How Much Does Accounting Cost for a Home Care or Hospice Agency?

You've gotten quotes from accounting firms that range from $500 a month to over $5,000, and you can't tell what's actually driving the price. 

Some firms quote based on revenue. Some quote based on transactions. Some won't quote at all until they see your books. And when you ask what's included, the answers feel vague.

If you run a home care or hospice agency, that confusion is even worse, because most accounting firms don't actually understand your industry. They don't know what a Medicare cost report is. They've never heard of PPD financials. They treat your agency like any other small business, and you end up paying for accounting that doesn't fit what you actually need.

At Patrick Accounting, we work with home care, hospice, nursing, and assisted living agencies across the country. Our home care division was built specifically for the financial complexity this industry carries: cost reporting, multi-payer revenue cycles, PBJ requirements, and audit-readiness that most generalist firms aren't equipped to handle.

In this article, you’ll learn:

• What home care and hospice accounting actually costs (with real numbers)
• Why hospice agencies pay more than home health
• What changes once you cross $5 million in revenue
• What should be included at each pricing level

Why Home Care and Hospice Accounting Costs More Than Standard Small Business Accounting

Before we get into specific numbers, it helps to understand why the cost for home health and hospice accounting looks different from the costs for, say, a service contractor or a salon.

Home care and hospice agencies operate in one of the most regulated environments in the small business world. You're managing Medicare and Medicaid reimbursements, private insurance claims, and patient documentation that has to hold up to audit at any time. You're producing cost reports that determine your reimbursement rates. You're tracking staff hours across registered nurses, aides, therapists, and administrative roles, each with different pay structures.

A standard small business accountant isn't trained for any of that. So, when you hire a firm that specializes in home care and hospice, you're paying for accounting that's built around the realities of your industry, not retrofitted to handle it.

The Baseline Monthly Cost for a Home Health Agency

For most home health agencies in the $1 million to $3 million annual revenue range, our baseline monthly fee starts at $2,500 per month.

That baseline buys you what we call our Core for Home Care package, which is designed to get your agency organized and compliant. At this level, you get:

• Monthly bookkeeping and reconciliations
• Standard financial reports (P&L, balance sheet, KPIs, graphs)
• A monthly financial summary with insight from your accounting team
• Cost reporting support for Medicare and Medicaid
• CMS compliance work
• Industry-specific KPI reporting
• Business federal and state income tax returns
• 1099, annual report, and tangible property filings
• A dedicated onboarding team
• Advisor access through phone, email, Zoom, and office hours

The $2,500 baseline reflects the floor of what it takes to run accounting for a home health agency the right way.

Even within home care and hospice, you may see pricing on the lower end of the range ($500–$1,000/month). In most cases, those services are focused on basic bookkeeping (recording transactions and reconciling accounts) but don’t include cost reporting support, CMS compliance work, or industry-specific financial oversight.

For agencies that don’t yet need that level of support (or are handling parts of it internally), those options can make sense. But as complexity increases, most agencies outgrow that model quickly.

What If You're Just Starting Your Agency?

If you're launching a new agency and haven't started generating revenue yet, the $2,500 baseline isn't necessarily where you'll start. We offer pre-revenue pricing for new agencies that are still building toward their first patients. The work we do at that stage looks different (entity setup support, foundational systems, tax structure decisions), and the price reflects that.

If this is you, the best next step is a quick conversation so we can scope what you actually need at this stage instead of charging you for services you won't use yet.

Why Hospice Agencies Pay $200 More per Month Than Home Health

If your agency provides hospice care, expect to pay roughly $200 more per month than a home health agency of the same size.

The reason is because of PPD (Per Patient Day) financial reporting.

PPD financials break down your costs and revenues on a per-patient, per-day basis. This is the reporting layer that helps you track hospice utilization and stay compliant with Medicare's aggregate cap requirements, which limits how much Medicare will reimburse a hospice agency on a per-beneficiary basis.

What you may not realize is that PPD reporting has to be done manually. It can't be automated the way standard month-end close can. Someone has to pull the data, calculate the per-patient-per-day figures, and assemble the report.

That additional manual work is what the extra $200 covers. It's not a markup for the hospice label. It's the labor cost of producing financial reporting that hospice agencies are required to maintain.

Why Agencies Over $5 Million in Revenue Pay More

Once an agency crosses $5 million in annual revenue, we typically add another $200+ per month, regardless of whether you're home health or hospice.

