Medical practice chart of accounts template

Most chart-of-accounts templates you will find for a medical practice are just a generic small-business list with the word "medical" added. They miss the three things that actually make a practice's books work: split patient and insurance receivables, a proper contra-revenue section for contractual adjustments and write-offs, and revenue tracked by provider and location. This page gives you the full numbered template, with the healthcare-specific accounts marked and explained, ready to copy into QuickBooks Online, Xero or any ledger.

What a generic template gets wrong

Before the template, the three fixes that separate a real medical-practice chart of accounts from a generic one. Each of these is an account structure a normal business never needs, and a practice cannot run correct books without.

The fix	Why it matters
Split patient and insurance accounts receivable	Insurers and patients pay on different timelines and need different follow-up. A single receivable balance cannot be acted on.
Break out contra-revenue by type	Contractual adjustments, insurance write-offs, patient bad debt and refunds are four different problems. Lumped together, none is visible, and the net collection rate cannot be calculated.
Track revenue by provider and location	Profitability by doctor and by site lives in dimensions on each transaction, not in duplicated accounts.

The template

A full numbered chart of accounts for a medical or dental practice. Rows marked healthcare-specific are the ones a generic template omits. Adjust the individual revenue and cost lines to your specialty.

Number	Account	Type
1000–1999 Assets
1000	Operating bank account	Asset
1010	Payroll bank account	Asset
1020	Petty cash	Asset
1100	Accounts receivable – patients ●	Asset
1110	Accounts receivable – insurance ●	Asset
1120	Accounts receivable – other	Asset
1200	Medical supplies inventory	Asset
1210	Drug and pharmacy inventory	Asset
1300	Prepaid insurance	Asset
1310	Prepaid rent	Asset
1500	Medical and dental equipment	Asset (fixed)
1510	Accumulated depreciation	Contra-asset
2000–2999 Liabilities
2000	Accounts payable	Liability
2100	Payroll liabilities	Liability
2110	Payroll taxes payable	Liability
2200	Patient credit balances and overpayments ●	Liability
2400	Short-term loan	Liability
2500	Long-term loan	Liability
3000–3999 Equity
3000	Owner or physician capital	Equity
3010	Owner contributions	Equity
3020	Owner draws	Equity
3100	Retained earnings	Equity
4000–4499 Revenue (gross)
4000	Consultation and office visit revenue	Revenue
4020	Procedure and surgery revenue	Revenue
4040	Diagnostic, lab and imaging revenue	Revenue
4070	Ancillary revenue (vaccination, pharmacy, hygiene)	Revenue
4090	Telemedicine revenue	Revenue
4110	Self-pay patient revenue	Revenue
4500–4599 Contra-revenue ● the accounts a generic template lumps into one
4500	Contractual adjustments ●	Contra-revenue
4510	Insurance write-offs and denials ●	Contra-revenue
4520	Patient bad debt ●	Contra-revenue
4530	Refunds to patients and payers ●	Contra-revenue
5000–5999 Direct clinical costs
5000	Medical and clinical supplies used	Expense
5010	Drugs and medications used	Expense
5020	Laboratory and outside services	Expense
5030	Dental lab fees ●	Expense
5100	Clinical and provider wages	Expense
6000–6999 Operating expenses
6000	Administrative and front-desk wages	Expense
6020	Payroll taxes and employee benefits	Expense
6100	Rent and utilities	Expense
6120	Telephone, internet and software	Expense
6200	Equipment repairs and maintenance	Expense
6300	Office supplies and administration	Expense
6400	Accounting and legal fees	Expense
6500	Medical malpractice insurance ●	Expense
6510	Licensing, credentialing and CME ●	Expense
6600	Marketing and patient communications	Expense
6700	Depreciation expense	Expense
7000–7999 Other income and expense
7000	Interest income	Other income
7100	Interest expense	Other expense
7200	Gain or loss on asset disposal	Other income or expense

How the revenue section is meant to flow

The reason the contra-revenue accounts sit in their own block just below gross revenue is so the profit and loss statement reads down to the number that actually matters. Gross revenue less the contractual adjustments, write-offs, bad debt and refunds equals net patient-service revenue, which is what the practice truly earned. A generic template that folds all of those into a single "revenue adjustments" line hides the collection story completely. Recording contractual adjustments correctly here is the foundation of the whole system, which we cover in recording insurance reimbursements and contractual adjustments.

Track revenue by provider and location with dimensions, not extra accounts

You will notice the template has one clean set of revenue accounts, not a separate set for each doctor. That is deliberate. Duplicating the revenue section per provider bloats the chart of accounts and still cannot show revenue by location. Instead, keep these accounts and tag every transaction with a provider and a location, using classes and locations in QuickBooks Online or the tracking categories in another ledger. That lets you run a profit and loss statement by provider, by location or by service line from the same accounts. The setup is covered in our guide on setting up bookkeeping in QuickBooks Online, and the reporting it enables in tracking profitability by provider or location.

Where Numetix fits

Numetix sets up and maintains a chart of accounts like this one for a medical or dental practice, with the contra-revenue accounts, the split receivables, and the provider and location dimensions configured correctly from the start, and then keeps the books on it each month. A good chart of accounts is only useful if transactions are consistently posted to the right accounts, which is the ongoing work. If you would rather have it built and maintained than assemble it yourself, that is what Numetix does. Want this as a downloadable file for QuickBooks or Xero import? It is available on request.

Frequently asked questions

How do you record contractual adjustments in the chart of accounts?

As a contra-revenue account just below gross revenue, not as an expense. A contractual adjustment is the gap between the billed charge and the payer's contracted rate, so it reduces gross revenue to net patient-service revenue. Keeping it separate from insurance write-offs, bad debt and refunds is what lets a practice see a true net collection rate.

Should I create separate revenue accounts for each provider?

No. Keep one set of revenue accounts and tag transactions with a provider and location dimension using classes and locations. That produces provider, location and service-line reporting from the same accounts without an unwieldy chart of accounts.

Does this work for a dental practice?

Yes. The structure is the same; a dental practice would emphasize hygiene and dentist production in the revenue accounts, dental lab fees in direct costs, and PPO write-offs in the contractual-adjustments account. The split receivables, the contra-revenue block and the provider and location dimensions all apply directly.

Do I need to change the account numbers?

Not necessarily. The numbering here follows the common convention of assets in the 1000s, liabilities 2000s, equity 3000s, revenue and contra-revenue 4000s, direct costs 5000s, operating expenses 6000s and other items 7000s, which most ledgers expect. Adjust individual lines to your specialty, but keeping the ranges makes the books easy for any accountant to read.

This template is a starting point to customize for your specialty and structure. Account numbering and the tax treatment of items such as owner draws, depreciation and reimbursements depend on your jurisdiction and entity, so confirm those with your accountant. This article is general information, not accounting, tax, or legal advice.