A Bookkeeping Setup for Therapists Working Through Headway, Alma, or Grow Therapy
If you're a mental health therapist running a private practice through Headway, Alma, Grow Therapy, Rula, or one of the other insurance billing platforms, your bookkeeping has a specific challenge that most generic small business advice doesn't address. The income arrives from multiple sources, each with its own dashboard, payment schedule, and tax form. Stitching it together so it makes sense at year-end takes some intentional setup.
Here's a workflow that holds up.
A quick note on what the platforms send you
Most of the major mental health platforms treat therapists as 1099 independent contractors. That means each platform you earn over the threshold from will send you a Form 1099-NEC reporting your income. In most cases, they don’t send a 1099-K—though in some situations (especially when payments are processed through third-party networks like Stripe), you may receive a 1099-K instead. The distinction matters because 1099-K is for payment card and third-party network transactions, while 1099-NEC reports nonemployee compensation directly from the entity that paid you.
Two things to know about the threshold:
For the 2025 tax year (the 1099s you received in early 2026), the threshold is $600. If you earned $600 or more from any platform during 2025, you should have received a 1099-NEC.
Starting with the 2026 tax year, the 1099-NEC reporting threshold increases to $2,000. If you earn between $600 and $1,999 from a platform in 2026, you may not receive a 1099 from that platform. You still owe tax on that income. The IRS still expects you to report it. The only thing that changed is the platform's reporting obligation.
A second specific: when you receive your 1099 from Headway, the sender on the form may show a legal entity name (such as ‘New York Medical Behavioral Health Services, P.C.’) rather than ‘Headway,’ depending on how payments are structured. This is the legal entity that pays providers under the Headway umbrella. If you've set up your books expecting income labeled "Headway" but the deposit memo and the 1099 show a different name, that's the reason.
Setting up your chart of accounts
In QuickBooks Online, the most useful structure is a separate income account for each platform you work with, plus one for any non-platform income. For example:
Income - Headway
Income - Alma
Income - Grow Therapy
Income - Private Pay (for cash, HSA, FSA, sliding scale, anything you bill directly)
This structure does two things. It lets you reconcile each platform's deposits to its dashboard report independently, and it gives you a year-over-year view of how your revenue mix is changing. If you started 2026 mostly on Headway and end the year mostly on Alma, your books will show that clearly.
The monthly workflow
Each platform has a dashboard where you can pull a monthly summary of what they paid you. Headway has a payments report. Alma has session payment reports. Grow Therapy has earnings history through Stripe Express. The exact name varies, but every major platform exposes this data.
Once a month, after the platform's payments for the prior month have settled:
First, categorize every transaction in your bookkeeping software, assigning each to the right platform's income account. Categorize the full month before moving on.
Then, reconcile each bank deposit against the platform's monthly report. The platform's report should match the deposits that hit your bank, accounting for processing time of one to several business days.
If the numbers don't match, the usual reasons are timing (a late-month session paid in the next month), refunds or cancellations, or sessions that were submitted late and are still in process. The platform's dashboard typically shows pending vs. paid sessions so it's possible to see what's stuck where.
Categorizing all transactions first and then reconciling is the standard order. The standard month-end routine covers the broader workflow, and works for therapy practices with the platform-specific additions described here.
Handling the platform fee question
Different platforms structure their fees differently, and how the fee shows up on your 1099 affects how you should record it.
Headway takes a commission from the insurance reimbursement before paying you. The 1099-NEC reports what was paid to you, which is already net of Headway's commission. There’s generally no separate ‘Headway fee’ expense to deduct for tax purposes because the fee was never your money, though some practices still track it internally for visibility.
Alma charges a monthly membership fee in addition to taking a cut on sessions. The monthly fee is a deductible business expense regardless. How Alma reports the per-session portion depends on whether your 1099 reflects gross or net income, which is worth confirming directly with Alma or your tax preparer.
Grow Therapy uses Stripe for payments, which may result in a 1099-K rather than a 1099-NEC, depending on how your payments are processed. The amount on the 1099 reflects what Grow Therapy paid you.
The general rule: confirm with each platform you use whether the 1099 shows gross (before platform fees) or net (after). If gross, the platform fee is a deductible business expense to record separately. If net, the fee was already excluded from your income and there's nothing extra to deduct. Getting this right matters because double-deducting fees, or missing a deduction, both create tax problems.
A few patterns to flag
If you switched platforms mid-year, expect multiple 1099s. A therapist who started 2025 on Alma and moved to Headway in July will receive both a 1099 from Alma and one from Headway. Your books should reconcile to both.
December sessions can land in the next year's income. The platforms pay on a schedule (Headway twice a month, Alma weekly, Grow Therapy varies). A session you held December 28 may not be paid out until early January, and may show up on the next year's 1099. This is a normal cash-basis situation, and most therapists are on cash basis, so it's usually fine. But if you're trying to forecast or compare year-over-year revenue, the timing is the reason.
Private-pay income needs its own tracking. The platforms only report what they paid you. Anything you billed directly (cash, sliding scale, HSA/FSA cards run through Stripe or Square, late fees, no-show fees) is yours to track. This is where most DIY therapy practice books have gaps.
Reconciling deposits to platform reports is the habit that catches everything else. Without it, errors compound. A missing deposit, a refund that wasn't recorded, an insurance reversal: any of these can sit unflagged for months in books that aren't being reconciled.
Deductible expenses common in therapy practice
A few categories that come up often:
Continuing education and professional development (substantial for therapists chasing modality certifications and CEUs)
Licensing and renewal fees
Professional association memberships (APA, NASW, AAMFT, state associations)
Liability insurance
Booking and EHR software (when not provided by the platform)
HIPAA-compliant email and storage
Office supplies and therapeutic tools
Consultation and supervision fees
The platforms' own fees (verify per-1099 reporting per the section above)
Most of these are specific to the field and are useful as named categories in your chart of accounts so they don't get buried under "Other Expense".
The bigger picture
Therapy practice income, by accounting standards, isn't that complex. The complexity comes from the platforms, the multiple 1099s, the timing differences, and the documentation a tax preparer expects at year-end. Set the structure up early, run a clean monthly close, and tax-time handoff becomes a non-event.
If your books aren't at this level of structure yet, the move isn't to overhaul everything in a weekend. It's to set up the chart of accounts, run one month of clean closing, and decide from there whether DIY is sustainable or whether handing it off makes more sense. This post on the signals to watch for covers when DIY stops being the right call.
A note on what this post is not: tax advice. Specifics about your situation, what's deductible, how to set up your entity, how to handle a multi-state license, all of that belongs with a qualified tax professional. This is general information about how to think about the bookkeeping side.
If your practice has reached the point where platform reconciliation and multi-stream income tracking is taking time you'd rather spend with clients, booking a free call is a low-pressure way to talk about whether ongoing bookkeeping support might fit.
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