Healthcare Accounting & CFO
Accounting & CFO Services for Digital Health Startups
PMPM, fee-for-service, and subscription revenue recognition, payer AR and long collection cycles, provider network cost accounting, and contribution margin per member your board expects.
Digital health finance blends three business models at once: recurring subscription, per-member-per-month capitation, and fee-for-service reimbursement, each with its own revenue timing and collection reality. Payers pay slowly and adjust claims after the fact, clinician networks sit somewhere between W-2 and 1099, and gross margin only means something after clinical delivery cost. StartupCFO pairs a CPA-led accountant with ClariFi to run digital health books that hold up to payer diligence and give your board real per-member unit economics. We handle the finance and accounting side only. We do not provide medical, clinical, or regulatory compliance advice.
What's Hard About Healthcare Finance
The healthcare-specific challenges that generic bookkeeping services miss.
Multi-model revenue recognition (PMPM, FFS, subscription)
Per-member-per-month capitation, fee-for-service reimbursement, and SaaS-style subscriptions each recognize differently under ASC 606. We build the revenue schedules so PMPM, claims, and subscription revenue are never conflated in your margin story.
Payer AR and long collection cycles
Insurer and employer AR ages far longer than card revenue, and claims get denied, adjusted, or clawed back. We track billed vs. collectible, book contractual allowances and denial reserves, and keep net revenue honest rather than overstated.
Provider network and clinician cost accounting
Salaried clinicians, 1099 contractor providers, and per-visit panels all hit cost of care differently. We classify clinical delivery cost consistently so gross margin after clinician time reflects real unit economics.
Vendor, BAA, and infrastructure cost tracking
HIPAA-adjacent vendors, business associate agreements, EHR integrations, and hosting all carry recurring finance obligations. We track and categorize these vendor costs on the finance side so platform spend is visible in gross margin (we do not advise on HIPAA compliance itself).
Non-dilutive funding and grant accounting
NIH, SBIR/STTR, and foundation awards carry allowable-cost and reporting rules distinct from equity funding. We segregate grant spend, apply F&A rates, and keep award reporting audit-ready alongside your commercial P&L.
Multi-state licensing and tax nexus
Operating providers across states creates income tax nexus, and telehealth and platform fees raise sales/use tax questions state by state. We monitor nexus across 51 jurisdictions and handle registration and filing.
How StartupCFO Helps
One integrated team (bookkeeper, CPA, and fractional CFO) running the right healthcare playbook.
- Monthly close with ASC 606 revenue recognition across PMPM, fee-for-service, and subscription
- Payer AR aging, contractual allowances, and denial/clawback reserve accounting
- Cost-of-care accounting for salaried and 1099 clinical provider networks
- Contribution margin per member and per patient reporting, live in ClariFi
- Grant and non-dilutive funding accounting (NIH, SBIR/STTR) with award-level reporting
- Multi-state income and sales/use tax nexus monitoring, registration, and filing
- Fractional CFO support for payer contract modeling, fundraising, and unit economics
Digital health metrics we track
- Revenue by model: PMPM / capitation, fee-for-service, subscription
- PMPM and per-member net revenue after contractual allowances
- Payer AR aging, days sales outstanding, and denial/clawback rate
- Gross margin and contribution margin per member after cost of care
- CAC and payback by acquisition channel (employer, payer, DTC)
- Member retention and engagement tied to revenue cohorts
- Cash runway under payer collection and enrollment scenarios
Frequently Asked Questions
How do you handle PMPM, fee-for-service, and subscription revenue together?
Each model is recognized on its own basis under ASC 606. PMPM capitation is recognized over the coverage period, fee-for-service is recognized as claims are earned and net of expected contractual allowances, and subscriptions are deferred and recognized over the term. We keep the three streams separated so your gross margin and net revenue are never a blended guess.
Do you handle payer accounts receivable and denials?
Yes. We age payer and employer AR separately from consumer revenue, book contractual allowances and denial reserves from your actual claim history, and reconcile collections against billed amounts. Your board sees billed revenue, expected net revenue, and cash collected as distinct numbers, not one optimistic figure.
Can you account for a mixed W-2 and 1099 clinician network?
Yes. Salaried clinicians, contractor providers, and per-visit panels are all mapped into cost of care so gross margin reflects the true cost of clinical delivery. We also handle the payroll and 1099 reporting side. We advise on the accounting, not on provider licensing or clinical compliance.
Do you support NIH or SBIR grant accounting for health startups?
Yes. We segregate grant spend into cost pools aligned with federal Uniform Guidance, apply your approved or de minimis F&A rate, track allowable vs. unallowable costs, and produce award-level reports, all while keeping your commercial P&L clean and separate.
What metrics do digital health investors expect in a board pack?
Revenue split by PMPM, fee-for-service, and subscription, net revenue after contractual allowances, payer AR aging and denial rate, contribution margin per member after cost of care, CAC and payback by channel, and member retention and engagement. Growth plan clients get a board-ready pack built around these, with the ClariFi platform and MCP access so your team can query the numbers directly.
Ready for Healthcare-Native Accounting?
Book a free consultation and we'll walk through how we'd run your healthcare books, taxes, and CFO support, live within 48 hours.
