15 Questions Med Spa Owners Ask Their Bookkeeper
November 21st, 2025
Written by Marc, Your Chief Bookkeeping Officer
For most med spa owners, bookkeeping feels complicated long before it gets big. The structure alone, an MSO paired with a PC, introduces its own accounting questions. We hear them every day. Here are fifteen of the most common ones, and how we actually answer them.
1. “We’re a med spa, but our structure’s a little different.”
Almost every conversation starts here. The MSO–PC model isn’t unique; it’s used by surgical centers, plastic surgeons, and ophthalmologists. We understand what belongs on each set of books, how management fees flow, and how to track those due to and due from balances that keep the cash flow clear.
2. “Do you actually understand MSO and PC accounting?”
Yes. At the base level, it’s just two sets of books. The best way to manage them is separately, as two independent entities tied together only where the management agreement says they should meet.
3. “What should be on the MSO books versus the PC books?”
Think of it like this: the MSO runs the business, the PC practices medicine. Rent, marketing, and admin staff are typically MSO. Licensed providers and the medical director belong to the PC. The MSA is the rulebook that decides what goes where.
4. “How is the management fee calculated?”
Every MSA handles this differently. Some use a flat fee, some a percentage of revenue. We don’t need the agreement itself, but we do need to know the calculation so we can make sure it’s being recorded properly every month.
5. “Should each entity have its own payroll?”
Yes. Both should. Admin and support staff usually fall under the MSO, while clinical staff belong to the PC. That separation is standard and keeps the reporting clean.
6. “Do you integrate with our EMR?”
Not typically. Unless you’re running multiple locations or eight-figure revenue, direct EMR integration isn’t worth the complexity. Most systems can export clean daily or monthly summaries we can book directly into QuickBooks.
7. “Are we supposed to be cash or accrual basis?”
Cash basis is fine for most med spas. Once you reach eight figures or more complex operations, accrual accounting becomes useful. Until then, simplicity wins.
8. “What’s the right tax election for our MSO?”
Your CPA will guide that decision. When the MSO becomes profitable, electing S-Corp status can help manage tax liability. Early on, there’s usually no rush.
9. “How should we pay the medical director?”
It depends on your MSA. Flat fee, percentage of revenue, or rental arrangement are all common. We just need to know how it’s calculated so it’s tracked consistently and accurately.
10. “Can you track vendor payments and supplies?”
Yes. We customize your chart of accounts so you can see exactly what’s being spent with vendors like Galderma, Allergan, or compounding pharmacies without overcomplicating your P&L.
11. “Can we run everything through one credit card?”
Many new med spas do, and it’s not the end of the world. We’ll separate those transactions and post reimbursements correctly as due to and due from balances so both entities stay aligned.
12. “What reports will we receive each month?”
You’ll receive a Profit & Loss and Balance Sheet for each entity, and a combined view if you need it. If your MSA ties the management fee to P&L performance, we can align your chart of accounts so it’s easy to verify.
13. “How do we handle prepayments, memberships, and packages?”
Those are deferred revenue, services paid for but not yet earned. Even on cash basis books, we can track them using your EMR reports. It’s a light, practical way to see what’s been earned versus what’s still owed.
14. “Do you work with our CPA or handle taxes?”
We don’t file taxes, but we work alongside your CPA. They’ll always have current financials for tax planning and a clean year-end package for filing, with no surprises or delays.
15. “What happens as we grow, more providers, more locations?”
That’s when structure becomes everything. We’ll discuss whether to use class or location tracking or form new entities altogether. The key is keeping your attorney, CPA, and bookkeeping team in sync so your MSA, reporting, and tax plan evolve together.
Closing Thoughts
Every med spa asks these questions at some point, and they should. Because clarity on structure, cash flow, and compliance is what turns a practice into a business.
If you’re operating under an MSO–PC setup and want your bookkeeping built right from day one, visit ChiefBookkeepingOfficer.com.
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