Medical practices & clinics
Books and taxes for mobile nursing services.
A retainer for 24/7 concierge access, per-visit private duty fees with travel time billed on top, and a roster of contract nurses assigned to different clients. Gus sorts all of it, an accountant checks every transaction, and you get one number a month.
- From $197 a month
- An accountant on every transaction
- Cancel whenever
April came in at $21,400. A new concierge retainer client signed on, so I kept that revenue apart from per-visit private duty fees to show the real split.
- Concierge retainer, Whitfield familyConcierge retainer revenue
- Per-visit wound care sessionsPer-visit nursing revenue
- Contract RN payout, three clientsContract nurse pay
- Wound care and IV suppliesNursing supplies
- Travel time billed to clientsTravel time revenue
Why your books are different
A mobile nursing service's books go wrong between two very different business models.
A concierge retainer client pays for guaranteed access whether or not a nurse visits this week, while a private duty client pays per visit, plus travel time, plus whatever supplies that visit used. A generalist blends both models together and loses the shape of either one.
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1
Concierge retainers pay regardless of visit frequency
A 24/7 on-call retainer client pays a flat monthly or annual fee for guaranteed access, whether they need a visit twice that month or not at all, and blended with per-visit revenue it hides how much of your income is actually predictable.
What we doKeeps concierge retainer revenue in its own line, apart from per-visit fees, so you can see the stable, predictable side of the business clearly. -
2
Travel time is billed revenue, not just a cost
Unlike a typical service business where travel is just a cost of doing business, many private duty nursing services bill travel time directly to the client, which means it shows up as both revenue and a labor cost, and mixing the two up misreads your margin.
What we doKeeps travel time billed to clients in its own revenue line, tracked against the actual pay for that travel time, so the real margin on it is visible. -
3
Contract nurse pay needs tracking by client, not just in total
A roster of contract RNs and LPNs assigned across different clients means labor cost varies client by client, and a single total for contractor pay hides which clients are actually profitable once staffing is accounted for.
What we doTracks contract nurse pay against the clients they're assigned to where the bank data allows it, so client-level profitability becomes visible. -
4
Per-visit supply costs get lost in general expenses
Wound care and IV supplies carried for a specific visit are a direct, traceable cost tied to that visit, not a generic office expense, and lumped together they disappear into the noise.
What we doKeeps nursing supply costs in their own line, tracked against per-visit revenue, so the real cost of delivering a visit is visible.
Your categories
The categories Gus keeps for a mobile nursing service.
Set up once for how retainers, visits, and travel time all get paid. You never pick a category. He does, and an accountant checks it.
Money in
- Concierge retainer revenueFlat monthly or annual fees for guaranteed on-call access.
- Per-visit nursing revenuePrivate duty visits billed individually.
- Travel time revenueTravel time billed to clients apart from the visit itself.
- Home health agency subcontract revenueFees earned providing nursing services through an agency contract.
Money out
- Contract nurse pay1099 RNs and LPNs paid per visit or per assignment.
- Employee nurse wagesAny nurses on payroll, kept apart from contract pay.
- Nursing suppliesWound care, IV, and medication administration supplies carried per visit.
- Vehicle and travel costsFuel and mileage for nurses traveling between visits.
- Liability insuranceCoverage for nurses working in homes and private residences.
- Scheduling and dispatch softwareTools for coordinating visits and on-call coverage.
- Licensing and credentialing costsState licensing and background checks for nursing staff.
What we watch for you
- Retainer versus per-visit mix
How much revenue is predictable retainer income versus variable per-visit fees.
- Travel time margin
What clients are billed for travel time against what nurses are actually paid for it.
- Client-level nurse cost
What contract nurse pay runs against each client's revenue, where the data allows it.
- The set-aside
What you will owe, tracked every month, so April is a number you already knew.
Ask Gus
Things mobile nursing service 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.
I keep concierge retainer revenue in its own line, apart from per-visit fees, so you can see that split clearly instead of guessing from the total.
I keep it in its own line, tracked against what nurses are actually paid for that travel, so the real margin on it is visible rather than blending into visit revenue.
Where the bank data allows it, I track contract nurse pay against the client they're assigned to, so that comparison is a real number you can look at.
The tax side
The tax side of a mobile nursing service.
Most of what matters here is worker classification for contract nurses and tracking travel time correctly.
What your return has to get right
Your accountant signs it, so it gets done right the first time.
- Employee or contractor for nursesA nurse who works your set schedule and follows your care protocols is usually an employee, while one who sets their own hours and works for multiple agencies may be a contractor.
- 1099-NEC for contract nursesAnyone not on payroll who is paid $2,000 or more in 2026 gets a 1099-NEC by January 31.
- Travel time and mileageTravel time billed to clients is ordinary business income, while mileage for nursing staff can generally be deducted at 72.5 cents a mile for the first half of 2026 and 76 cents a mile from July through December.
- The pass-through deductionMost owners can take up to 20 percent of business profit off their taxable income. It comes out right when retainer, per-visit, and travel time revenue are all kept straight all year.
Deductions mobile and concierge nursing services miss
Your bookkeeper knows what to look for in your statements. You never have to.
- Nursing supplies
- Vehicle mileage or actual costs
- Liability insurance
- Scheduling and dispatch software
- Licensing and credentialing costs
- Continuing education for nursing staff
- Uniforms and identification badges
- Cell phone for scheduling and dispatch
- Background check fees
- Biohazard disposal
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 mobile nursing year, kept every month.
Retainers, per-visit demand, and contract staffing each move on their own rhythm. Your taxes run on a fixed 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
Plan the year
Last year's return gets started, any contract nurse's 1099 is ready, and you get a monthly set-aside so April is already handled.
- April
Filed. Done.
Your return is filed and signed. No surprise bill, because the set-aside has been running since January.
- July
Halfway check
Where you stand, what you will owe, and whether retainer growth or per-visit demand changed the number.
- October
Before year end
Gus looks at anything worth doing before December, including whether your contract nurse roster matches client demand.
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 mobile and concierge nursing services. 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 mobile nursing service owners ask first.
Do you bill insurance or home health agencies on our behalf?
No. Gus does not handle insurance billing, medical coding, or agency contract invoicing. He works from what actually lands in your bank account.
How do you separate our concierge retainer clients from per-visit clients?
By revenue type from the start. Concierge retainer revenue and per-visit nursing revenue are kept in separate lines, so you can see the split between predictable and variable income.
We bill clients for travel time. Does that get tracked differently than visit fees?
Yes, travel time revenue is kept in its own line, tracked against what nurses are paid for it, so the real margin is visible.
Some of our contract nurses cost more to keep on a client than others. Can that be tracked?
Where the bank data allows it, Gus tracks contract nurse pay by client, so you can see which assignments are actually profitable.
Do I need to send 1099s to nurses who pick up occasional shifts?
If they set their own schedule and aren't on payroll, yes, once you pay them $2,000 or more this year, by January 31. Gus keeps that list as the year goes.
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