Senior care & aging services
Books and taxes for skilled home health agencies.
Medicare periodic payments, per-visit clinician pay, territory mileage, and clinical supply orders that swing month to month. Your own bookkeeper keeps it straight, an accountant checks every transaction, and you get one clear number each month.
- From $197 a month
- An accountant on every transaction
- Cancel whenever
March cleared $14,000. A run of wound care patients meant a bigger supply order, so I kept that separate from a slow caseload month.
- Medicare periodic paymentMedicare home health
- Aetna Medicare AdvantageMedicare Advantage
- Payroll, clinical staffClinician wages
- McKesson medical suppliesClinical supplies
- Homecare HomebaseDocumentation software
Why your books are different
A skilled home health agency's books go wrong in the same four places.
A generalist sees deposits and payroll. Your business is nurses and therapists driving a spread-out territory, paid by an insurer on its own schedule, not per visit. When the books do not know that, a busy month can look empty and a supply order can look like a problem it is not.
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1
Medicare payments arrive in a lump, weeks later
Medicare's home health benefit pays out after a care period closes, not visit by visit, so care delivered in week one might not show up as cash until well into the following month.
What we doTracks what has been delivered against what has actually been paid, so a month with a full visit schedule does not look thin just because the payment has not landed. -
2
Per-visit clinicians blur into wages
Many nurses and therapists legitimately work per visit, picking their own schedule for more than one agency, but once a few start working set weekly hours under your supervision, that same 1099 treatment stops fitting.
What we doFlags any per-visit clinician whose schedule and supervision start to look like employment, so the accountant can weigh in before it is a pattern across the roster. -
3
Territory mileage gets buried in wages
A nurse driving to visits spread across a county logs real miles that are a legitimate cost, but when it is folded into a flat pay stipend, nobody can see what covering that territory is actually costing.
What we doKeeps mileage reimbursement in its own line, so you can see what territory coverage costs against what those visits bill. -
4
Clinical supply orders swing wildly month to month
A run of wound care or catheter patients means a bigger supply order that makes one month look expensive and the next look cheap, when caseload, not spending, is the real reason.
What we doKeeps medical supplies in one steady line and tells you when a caseload, not a spending problem, explains a heavy month.
Your categories
The categories Gus keeps for a skilled home health agency.
Set up once for how you get paid and what you spend. You never pick a category. He does, and an accountant checks it.
Money in
- Medicare periodic paymentsThe home health benefit, paid after an episode of care closes, not per visit.
- Medicare Advantage and private insuranceSimilar timing to Medicare, negotiated per plan.
- Private-pay skilled visitsFamilies paying directly for a nurse or therapist visit insurance will not cover.
- Long-term care insuranceReimbursement for skilled visits under a family's policy.
Money out
- Clinician wages and per-visit payNurses, therapists, and aides paid by salary, hourly rate, or per visit.
- Payroll taxes and workers compThe cost of employing clinical staff, not just paying them.
- Territory mileageWhat clinicians are paid for driving between patient visits.
- Clinical suppliesWound care, catheters, and other supplies used on visits.
- Documentation softwareHomecare Homebase, WellSky, or Netsmart, billed monthly.
- Licensing and credential renewalsState and clinical license fees for each clinician.
- Liability and malpractice insuranceCoverage for clinical staff providing skilled care.
What we watch for you
- Days to payment
How long a Medicare care period takes to pay out after the visit happens.
- Clinician cost per visit
Wages, mileage, and tax against what each visit actually bills.
- Supply cost per patient
Clinical supplies against caseload, so a heavy month reads correctly.
- Payer mix
Share from Medicare against Medicare Advantage, private insurance, and private pay.
Ask Gus
Things skilled home health 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.
Medicare pays out after the care period closes, not per visit. I am tracking what is billed against what has actually paid, so the gap makes sense.
Maybe. Once someone works set hours under your supervision instead of picking her own visits, she starts looking like an employee. I flagged it for the accountant to weigh in.
That is outside what I do. Claims, coding, and assessments run through your clinical and billing systems. I pick up once the payment lands in your bank account.
The tax side
The tax side of a skilled home health agency.
Most of what goes wrong here is whether a clinician counts as an employee and what a payment's timing actually means. Get those two right and the rest follows.
What your return has to get right
Your accountant signs it, so it gets done right the first time.
- Per-visit clinician or employeeA nurse or therapist who picks her own visits and schedule can genuinely be a contractor, but one who works set hours under your supervision usually is not. That line matters more here than in most trades.
- Mileage across the territoryMiles a clinician drives between patient visits in her own car can be deducted at 72.5 cents through June 2026 and 76 cents after, when not already reimbursed at that rate.
- 1099s for contracted cliniciansA nurse or therapist legitimately working per visit for more than one agency, paid $2,000 or more in 2026, gets a 1099-NEC by January 31.
- The pass-through deductionOwners can often deduct up to 20 percent of business profit, though personal-care and health businesses can see it limited once taxable income passes $201,750 single or $403,500 joint.
Deductions skilled home health agencies miss
Your bookkeeper knows what to look for in your statements. You never have to.
- Clinician liability insurance
- Malpractice coverage
- Mileage between patient visits
- Wound care and clinical supplies
- Documentation software subscription
- License renewal fees
- Continuing education for clinicians
- Background checks per hire
- Phone and tablet for visit notes
- Clinical bags and carrying cases
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 skilled home health year, kept every month.
Referrals come any week of the year. Medicare's calendar and your taxes come on a 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
Medicare year rolls over
Home health payment rates and benefit periods often reset in January. The team checks new billing assumptions before it plans this year's set-aside.
- April
Filed between visits
Your return is filed and signed without pausing a single scheduled visit. The set-aside running since January already covers what is owed.
- July
Halfway on clinician cost
A look at territory mileage and per-visit pay against what the caseload is billing, and whether coverage is worth the ground it costs to cover.
- October
Before winter caseload climbs
Flu season and winter falls send more patients into home health. Before the rush, the team looks at staffing and any equipment worth buying before December.
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 skilled home health 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 skilled home health owners ask first.
Can Gus help with Medicare billing or clinical assessments?
No. That runs through your clinical and billing systems. Gus picks up once a payment lands in your bank account and keeps it straight from there.
Why does a month with a full visit schedule still look thin?
Medicare pays after a care period closes, not per visit. Gus tracks what has been delivered against what has actually paid out, so the timing gap is not mistaken for a slow month.
My nurses are a mix of employees and per-visit contractors. Does that complicate things?
It just needs the right label on each one. Gus flags anyone whose per-visit work looks like it has turned into a set schedule, so the accountant can weigh in before it becomes a pattern.
Do I need to switch off Homecare Homebase or WellSky to use Goatkeeper?
No. Keep your clinical system exactly as is. Gus works from your bank statement and asks once if a deposit is unclear.
A wound care caseload made this month's supply cost spike. Is that a red flag?
Not on its own. Gus keeps supplies in one steady line and tells you when a caseload, not a spending problem, explains the jump.
My books are behind from a clinical system switch last year. Can you still help?
Yes. Send the bank statements you have. Gus sorts them, the accountant checks them, and most owners know where they stand inside 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.
More in senior care & aging services
We keep books for the business next door too.
- Adult day care centers
- Geriatric care managers
- Medical alert system dealers
- Residential care homes (board & care)
- Respite care providers
- Senior dental & mobile care
- Senior home safety assessments
- Senior living placement advisors
- Senior move managers & downsizing specialists
- Companion care services
- Memory care communities
- Small assisted living facilities
- Hospice providers
- Non-medical home care agencies
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