractors — each with different tax implications.

Generalist accounting services may miss these nuances. That’s why specialized accounting for medical practices is not only helpful — it’s essential.

With Presti & Naegele, practices gain access to professionals who understand the unique structure and demands of healthcare finance. They’ve worked with everything from independent family doctors to group specialty clinics and surgical centers, providing tailored strategies that align with how medical practices really operate.

Tax Optimization Strategies Medical Practices Often Miss

Taxes are one of the biggest expenses for medical practices — yet many practices are overpaying simply because they’re unaware of the deductions and credits available to them.

Commonly Missed Tax Opportunities:

1. Business Expense Deductions
Medical practices can deduct everything from office rent and staff salaries to clinical supplies and malpractice insurance. But those deductions must be properly categorized to withstand IRS scrutiny — and to ensure maximum value.

2. Retirement Contributions
Practices can reduce taxable income by setting up and contributing to plans like SEP IRAs or 401(k)s. These plans not only offer tax benefits, but also support employee retention.

3. Health Savings Accounts (HSAs)
HSAs provide a triple tax advantage — contributions are tax-deductible, growth is tax-free, and withdrawals for qualified medical expenses are tax-exempt. They’re a smart tool for both practice owners and employees.

4. Equipment Depreciation
Medical equipment purchases can qualify for immediate expensing under Section 179 or bonus depreciation. Timing these purchases strategically can yield significant tax savings.

5. Tax Credits
From energy-efficient upgrades to hiring credits, many practices qualify for incentives they’re not claiming.

Presti & Naegele helps medical professionals navigate these opportunities, ensuring no deduction or credit is left on the table.

Equipment & Capital Expenditures – Accounting Considerations

Medical practices often need to invest in expensive equipment — imaging machines, surgical tools, exam room tech, and more. These are major expenses with major tax implications.

Instead of spreading depreciation over many years, practices can use Section 179 to deduct the full cost in the year of purchase (up to allowable limits). There’s also bonus depreciation, which may allow for 100% expensing in the first year, depending on the timing and nature of the asset.

However, these options come with strict rules. Mistakes can lead to audit triggers or missed savings.

Presti & Naegele helps medical practices plan capital purchases with timing, tax impact, and compliance in mind — ensuring that every dollar invested is working as efficiently as possible.

Navigating Entity Structure and Liability Protection

Choosing the right business entity is one of the most foundational accounting decisions a medical practice can make — and it has long-term implications for taxes, operations, and liability.

Should you be an S-Corp, LLC, or partnership?
Each structure affects:

• How income is taxed
• How owners are compensated
• What liability protections are in place

For example, an S Corporation may reduce self-employment taxes by allowing owner distributions in addition to salaries. An LLC, meanwhile, may provide more flexibility in ownership and taxation options.

There’s no one-size-fits-all answer — but the wrong choice can cost tens of thousands over time.

With Presti & Naegele, practices get personalized advice tailored to their growth goals, risk profile, and compensation structure — not generic recommendations.

Payroll, Contractor Classification, and Staff Costs

Medical practices often operate with a mix of full-time employees, part-time workers, and independent specialists. It’s essential to classify each correctly.

Misclassifying a worker as an independent contractor can lead to back taxes, penalties, and legal challenges.

Presti & Naegele helps practices:

• Properly distinguish between employees and contractors
• Process payroll accurately and on time
• Set up tax-advantaged benefits for employees
• Integrate payroll with accounting systems like QuickBooks

Their payroll services are designed for practices that don’t have time to deal with tax filings, wage calculations, or compliance headaches — freeing up time and energy for patient care.

Building a Resilient Financial Operation Without the Jargon

One of the biggest frustrations medical professionals have with accounting? Jargon. Terms like “forecasting variance” or “deferred amortization schedules” don’t help when what you really need is clarity.

That’s why Presti & Naegele takes a plain-language approach. Their clients don’t need to become accountants — they just need clean, accurate data they can trust, presented in a way that supports daily decision-making.

Their services include:

• Routine monthly bookkeeping
• Organized financial reports
• Responsive support from real humans
• Recommendations in plain English

This approach makes financial oversight feel manageable — not overwhelming.

Cost Segregation for Office Owners

If your practice owns its office building, you may qualify for a tax strategy known as cost segregation. This allows you to reclassify certain parts of the building for faster depreciation, which can lead to large tax deductions in the early years of ownership.

For example, instead of depreciating an entire building over 39 years, items like flooring, lighting, or plumbing systems might be depreciated over 5, 7, or 15 years.

This can create significant cash flow benefits — especially for practices investing in their own real estate.

Presti & Naegele works with medical professionals to evaluate whether a cost segregation study is worthwhile and how to implement it properly.

The Long-Term Value of Organized Accounting

When medical practices operate with sloppy or outdated financial systems, they often don't realize the damage until it's too late. Disorganized books can lead to missed deductions, late filings, cash flow blind spots, or even penalties.

But clean, well-maintained accounting does more than just avoid problems:

• It provides peace of mind at tax time
• It supports smarter staffing and purchasing decisions
• It makes practices more attractive for financing or future sale
• It reduces day-to-day stress and uncertainty

Ultimately, the value of accounting is consistency. With Presti & Naegele, medical practices get a reliable framework that supports the rest of their operations — month after month, year after year.

Why Partner With Presti & Naegele

Presti & Naegele has spent decades working with medical practices across the U.S. They understand the pressures doctors face — and they know how to build accounting systems that support long-term success without adding unnecessary complexity.

Their team has supported:

• Surgical centers
• Private physician offices
• Multi-specialty group practices
• Dental offices and physical therapy clinics

Their services include:

• Bookkeeping
• Tax strategy and preparation
• Payroll
• QuickBooks support
• Entity formation and restructuring
• Asset protection
• Succession planning
• Valuations and M&A support

Learn more about their full capabilities here.

Whether you’re just getting started or managing a mature medical group, Presti & Naegele can build accounting systems that keep your practice compliant, confident, and ready to grow.

Final Thoughts + Call to Action

If you're running a medical practice, your energy should be spent on patient care — not paperwork, tax codes, or accounting confusion.

Smart, specialized accounting allows you to:

• Maximize profitability
• Avoid costly errors
• Free up time for what matters
• Build a more resilient business model

The team at Presti & Naegele is ready to help. Their experience, clarity, and personal service have helped hundreds of medical professionals like you streamline their financial operations without the noise or confusion.

Ready to take control of your accounting?
Schedule a consultation with Presti & Naegele today.