Staffing, recruiting & HR services
Books and taxes for healthcare staffing agencies.
Per diem nurse shifts, allied health placements, credentialing costs, and hospital invoices on net-45 terms. Gus sorts it, an accountant checks every transaction, and you get one number a month.
- From $197 a month
- An accountant on every transaction
- Cancel whenever
February came in at $31,200. Riverside Medical's invoice is still sitting at 40 days out, so I kept it as a receivable instead of counting it as collected.
- Riverside Medical payoutHospital billings
- Shiftkey portal payoutPer diem shift billings
- Paychex payroll runNurse and CNA wages
- Nurse license verificationCredentialing costs
- Hays comp premiumWorkers comp
Why your books are different
Healthcare staffing books go wrong in the same four places.
A generalist sees deposits and paychecks. Your business is a per diem nurse on a shift differential, a credential file that has to stay current before anyone gets dispatched, and a hospital invoice that pays on its own clock. When the books don't know that, you can't tell which shifts actually pay.
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1
Shift differentials get lost in one wage number
A nurse working nights or a holiday shift bills the hospital at a higher rate, but if payroll just shows one lump wage figure, you can't see whether the differential you charged the client actually covered what you paid out.
What we doKeeps base pay and shift differential billing in separate lines so the margin on a night or holiday shift is visible, not guessed at. -
2
Credentialing costs get buried in general expenses
License verification, background checks, and compliance documentation for every nurse or allied health worker cost real money before that person ever bills an hour. Filed as miscellaneous, you lose sight of what it actually costs to onboard someone.
What we doKeeps credentialing and verification fees in their own line so onboarding cost per hire stays visible against what that placement earns. -
3
A hospital invoice pays on its own schedule
A facility that runs net-45 or net-60 terms can leave a real month of billed shifts sitting uncollected while payroll for those same shifts already went out. Book the invoice as income the day it's sent and the month looks better than the cash actually is.
What we doTracks what's billed against what's collected so a slow-paying facility shows up as a receivable, not a phantom profit. -
4
Nursing and allied health comp rates get flattened
A CNA doing patient handling and a medical technician running lab equipment carry different injury risk and different workers comp class rates. One blended rate either overpays on lower-risk roles or misses cost on higher-risk ones.
What we doKeeps placements coded by role so comp premiums track the right class and the true cost of each specialty stays visible.
Your categories
The categories Gus keeps for a healthcare staffing agency.
Set up once for how facilities pay you and what it costs to keep a roster credentialed. You never pick a category. He does, and an accountant checks it.
Money in
- Hospital and facility billingsPer diem and contract shift invoices, often on net-30 to net-60 terms.
- Per diem shift billingsSame-day and short-notice shifts booked through a portal like Shiftkey or a similar vendor system.
- Shift differential premiumsNights, weekends, and holiday rates billed above the standard shift rate.
- Contract-to-hire conversion feesWhat a facility owes when it hires a placed nurse or tech onto its own payroll.
- Overtime billingsExtended shifts and coverage gaps billed at premium rates.
Money out
- Nurse and allied health wagesW-2 pay for every placed clinician, run through payroll on a per-shift basis.
- Workers comp premiumsBilled by role: patient handling, lab work, and clerical support all carry different rates.
- Credentialing and license verificationPer-clinician fees for license checks, exclusion list screening, and compliance files.
- Background checks and drug screensRequired before dispatch for nearly every placement.
- Immunization and health screening costsTB tests, titers, and vaccination records kept current for facility requirements.
- Staffing and scheduling softwareThe system running shift assignments, timesheets, and facility invoicing.
- Job board and recruiter costsPostings and recruiter seats to keep the per diem roster full.
What we watch for you
- Days sales outstanding by facility
How long each hospital takes to pay. Some run 45 to 60 days, and that gap is what strains payroll.
- Credentialing cost per clinician
What it costs to get someone dispatch-ready. A rising number means the onboarding pipeline needs a look.
- Margin by shift type
Standard, night, and holiday shifts against what was paid out. Shows which shifts are actually worth chasing.
- The set-aside
What you'll owe on the year's shift income, tracked every month, so April lands as a number already known.
Ask Gus
Things healthcare staffing owners ask Gus.
Text him like you would text anybody. He answers in plain English, and when a question is above his pay grade, an accountant looks and gets back to you.
Not behind, just waiting. I've got that invoice tracked as a receivable at 40 days out, so it's not counted as income you don't have yet.
About $180 per clinician this quarter between license checks and screening. I keep it as its own line so it doesn't hide inside general expenses.
If they're W-2 through you, that's standard payroll. If any are 1099 and paid $2,000 or more this year, they get a 1099-NEC by January 31. I keep that list current.
The tax side
The tax side of a healthcare staffing agency.
Most of what goes wrong here is timing and classification. Slow-paying facilities, credentialing costs that get lost in the noise, and a clinician who should be W-2 but got paid like a vendor.
