Bookkeeping and tax for medical businesses • Personal tax returns for individuals

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A client prepaid for a package of sessions. Is that income now?

The money in your bank account is not automatically income on your books. When a client pays upfront for a package of sessions, that payment is a liability until you deliver the sessions.

Think about what you owe the client. If they paid $1,200 for six sessions and you’ve delivered zero, you owe them six sessions or a refund. That obligation shows up in your books as deferred revenue or unearned revenue. It sits as a liability on your balance sheet, not revenue on your income statement.

As you deliver each session, you recognize a portion as income. After the first session, you move $200 from the liability to revenue. After the second, another $200. This continues until all sessions are delivered and the full amount has moved from liability to income.

This isn’t an optional accounting choice. It’s how accurate books work. Booking the entire $1,200 as income on day one creates several problems. Your profit looks higher than it actually is. You’ll pay taxes on money you haven’t really earned yet. Your books hide the fact that you still owe services to that client. If the client asks for a refund, your financials will show a loss when really you’re just returning unearned money.

This issue shows up constantly in medical businesses. Med spas sell treatment packages and monthly memberships. Therapy practices bundle sessions at a discount. Home care agencies collect deposits for care hours. A CPA who works with medical businesses sees this situation regularly and knows how to set up your chart of accounts correctly from the start.

Your books should always show the outstanding balance you owe to clients in prepaid services. This gives you an accurate picture of what you’ve actually earned versus what you still need to deliver. It also keeps your tax liability aligned with income you’ve genuinely recognized.

If your current bookkeeping dumps prepaid packages straight into revenue, that’s a problem worth fixing. Monthly full-service bookkeeping ensures deferred revenue is tracked properly and income gets recognized correctly as sessions are delivered.

If you’re not sure how prepaid packages are flowing through your books, let’s take a look together. Book a consultation and we can review how your revenue is being recorded.

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More Questions

I inject on weekends and run the spa around my hospital shifts. What does my tax picture look like?

Your W-2 income sets your bracket, then spa profit stacks on top at that rate. You face self-employment tax, quarterly estimates, and potential QBI phaseout as a high earner in a health business. The wins come from structure and planning.

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My injectors want commission. How do I keep that from wrecking my margins?

Define your commission base precisely because paying on gross revenue versus net of product cost changes everything. Track provider-level margin so your most popular injectors are also your most profitable ones.

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How should injectables be handled in my books?

Injectables are inventory, not an expense at purchase. Record them as an asset when they arrive, then move cost to expense as units are used on clients. This approach shows you true cost per treatment and surfaces waste.

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What changed with 1099 rules, and what do I file this January?

The $2,000 reporting threshold applies to payments made in 2026, not 2025. This January, you still file 1099s for contractors who received $600 or more. The first filings under the new threshold happen in January 2027.

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What should an hour of care actually cost me to deliver?

An hour of care costs far more than the caregiver's wage. Add employer payroll taxes, workers comp, travel time, training, and unbilled gaps, and the fully loaded cost can run 30 to 50 percent above the wage itself.

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What financial habits should I build in my first year of business?

The habits you build early cost almost nothing to maintain and make everything easier later. Separate banking, monthly bookkeeping, tax reserves, and clean digital records form the foundation.

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Hunter Green CPA provides bookkeeping, tax preparation, and tax strategy for medical business owners across the United States. Alongside its business services, the firm prepares personal tax returns for individuals and families. Based in Oak Park, Illinois and led by Mason Hunter, a CPA with 10 years of tax experience and a background in corporate tax management.

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