How to Choose a CPA for Your Medical Practice: 12 Questions to Ask

Choose a CPA for your medical practice by matching the firm's experience, written scope, reporting, tax coordination, and communication to the work your practice needs. Ask for examples and named responsibilities before comparing fees. A useful proposal explains who does the work, what you receive, what is excluded, and how unresolved issues reach you.

An employed physician choosing help with a personal return faces a different decision from an administrator hiring an accounting team for a staffed practice. Start with that distinction. Then use the questions below to compare firms on the same work instead of comparing two unexplained prices.

Start with the work you need

For an employed doctor, the assignment may involve household tax planning, investment records, withholding, and side income. A locum tenens physician may also need business books and coordination across assignments and states. A practice owner needs reliable practice reporting as well as a coordinated view of the owner's taxes.

Taxstra's CPA services for doctors and physicians describe the individual and owner tax work. Our medical practice accounting guide explains the operating-practice workflow. Use those distinctions when writing your own requirements, whichever firm you choose.

Twelve interview topics for a medical practice CPA

1. Have you worked with practices that operate like ours?

Explain your ownership structure, providers, locations, payer mix, and current systems. A direct-pay practice and a multi-provider group can have quite different reporting needs.

Evidence to request: a description of comparable work and an anonymized or illustrative report. The firm should explain what changes for your practice. Ask a follow-up if the answer is only a list of medical specialties or an unsupported claim about savings.

2. Who owns the monthly close?

Transaction entry is only part of the job. Agree on who reconciles the accounts, reviews the result, follows up on missing records, and delivers the reports.

Evidence to request: a close checklist naming the preparer, reviewer, required inputs, and delivery date. Ask what happens when a source report arrives late. A bank feed or software login alone does not describe a completed close.

3. Who reconciles billing-system collections to the bank?

A billing company may post patient and payer activity while an accounting firm maintains the general ledger. Neither engagement automatically includes the other team's work.

Evidence to request: an example tracing posted collections through fees, refunds, timing differences, and deposits. Ask who owns unexplained differences. An answer that simply says the billing company handles everything leaves a responsibility gap.

4. How will you coordinate the practice's taxes with the owners' taxes?

Identify which entity and individual returns the firm prepares and which advisers receive information. For owners with several income sources, someone needs to maintain the combined planning picture.

Evidence to request: a list of entities, owners, states, deadlines, and information handoffs. Ask how income changes are communicated during the year. Do not assume personal planning is included in a business-return fee.

5. What will we receive during the year?

Ask about outputs rather than accepting the word “advisory.” You may need financial statements, a reconciliation summary, a cash forecast, a planning memo, or help interpreting an unusual month.

Evidence to request: an illustrative reporting package and meeting agenda. Identify which reports are recurring and which are separately scoped. A long list of services is not a commitment to deliver them in your engagement.

6. Who reviews payroll and owner compensation records?

Name the payroll provider and the person responsible for checking the payroll records against the books. Keep compensation agreements, reimbursements, distributions, and payroll questions visible to the appropriate advisers.

Evidence to request: a payroll-to-ledger checklist and an escalation path for discrepancies. Ask who approves changes. Avoid assuming that running payroll also includes reviewing the owner's entire compensation arrangement.

7. How do you evaluate planning recommendations?

A recommendation should identify the facts it relies on, implementation steps, ongoing costs, and circumstances that would change the conclusion. A promised result before the facts are reviewed is not a substitute for analysis.

Evidence to request: a sample decision memo with assumptions and alternatives. Ask who implements each action and how completion is checked. Use our physician tax-planning playbook to organize topics for that conversation, not as a list of strategies every physician should use.

8. Who answers questions, and what response schedule is included?

Find out whether your main contact prepares the work, supervises it, or routes questions to another person. Discuss routine questions, time-sensitive decisions, absences, and tax-season availability.

Evidence to request: named roles, communication channels, and the response expectations in the engagement. Ask what is billed separately. “Unlimited support” needs a definition that both sides understand.

9. What records and system access do you need?

Begin with financial reports, prior returns, account reconciliations, and a system inventory. Ask the firm to explain its access process before sharing sensitive records.

Evidence to request: an onboarding checklist, approved transfer method, and a list of requested access permissions. Patient information and any legal or privacy arrangements require deliberate review with the practice's appropriate advisers. Do not send patient-level exports merely to obtain an initial quote.

10. What does the fee include and exclude?

Separate recurring bookkeeping, cleanup, tax returns, payroll work, software, and advisory projects. Ask how an added provider, location, entity, or state changes the scope.

