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The full MSO stack

One back office for your entire practice

Accounting, tax, payroll, CFO strategy and compliance under one CPA-led team — for a flat monthly fee. No equity, no share of collections, no hourly billing.

CPA-led on every engagementFlat monthly feeNationwide, fully remote

Outsourced Accounting

Clean, current books, monthly financials, and reconciliations tuned to your specialty’s chart of accounts.

  • Monthly bookkeeping & reconciliations
  • Financial statements per entity
  • Combined multi-site reporting
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Fractional CFO

Budgeting, cash-flow forecasting, KPI dashboards, and provider-comp modeling — CFO insight without the hire.

  • 13-week cash forecasting
  • KPI & utilization dashboards
  • Quarterly strategy reviews
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Tax Strategy & Planning

Entity and S-corp optimization, reasonable-comp studies, PTET, and year-round planning to lower the combined bill.

  • Business & owner returns
  • Reasonable-comp studies
  • Proactive year-round planning
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Recruiting & HR

Provider and staff payroll, contractor 1099s, and benefits coordination across every location and entity.

  • Full-service payroll runs
  • 1099 & W-2 filings
  • New-hire & classification support
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Benchmarking & KPIs

See overhead, collections, and profitability against specialty peers — and know exactly where to act.

  • Specialty peer benchmarks
  • Provider productivity metrics
  • Margin by service line
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Compliance & Risk

Entity governance, professional-corporation rules, and HIPAA-aware financial workflows and controls.

  • PC governance & filings
  • HIPAA-aware workflows
  • Internal controls & segregation
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Transaction Advisory

Buy-ins, buy-outs, partner admissions, acquisitions, and practice-sale readiness — modeled and guided.

  • Buy-in / buy-out modeling
  • Acquisition due diligence
  • Sale & succession readiness
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Retirement & Wealth

401(k), cash-balance, and defined-benefit plan design to shelter income and build owner wealth tax-deferred.

  • Solo 401(k) & SEP design
  • Cash-balance plans
  • Owner wealth strategy
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Practice Launch & Setup

Entity formation, S-election, EIN, banking, and systems — everything to open and operate cleanly on day one.

  • Entity formation & S-election
  • Payroll & banking setup
  • Systems & software onboarding
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Simple, Transparent Packages

Flat-fee plans that scale with your practice

Every plan is a fixed monthly fee — no hourly surprises. We’ll right-size it to your practice in a free assessment.

Solo & Early-Stage

Foundation

from $1,000/mo

For solo and early-stage practices getting clean and compliant.

  • Monthly bookkeeping & reconciliations
  • Monthly financial statements
  • Annual business & owner tax returns
  • Payroll for owner + small team
  • Email & portal support
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Most Popular

Growth

from $3,000/mo

For multi-clinician practices ready for proactive strategy.

  • Everything in Foundation
  • Fractional CFO & KPI dashboards
  • Quarterly tax planning & projections
  • Full-service payroll & 1099s
  • Benchmarking & quarterly reviews
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Multi-Site & Groups

Scale

from $5,000/mo

For multi-site groups, DSOs/MSOs, and complex ownership.

  • Everything in Growth
  • Multi-entity consolidation
  • Transaction & buy-in advisory
  • Retirement & wealth plan design
  • Dedicated CFO & monthly reviews
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Final fee is scoped to your practice in a free assessment.

Which plan fits

Most owners are not sure which tier they are

So here is the honest sizing. If you fall between two, we will quote you the lower one and tell you when it stops being enough.

Foundationfrom $1,000/moGrowthfrom $3,000/moScalefrom $5,000/mo
Annual collectionsUnder $750K$750K – $2M$2M and above
Clinicians or providers1–23–1010 or more
EntitiesOneOne or twoMultiple
LocationsOneOne or twoTwo or more
Where the pressure isGetting clean and compliantMargin and taxConsolidation and growth
What is included
Monthly bookkeeping and reconciliations
Monthly financial statements
Plain-English monthly summary
Business and owner tax returns
Named CPA on your account
Reply within one business day
PayrollOwner and small teamFull service, including 1099sFull service, multi-entity
Quarterly tax planning and projections
Reasonable compensation study
KPI dashboard and peer benchmarking
Cash-flow forecasting13-week13-week plus scenarios
Fractional CFO timeQuarterlyMonthly
Multi-entity consolidation
Transaction, buy-in and exit advisory
Retirement plan design

Every plan is a flat monthly fee for a defined scope, quoted after we look at your books. No equity, no share of collections, no hourly billing.

The comparison that matters

What you are probably paying already

The useful question is not whether the fee is large. It is what the fee replaces, and whether the pieces it replaces were ever talking to each other.

The assembled stackTypical ranges
Outsourced or part-time bookkeeper$1,200 – $2,500 / mo
Payroll service$150 – $400 / mo
CPA firm for returns and some planning$400 – $900 / mo equivalent
Office manager or controller time spent on finance$1,500 – $3,000 / mo loaded
Total, across three or four vendors$3,250 – $6,800 / mo

Where this actually breaks

  • Nobody owns the whole pictureYour bookkeeper does not know your tax position. Your CPA sees the year once it is over. The gap between them is where the money goes.
  • You are the integration layerThe hours you spend chasing four vendors for one answer are the real cost, and they never appear on any invoice.
  • When we are not the cheaper optionA solo practice under roughly $400K with simple books and no entity complexity is usually better served by a good bookkeeper and a CPA at tax time. We will say so on the call.
Scope

What we do not do

Naming the edges is more useful than another feature list, and it saves us both a call.

We do not bill your payersCoding, claims, denials and patient balances stay with your billing team or RCM vendor. We reconcile what actually lands.
We do not audit your statementsWe prepare them. Independence rules mean the firm that prepares cannot also attest. If you need an audit or review, we will help you scope one.
We do not sell productsNo insurance, no securities, no vendor commissions, no referral fees. We are paid by you and nobody else.
We do not give legal adviceWe build the financial structure and work alongside your counsel on the agreements. We do not draft them.
We do not take equityNo ownership stake, no share of collections, no right of first refusal if you sell.
Not ready for a monthly engagement?Single projects — a cleanup, an entity election, a valuation — are available on their own. See a la carte services →
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Ready to hand off the back office?

Book a free, no-pressure practice assessment. We'll review your books, entity structure, and tax posture and show you exactly where we'd add value.

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