Senior care & aging services
Books and taxes for hospice providers.
Medicare per diem payments, room and board pass-through for facility patients, comfort medications, and an interdisciplinary team paid regardless of visit count. 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
September brought in $17,000 net. A patient's stay in a nursing facility meant a room and board remit went out separate from the team's pay, so I kept it out of your real revenue.
- Medicare hospice per diemHospice per diem
- Facility room and board remitRoom and board pass-through
- Payroll, care teamTeam wages
- Home medical equipment rentalEquipment rental
- Bereavement counselor stipendBereavement program
Why your books are different
A hospice provider's books go wrong in the same four places.
A generalist sees deposits and payroll. Your business is a flat daily rate that does not track to how many visits happen that day, plus room and board money that passes through you but is not really yours. When the books do not know that, a quiet week reads as a loss it never was.
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1
The per diem does not track to daily visits
A patient enrolled thirty days might get four nurse visits and one chaplain visit that month, all paid at the same flat daily rate, and an owner who expects income to track visit volume misreads a quiet week as a loss.
What we doBooks the per diem as steady daily revenue regardless of visit count, so a lighter visit week does not look like lost income. -
2
Room and board passes through on a different schedule
Medicare pays the room and board portion to hospice, and hospice owes it to the nursing facility, sometimes on a different timeline, so if both sides are not tracked apart it looks like the business kept money it actually owes someone else.
What we doKeeps the pass-through portion separate from real revenue, so it is clear what belongs to the facility and what belongs to your business. -
3
Bereavement and volunteer costs get lost in overhead
Counseling families after a death and running a volunteer program are required parts of hospice care, but because neither one bills anyone, the cost quietly disappears into general overhead where nobody can see what it is really costing.
What we doKeeps bereavement and volunteer costs in their own lines so you can see what they cost against the patients you serve. -
4
Equipment rentals get treated as extra billing
A hospital bed or oxygen concentrator delivered to a patient's home is already covered by the per diem, so if the rental invoice gets booked as a separate charge to the patient, the numbers end up double counted.
What we doKeeps equipment rental as a cost of care already covered by the per diem, not a separate charge to anyone.
Your categories
The categories Gus keeps for a hospice provider.
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 hospice per diemThe routine home care daily rate, paid for every day of the election, not per visit.
- Medicaid hospice per diemA similar daily rate for Medicaid patients who elect hospice.
- Private insurance and private payFamilies without Medicare or Medicaid hospice coverage.
- Room and board pass-throughThe portion Medicare pays when a patient lives in a nursing facility, most of which is owed back to that facility.
Money out
- Interdisciplinary team wagesRNs, aides, chaplains, and social workers, paid regardless of how many stops a day brings.
- Payroll taxes and workers compThe cost of employing the care team, not just paying them.
- Room and board to nursing facilitiesPassed through for patients who live in a facility.
- Durable medical equipment rentalsHospital beds, oxygen concentrators, and wheelchairs covered under the daily rate.
- Comfort medicationsDrugs related to the terminal diagnosis, covered under the per diem.
- Bereavement program costsCounseling for families after a death, required but not billed to anyone.
- Volunteer program costsBackground checks, training, and mileage for hospice volunteers.
What we watch for you
- Average daily census
Patients enrolled on a given day, the number the per diem revenue is built on.
- Cost per patient day
Team wages, equipment, and medications against what the per diem earns that day.
- Room and board owed
What has been collected for facility patients and still needs to go out to the nursing home.
- Average length of stay
How long patients stay enrolled, since a very short or long stay changes what a day of care really costs.
Ask Gus
Things hospice providers 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.
The per diem pays the same daily rate whether a patient gets one visit or five that day. I book it steady, so a lighter visit week is not mistaken for lost income.
It is money that passed through you, not money you earned. I keep it separate from real revenue so it is clear what you actually owe the facility.
That is above my pay grade. The cap involves rules I do not track. The accountant looks at that with your full year of numbers in view.
The tax side
The tax side of a hospice provider.
Most of what goes wrong here is what counts as covered care versus billable cost, and who on the team counts as an employee.
What your return has to get right
Your accountant signs it, so it gets done right the first time.
- Comfort medications and equipment are part of careMedications tied to the terminal diagnosis and durable equipment delivered to the home are covered under the per diem, not billed separately, which changes how they should be booked.
- Interdisciplinary team, employee or contractorChaplains, social workers, and aides who work a set schedule under the agency's direction are usually employees, even when paid per visit.
- Mileage for team and volunteersStaff and volunteers driving to patient homes in a personal vehicle can deduct mileage at 72.5 cents a mile through June 2026 and 76 cents after.
- 1099s for contracted specialistsA chaplain or bereavement counselor legitimately working for more than one hospice, paid $2,000 or more in 2026, gets a 1099-NEC by January 31.
Deductions hospice providers miss
Your bookkeeper knows what to look for in your statements. You never have to.
- Bereavement counseling costs
- Volunteer background checks
- Volunteer mileage reimbursement
- Chaplain and social worker mileage
- Comfort medication costs
- Durable equipment rental
- Liability insurance for clinical staff
- Continuing education for hospice staff
- Office space for the care team
- Phone and tablet for visit documentation
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 hospice provider's 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
New per diem rates begin
Hospice per diem rates often update in January. The team confirms this year's numbers while planning your set-aside for the months ahead.
- April
Filed, care continues
Your return is filed and signed while the care team keeps working its cases. The set-aside built since January means April is not a scramble.
- July
Halfway on census and cost
A look at average daily census and cost per patient day against the year so far, and whether the team's size still fits it.
- October
Before winter referrals climb
Hospital and nursing home referrals to hospice often rise through fall and winter. Before that, the team looks at staffing and equipment needs.
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 hospice providers. 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 hospice providers ask first.
Can Gus track whether we are near the hospice cap?
No, that is a Medicare-specific calculation outside what Gus tracks. The accountant looks at that with your full year of billing and census in view.
Why does income look the same even in a slow visit week?
The per diem pays a flat daily rate regardless of visit count. Gus books it steady so a lighter week is not mistaken for lost income.
We pass room and board through to a nursing facility. Does Gus keep that straight?
Yes. He keeps what you owe the facility separate from what you actually earned, so the two never get confused.
Our chaplains and social workers are paid per visit. Does that change anything?
It might. If they work a set weekly schedule under your direction, that usually reads as employment even when paid per visit. Gus flags it for the accountant.
Do bereavement services need their own budget line?
It helps to see them separately since they never bill anyone directly. Gus keeps that cost visible instead of buried in general overhead.
My books are behind. Can you still help?
Yes. Send the bank statements you have, and Gus will sort out per diem revenue from room and board pass-through as he goes. 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.
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
- Home health agencies (skilled)
- 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