Evidence to request: a written schedule of services, fees, assumptions, and change approval. Compare a full year on a consistent basis. An inexpensive proposal can be entirely suitable, but only if it covers the work you actually need.

11. How would you take over from our current firm?

Discuss historical files, opening balances, unfinished reconciliations, filing responsibilities, and outstanding questions. Assign deadlines before ending the old engagement.

Evidence to request: a transition plan that names who requests files, validates balances, and handles filings during the handoff. Keep access to historical records. A new software file does not resolve unexplained old balances.

12. What happens when something falls outside your scope?

Medical billing, coding, legal advice, investment management, and accounting can involve different providers. A good relationship makes those boundaries explicit.

Evidence to request: exclusions, referral or coordination procedures, and an owner for each handoff. Ask what happens when an unresolved issue affects a report or deadline. Prefer an accurate boundary to an unsupported promise that one firm handles everything.

Compare the engagement, not just the monthly fee

This simplified example compares two hypothetical proposals for the same practice. These are invented figures for illustration, not Taxstra prices, market averages, or client results.

Proposal A has the lower monthly fee but the higher first-year total for the listed work. That does not make Proposal B better automatically. Compare reviewer involvement, the exact returns included, reporting, communication, and exclusions. Neither total includes services not shown. Ask both firms to quote the same assignment before deciding.

For broader fee drivers, see how much a CPA costs. The bookkeeping cost calculator can help organize scope questions; its estimate does not replace a practice-specific proposal.

Use the CPA-selection scorecard

Score each criterion 0 for unanswered, 1 for a verbal explanation, or 2 for written scope or an example you can evaluate. Mark genuinely irrelevant items N/A. Compare the same applicable criteria across firms. This is an editorial decision aid, not a validated rating system or a predictor of outcomes. A high total does not override an unresolved issue that matters to your practice.

Download the fillable Excel CPA-selection scorecard. Enter three firm names, select scores from dropdowns, and record evidence and follow-up actions. Save your copy in Excel to keep your entries. No email is required.

Before you switch firms

Confirm the new engagement and the handoff date. List every return, payment, payroll task, and report due during the transition. Obtain copies of returns, financial statements, trial balances, reconciliation reports, debt and asset schedules, and relevant ownership documents. Agree on opening balances and record unresolved exceptions instead of hiding them in a miscellaneous adjustment.

Assign a person to approve access changes and confirm that the new team has the required files before removing old access. Ask both firms which unfinished items remain their responsibility. Timing depends on record quality, access, upcoming deadlines, and agreed scope; there is no universal switch date.

Questions physicians often ask

Do I need a local CPA for my medical practice?

A remote firm can be a fit when it understands the practice's work, relevant jurisdictions, and reporting needs and has an agreed communication process. Compare experience and scope rather than distance alone. Ask how meetings, document transfers, and time-sensitive questions work.

Does a billing company replace a medical practice bookkeeper?

Do not assume so. Billing and bookkeeping are separate responsibilities unless the contract specifically combines them. Ask who reconciles collections to deposits, maintains the ledger, reconciles payroll and debt, and produces financial statements.

Can I hire a CPA just for tax preparation?

Yes, a preparation engagement can be the right scope when that is the work you need. Confirm whether planning, bookkeeping, notice response, and meetings are excluded or separately billed. The important distinction is the written assignment, not the label on the firm's website.

How do I know whether a planning recommendation is right for me?

Ask for the assumptions, alternatives, implementation costs, ongoing obligations, and relevant authority. Your adviser should explain which facts would change the recommendation. A sample scenario or online calculator cannot establish your individual outcome.

Check credentials and supporting records

Use NASBA's CPAverify and the relevant state board to check licensing information. The IRS directory of preparers with credentials and select qualifications is another reference; a directory entry alone does not establish healthcare experience or the scope of a proposed engagement. The IRS recordkeeping guidance explains why supporting records matter.

This guide was prepared September 18, 2026. Educational, not individualized tax advice. The questions and scorecard are editorial tools; service scope, tax decisions, and privacy arrangements depend on the practice's circumstances.

Discuss your practice's needs

Taxstra provides tax planning and preparation, bookkeeping, and fractional CFO services. We work remotely with physicians and practice owners nationwide. An initial conversation establishes fit and proposed scope; detailed analysis and recommendations begin after engagement.

Book a free initial consultation, or use the scorecard to prepare questions first. For further context, read our medical practice accounting guide, locum tenens tax guide, and private-practice tax planning page.