For a medical practice, an accounting proposal is easier to evaluate when it explains the work behind the fee. Two practices with similar revenue can need different support: one may have reconciled records and a consistent monthly close, while another needs historical corrections, reporting across locations and closer oversight.
QonsultFirm uses customized-scope pricing. The starting point is understanding your records, systems, priorities and the responsibilities you want the engagement to cover.
Start with the work you need
Before comparing proposals, identify the questions your financial information needs to answer.
- Are the books current and reconciled?
- Can you understand monthly results and explain material changes?
- Do you need consistent reporting across providers, locations or entities?
- Are you planning a hire, equipment purchase or expansion that requires a forecast?
These needs can overlap. The aim is to agree a useful scope rather than select a service label without understanding its deliverables.
Six factors that shape the scope
1. The condition of your records
Current, reconciled records provide a different starting point from books with missing statements, unresolved balances or uncategorized transactions. Historical cleanup may need a defined project before a dependable recurring close can begin.
Ask which periods need review, what information is missing and how unresolved items will be documented. Distinguish the initial cleanup work from the ongoing engagement so you can compare proposals clearly.
2. Entities, locations and financial activity
Provider count alone does not describe the accounting work. Relevant details can include the number of legal entities, locations, bank and credit-card accounts, payroll arrangements and intercompany transactions.
For a group with several locations, discuss whether you need separate location reports, a consolidated view or both. Agree how shared costs will be treated before relying on comparisons.
3. Systems and available information
The work also depends on how records can be accessed and compared across accounting, billing and practice-management systems. The existence of a report does not necessarily mean it uses the same dates, categories or definitions as another system.
QonsultFirm works with QuickBooks, Xero, Sage Intacct and Oracle NetSuite, alongside the billing and practice-management systems your practice uses. Available reports, access and workflow are agreed during scoping; this does not assume automatic integrations.
4. Reporting and review needs
A scope focused on monthly financial statements differs from one that also includes provider reporting, location comparisons, management commentary or budget-versus-actual review.
Specify the reports you expect, how often they are needed and who will review them with you. A useful proposal explains both the deliverable and the question it is intended to help answer.
5. Oversight and planning responsibilities
Healthcare accounting establishes the financial records and recurring reporting foundation. Controller support can add close oversight, review and accounting-process controls. Fractional CFO support can add forecasts, scenarios and financial analysis for leadership decisions.
The right combination depends on the work required. Ask who prepares the information, who reviews it and which decisions remain with practice leadership.
6. Timing and your team’s involvement
Agree the target timetable alongside the information and participation needed from your team. Missing records or unresolved questions can affect when work can be completed.
Identify a practice contact, the information they will provide and how questions will be resolved. Clear responsibilities help make the engagement practical for both teams.
Compare proposals by deliverables, not just the fee
Use the same questions when reviewing each proposal:
| Question | What to look for |
|---|---|
| What is included? | Named deliverables, periods covered and reporting frequency. |
| What is outside the scope? | Clear boundaries and a process for agreeing additional work. |
| Is cleanup separate? | A distinction between historical corrections and recurring support. |
| Who is responsible? | Preparation, review and practice-team responsibilities. |
| What information is required? | Systems, reports, access and records needed to complete the work. |
| When is delivery expected? | A timetable that identifies dependencies rather than assuming all records are ready. |
| How are changes handled? | A way to revisit scope when entities, locations or reporting needs change. |
A lower fee is not a like-for-like comparison if the proposal omits work you expect. Equally, a broader scope is not automatically the right choice if its deliverables do not address your current needs.
What to prepare for an initial conversation
Be ready to describe your practice’s locations and entities, the systems you use, whether the books are current and your main reporting or planning concerns. You do not need to assemble a complete accounting file before discussing the fit.
For the initial consultation, provide business contact details only. During an engagement, clients share records through a client portal supported by Microsoft 365, with required records and access agreed during onboarding.
Agree a scope that fits your practice
QonsultFirm does not apply a fixed minimum provider count. The conversation focuses on the work needed, the available information and an appropriate division of responsibilities.
A complimentary 30-minute consultation is an opportunity to discuss those needs and the next step toward a customized scope.