Start with a fixed asset schedule. This is a list of every piece of equipment your practice owns, and it’s the foundation for tracking depreciation accurately. Without this list, you’re guessing at depreciation expense and likely missing deductions or overstating them.

For each piece of equipment, record the description, purchase date, original cost (including delivery and installation fees), depreciation method, useful life, and any salvage value. Medical practices typically have a mix of equipment with different useful lives. Exam tables and office furniture might have 7-year lives. Imaging equipment, X-ray machines, and specialized diagnostic tools often fall into 5-year property for tax purposes.

Book depreciation and tax depreciation can differ. Many healthcare practices use straight-line depreciation for financial statements because it shows consistent expense over time. For taxes, MACRS front-loads the deduction, giving you larger write-offs in early years. Your accountant handles the tax side, but your books should reflect one consistent method.

Section 179 allows you to deduct the full cost of qualifying equipment in the year you purchase it, up to annual limits. This makes sense when you want to reduce current-year taxable income significantly. Buying a new digital X-ray system for $80,000 could be expensed entirely rather than spread over five years. The right choice depends on your practice’s income level and tax situation that year.

In QuickBooks, track fixed assets using asset accounts for each category like medical equipment, computer equipment, and furniture. Set up corresponding accumulated depreciation accounts. Record depreciation monthly or annually with a journal entry that debits depreciation expense and credits accumulated depreciation. Monthly entries give you more accurate financial statements throughout the year.

Review your fixed asset list annually. Equipment that’s been disposed of, donated, or is sitting broken in storage shouldn’t keep showing up on your balance sheet. When you sell or trade in equipment, you need to remove it from the schedule and record any gain or loss on disposal.

The distinction between repairs and capital improvements matters. Replacing a part to keep equipment running is a repair expense, deductible immediately. Upgrading equipment or making improvements that extend its useful life is a capital expenditure that gets depreciated. The IRS has specific rules around this distinction, and getting it wrong can create problems in an audit.

Working with an Andover, MA bookkeeping service familiar with medical practices helps because equipment classifications and depreciation conventions vary by industry. Someone experienced with healthcare clients knows which category your new ultrasound machine falls into without researching it from scratch. They also catch common mistakes like forgetting to capitalize installation costs or continuing to depreciate fully depreciated assets.