That increase reflects the operational reality at this size:

• Transaction volume goes up. More patients, more claims, more vendor activity, more reconciliation work.
• Multiple entities are common. Larger agencies often run multi-state operations, separate Medicare-certified entities, or related businesses that all need to be accounted for.
• Reporting requirements expand. More stakeholders, more granular financial analysis, more frequent reporting cycles.
• Compliance complexity scales. More patient days, more cost report exposure, more audit surface area.

Complexity in home care and hospice doesn't scale linearly with revenue, but it does increase meaningfully.  A $6 million agency isn't twice as complex as a $3 million agency, but it's meaningfully more complex, and the accounting work reflects that.

When You'll Outgrow the Baseline and Move to Advanced or Ultimate

The $2,500 baseline covers Core for Home Care, with the additional $200 per month for hospice agencies and another $200+ per month for agencies over $5 million in revenue layered on top as applicable. But many agencies eventually need more than what Core provides.

We offer two higher tiers built specifically for home care:

• Advanced for Home Care averages $3,250 per month. It's for agencies that need weekly cash visibility, accounts payable management, customized KPI reporting, and more strategic budgeting support.
• Ultimate for Home Care averages $5,000 per month. It's for agencies making bigger moves, like opening new locations or planning acquisitions, and includes 13-week cash flow forecasting, quarterly strategy sessions, premium financial reporting, and IRS notice response built into the monthly fee.

Most agencies start with Core and move up as their needs evolve. You're not locked in. You're supported based on where your agency is today.

What's Always Included (and What's Not) in Home Care Accounting Fees

Across every one of our tiers, certain things are always included:

• Monthly close and financial reporting
• Cost reporting support for Medicare and Medicaid
• CMS compliance work
• Business tax returns
• Advisor access

A few common items that sit outside the monthly fee:

• Payroll is a separate service through Whirks, our sister company. Most home care and hospice agencies need payroll given the staffing complexity, and keeping accounting and payroll under one roof improves accuracy and can reduce long-term costs. Because of that, payroll is part of how we support our accounting clients.
• Individual tax returns for owners are a separate add-on at Core and Advanced.
• QuickBooks Online subscription runs roughly $70 per month and is billed separately by Intuit.
• Profit First Accelerator program is available as an add-on for owners who want to implement that cash management methodology.

Knowing what's in and what's out matters. It's what lets you compare quotes apples to apples instead of guessing why one firm is $500 less than another.

What Drives Your Specific Cost

Three factors determine where your specific quote lands within the ranges above:

1. Volume of transactions. How many claims you process, how many vendors you manage, how many bank and credit card accounts need reconciling. Higher volume means more work, which means a higher fee
2. Operational complexity. A single agency with one payer source costs less to account for than a multi-entity operation with hospice, home health, and private pay all running through the same back office. Hospice billing, in particular, adds the PPD reporting layer we discussed earlier.
3. Level of internal support. If you have a back-office team handling AP, invoicing, and day-to-day financial operations, we're filling fewer gaps and the fee reflects that. If you're a solo owner doing everything yourself, we're taking more off your plate.

This is why we don't quote without first reviewing your books. A quote without context is a guess, and guesses tend to be either too low (which causes us to underdeliver) or too high (where you overpay). We wrote a separate article on why we always look at financials before pricing, if you want to understand the process in more detail.

Building the Right Accounting Support for Your Agency

Now you have a clearer picture of what home care and hospice accounting actually costs:

• $2,500 a month as the home health baseline

• $200 more for hospice agencies running PPD financials

• another $200+ once you cross $5 million in revenue

…with Advanced and Ultimate tiers available for agencies that need more visibility or strategic guidance.

If you started this process confused about why accounting quotes range from $500 to over $5,000 per month, that gap comes down to how much of the required financial, compliance, and reporting work is actually being handled.

It's about whether you're getting accounting that's actually built for the regulatory, reimbursement, and reporting realities of your industry. Generic small business accounting often costs more in missed reimbursements, compliance risk, and poor financial decisions than it saves.

At Patrick Accounting, our home care division was built specifically for home care, hospice, nursing, and assisted living agencies. We handle the cost reporting, the CMS compliance, the multi-payer revenue cycle work, and the industry-specific KPIs, so you can focus on patient care and growing your agency.

If you want a deeper understanding of what actually makes home care accounting complex, check out our article on the biggest financial challenges in home health agencies.

If you'd like to see how this fits your specific agency, we'd love to have a conversation about where you stand today and what the right level of support looks like for you. Visit our Home Care & Hospice Industry page for more on how we work with agencies like yours.