Heard Accounting Review: What Mental Health Practice Owners Should Know
I use Heard for accounting and taxes for my behavioral health group practice. Overall, I think it is a good service once everything is set up correctly.
That qualification matters.
Heard handles several things I would rather not manage myself, particularly bookkeeping, quarterly tax estimates, and year-end taxes. Electing S-corporation status through Heard has also been financially worthwhile for my practice.
But my initial onboarding was frustrating, and my later S-corp transition exposed some significant gaps that practice owners should understand before signing up.
Heard appears to be actively seeking feedback and exploring improvements, including more personalized support. My experience may therefore not reflect its current onboarding process. Still, these are the things I wish someone had told me.
What Heard Does Well
Heard's biggest advantage is that it is built specifically for therapists and other wellness professionals.
Instead of coordinating a separate bookkeeper, accountant, tax preparer, and payroll provider, Heard brings much of that into one ecosystem.
For my practice, the most valuable features are straightforward:
Bookkeeping and financial reporting
Quarterly estimated taxes
Business and personal tax preparation
S-corporation tax filing and support
Payroll integration through Gusto
As my practice has grown and income has become less predictable, having someone else calculate quarterly taxes and handle year-end filings has become increasingly valuable.
The underlying service is useful. My biggest concern has been getting everything set up correctly in the first place.
The Initial Onboarding Was Frustrating
My difficulties started before the S-corp transition.
Heard promises relatively quick responses to questions, but there is a meaningful difference between receiving a response and receiving an answer.
I sometimes received a timely acknowledgment essentially saying, "We'll look into this and get back to you." That may technically meet a response-time goal, but it doesn't necessarily help a new customer complete an unfamiliar accounting or compliance task.
More importantly, onboarding felt fragmented. There wasn't one person clearly responsible for walking me through the process and verifying that everything was actually configured correctly.
For a service like this, I think new customers would benefit enormously from an assigned onboarding specialist, ideally with the option for a phone or video meeting.
Someone should be able to say:
Here's what we need from you. Here's what we're doing. Here's what you need to do. And here's what we still need to verify.
Heard has surveyed users about potential improvements, including more personalized support, so this appears to be something they are actively considering. I hope it improves.
The S-Corp Transition Exposed Bigger Problems
Heard eventually recommended that I elect S-corporation status and provided an analysis showing the potential tax savings.
For my practice, the recommendation made sense.
The transition itself was another story.
Heard submitted the S-corp election paperwork to the IRS, and then I waited.
When it seemed to be taking unusually long, I called the IRS myself. After considerable time on the phone, the IRS eventually located the paperwork and determined that something about the submission had been completed incorrectly.
It had to be resubmitted.
That meant another couple of months waiting in the IRS queue, followed by another call on my part to confirm that the election had finally been processed.
If a service recommends an S-corp election and submits the paperwork, I think it should also have a process for confirming that the IRS actually accepted it.
Becoming an S-Corp Changes More Than Your Tax Return
This was the biggest thing I wish had been explained clearly.
An S-corp owner generally needs to pay themselves a reasonable salary as a W-2 employee. That means becoming an employer, setting up payroll, handling withholding, completing appropriate registrations, and meeting payroll-tax requirements.
Despite asking whether there were other things I needed to do, I wasn't given a clear roadmap.
Initially, I continued paying myself through Melio, the contractor payment platform I already used.
That was a mistake. I needed W-2 payroll.
The mistake eventually resulted in a tax penalty. To Heard's credit, after reviewing what happened, they agreed to cover the penalty because the S-corp transition had not adequately addressed the payroll requirement.
I appreciated that response.
But good onboarding should have prevented the problem.
If You're Using Heard as an S-Corp, Set Up Gusto Properly
Heard integrates payroll with Gusto, and I would recommend using that setup from the beginning if you elect S-corp status through Heard.
What I needed was someone to tell me explicitly:
You're now an employer. Log into Gusto, complete your company setup, configure your withholding and employer information, and begin running W-2 payroll.
I wasn't told that.
I also eventually discovered that parts of the automated company setup in Gusto had not been completed correctly, which could potentially have created additional tax problems.
Again, I figured this out independently as issues arose.
This is why I think the solution is less about adding more help articles and more about giving customers one knowledgeable person who owns the transition.
Is Heard Worth the Cost?
For me, yes.
Moving to S-corporation status substantially increased the cost of the service. My overall expense went from roughly the $50-per-month range to around $300 per month once the higher-level accounting service and W-2 payroll were included.
Current pricing and plan structures may differ, so those numbers should not be treated as a quote.
Even with the higher cost, however, the S-corp tax savings make the arrangement financially worthwhile for my practice.
And there is another kind of savings: time.
I don't want to maintain my own books, calculate quarterly estimated taxes, prepare an S-corporation return, prepare my personal taxes, and coordinate all of those pieces myself.
Once everything was working properly, Heard took a meaningful amount of that work off my plate.
One Financial Control Heard Doesn't Replace
There is one other limitation particularly relevant to insurance-based practices.
Heard performs bookkeeping and bank reconciliation, but bank reconciliation is not the same thing as insurance payment reconciliation.
An Electronic Remittance Advice (ERA) tells you that an insurance company says it issued a payment.
It doesn't independently confirm that the corresponding money actually reached your bank account.
If you use an enterprise revenue-cycle management system, that reconciliation may already be handled for you. But many small practices use a billing specialist or more typical billing service and may still have a gap between:
"The insurer says it paid us"
and
"We confirmed the payment reached the bank."
I wrote more about that issue in my insurance ERA reconciliation article.
Why I Built Insurance Auditor
That gap is why I developed Insurance Auditor for small and solo behavioral health practices.
It allows practices to connect their bank account through Plaid and review insurance-related deposits without paying for an enterprise revenue-cycle platform.
The first month is free with no credit card required, then $5/month or $48/year.
You can also see how it works in this short demo:
Would I Recommend Heard?
Yes—with qualifications.
My criticism is mostly about onboarding and implementation, not the underlying value of the service.
Once properly configured, Heard handles accounting and tax responsibilities that I am happy not to manage myself. For my practice, the combination of tax savings and administrative convenience makes it worthwhile.
But new customers—especially those transitioning to an S-corp—should not assume that every necessary step will automatically be handled for them.
Ask explicitly about:
IRS confirmation of your S-corp election
Employer registrations
W-2 payroll
Gusto setup
Tax withholding and payroll compliance
Who is personally responsible for guiding you through the transition
Ideally, Heard will increasingly provide an assigned specialist who walks customers through those steps rather than requiring clinicians to figure out what questions they should have known to ask.
For me, Heard is worth using. I just wish the onboarding had provided at the beginning what I ultimately had to learn along the way.
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