What your return has to get right
Your accountant signs it, so it gets done right the first time.
- Worker classificationA nurse or tech working a facility's schedule under a facility's supervision is usually a W-2 employee, either the agency's or the facility's, not a 1099 contractor. This is the highest-stakes call in the trade.
- Multi-state payroll taxPlacing clinicians at facilities across a state line, common near metro borders, usually creates new payroll tax and unemployment insurance obligations there.
- Work Opportunity Tax CreditHiring clinicians or support staff from certain groups, including long-term unemployed workers, can earn up to $9,600 per qualifying hire.
- The pass-through deductionMost owners can take up to 20 percent of business profit off their taxable income, a benefit that comes out right when margin by facility and shift is tracked all year.
Deductions healthcare staffing agencies miss
Your bookkeeper knows what to look for in your statements. You never have to.
- Credentialing and license verification fees
- Background checks and drug screens
- Staffing and scheduling software
- Job board postings
- Workers comp premiums
- Professional liability insurance
- General liability insurance
- Recruiter mileage to facility visits
- Continuing education for placed clinicians when reimbursed
- Phone and laptop for scheduling coordinators
- Immunization and health screening costs
- Card processing fees on facility payments
General information about 2026 federal rules, not advice for your business. Your accountant looks at your actual numbers before anything gets filed.
All year, not just April
A healthcare staffing year, kept every month.
Facilities need coverage every week of the year, and your taxes still land on their own schedule. Your team keeps you ahead of both. Every month in between, your bookkeeper closes the books and speaks up the moment something looks off.
- January
Start the year clean
Last year's return gets started, roster W-2s go out, and a monthly set-aside kicks off so April is already spoken for.
- April
Return signed and sent
Your return is filed and signed while shifts keep getting covered. No scramble, because the set-aside has been tracked since January.
- July
A look at the year so far
Where margin by facility and shift type stands, and whether any slow-paying accounts need a collections conversation.
- October
Before flu season demand
Facility coverage needs often climb going into winter. Gus looks at credentialing pipeline and comp classes before the ramp.
What you get
What you pay depends on what your business needs, and it does not move after that, busy season or slow. No hourly bills, no surprise invoices, no setup fee.
Book a call- Monthly bookkeeping
Every transaction sorted into categories set up for healthcare staffing agencies. You never categorize a thing.
- An accountant checks every transaction
Real review, every month, before your books close. Not a spot check.
- Your business tax return, filed
Prepared, reviewed, and signed by that same accountant every year.
- The monthly number
What you made, what you spent, what to set aside for taxes.
- Your own bookkeeper
A real person assigned to your business, in the app whenever you need them. No hold music.
- On your books all year
Every month, not just in April. Your team speaks up whenever something is worth your attention.
- Cancel any time
No contract. No cancellation call. Your books are yours.
Straight answers
Questions healthcare staffing owners ask first.
A hospital pays us on net-60 terms. Does that throw off the monthly number?
No. Gus tracks what's billed against what's actually collected, so a slow-paying facility shows up as a receivable owed to you, not as a loss or as counted income you don't yet have.
Do credentialing costs count as a write-off?
Yes, license verification, screening, and compliance file costs for placed clinicians are ordinary business expenses. Gus keeps them in their own line so you can see the real cost of getting someone dispatch-ready.
We run both W-2 nurses and a few 1099 specialists. Is that a problem?
It's common, but it needs to be right. Gus flags anyone paid outside payroll so a 1099 is ready if they cross $2,000 for the year, and the accountant reviews whether the arrangement itself holds up.
How does Gus handle different comp rates for nurses versus clerical staff?
He keeps placements coded by the actual role, patient handling, lab work, or administrative support, so premiums track the right class instead of one blended rate.
Our per diem volume swings a lot week to week. Does that make the books harder?
It changes the volume, not the method. Gus works from your bank statement and payroll runs either way and keeps shift billings separate from base wages.
My books are behind from a busy flu season. Can we catch up?
Yes. Send the bank statements and any shift billing detail you have. Gus works through the backlog by facility, and most owners see where they stand within a week.
Is a real accountant checking my books?
Yes. You get your own bookkeeper, Gus does the first pass on every transaction, and an accountant checks every one before your month closes. That same accountant prepares, signs, and files your business return. Goatkeeper is not a CPA firm, and we never pretend a person looked when they did not.
What does it cost, and can I cancel?
It starts at $197 a month, depending on what your business needs. No setup fee, no hourly bills, no contract. Cancel any time from the app, and your books go with you.
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What makes a bookkeeper worth paying for Every business we keep books for
Book a call
Pick a time. That's the whole signup.
Fifteen minutes with a real person on our team. They look at where your books are, tell you straight what it takes to get caught up, and get you set up on the spot if it fits.
- $197 a month to start
- An accountant on every transaction
- Cancel whenever