For most solo NP practices, QuickBooks Solopreneur is sufficient for the first 1–2 years. Upgrade to Simple Start when you hire your first admin or contractor, or when your accountant requests access.

• ↗ QuickBooks Solopreneur — Sign Up
• Free 30-day trial available — start the trial the week your business bank account opens

After signing up, go to Transactions → Connect Account → select your bank. QuickBooks uses Plaid or similar bank-link technology to pull transactions automatically. Connect your dedicated business checking account and any business credit cards. Do not connect personal accounts — only business accounts should be linked.

• Transactions from the connection start date forward are imported automatically
• You can manually import older transactions via CSV from your bank’s statement download
• If your bank is not listed: download your statement as .CSV and import via File → Import

Under Settings → Company: enter your business legal name, EIN (not SSN), business address, industry (Healthcare / Ambulatory Health Care Services), and fiscal year start (January 1 for most NP practices). Under Tax → Tax Profile: select “Sole Proprietor / Single-Member LLC” and confirm your primary tax form is Schedule C (Form 1040).

QuickBooks has default Schedule C categories. For NP private practice, also add or confirm these categories exist:

• Medical supplies and equipment (deductible as business expense)
• EHR and telehealth software subscriptions
• Malpractice insurance premiums
• Continuing education and professional licensing fees
• Professional association memberships (AANP, ANCC, state NP association)
• Medical reference subscriptions (UpToDate, Epocrates, etc.)
• Home office deduction (if you see telehealth patients from a dedicated home office space)
• Business phone and internet (business-use percentage only)

• ↗ IRS Direct Pay — Pay Quarterly Taxes Online
• When paying: select “Estimated Tax” → “1040-ES” → current tax year
• QuickBooks Solopreneur shows your estimated quarterly tax under “Taxes” tab
• General guideline: set aside 25–30% of net income each month for taxes (federal + self-employment tax + state income tax)

As a self-employed NP, you pay both the employer and employee portions of Social Security and Medicare taxes — a combined 15.3% on net self-employment income (on top of regular income tax). QuickBooks factors this into its estimated tax calculation. You can deduct half of the self-employment tax on your Schedule C. This is why your effective tax rate as a self-employed NP is higher than when you were a W-2 employee at the same gross income.

• On $150,000 net income: approximately $22,000 self-employment tax + $28,000–$33,000 federal income tax = $50,000–$55,000 total federal tax, depending on deductions
• Work with a CPA who specializes in healthcare or self-employed professionals for your first-year taxes
• ↗ IRS — Self-Employed Tax Center

Go to Reports → Profit and Loss → set date range to “Last Month.” The report shows: Revenue (all insurance payments received), Expenses by category, and Net Profit (what you actually earned after expenses). Compare month over month. Key metrics to track:

• Revenue per session: total revenue ÷ total sessions. Should match your expected reimbursement rates
• Expense ratio: total expenses ÷ revenue. Target: under 30% for a lean telehealth practice
• Net profit margin: net profit ÷ revenue. Target: 70%+ for solo telehealth; 50–60% for in-person with overhead
• Month-over-month revenue trend: growing, flat, or declining — adjust marketing and patient acquisition accordingly