How Much Does a CPA Cost for a Home Care Agency?
CPA and accounting costs for a home care agency range from $2,500/year for tax prep only to $25,000+/year for full-service bookkeeping and CFO advisory. What drives the price, what each tier should include for an agency specifically, and how to tell whether you're buying transactions or judgment.
CPA costs for a home care agency generally fall into three tiers: $2,500–$6,000 per year for tax preparation only, $8,000–$15,000 per year for monthly bookkeeping plus tax, and $15,000–$30,000+ per year for full-service engagements with advisory — with payer-mix complexity, payroll volume, and the amount of actual judgment work driving where you land. The spread is wide because “accounting” in home care spans everything from data entry to running the financial side of the business.
What Drives the Price for an Agency Specifically
Four factors move the quote more than revenue does:
- Payer mix. An all-private-pay agency is simple. Add VA community care, long-term-care insurance, and a Medicaid waiver program, and reconciliation, receivables tracking, and revenue recognition all get heavier.
- Payroll volume. Dozens of hourly W-2 caregivers with weekly pay and overtime is a materially bigger monthly workload than a firm with five salaried staff.
- Books structure. Producing margin by payer and overtime reporting costs more than a one-line P&L — and is the difference between books you run the agency on and books you file taxes from.
- Judgment work included. Owner-salary review, quarterly projections, cash forecasting, classification questions. This is where tiers genuinely differ.
The Three Tiers, Honestly Described
Tax preparation only — $2,500–$6,000/year
Form 1120-S, owner 1040, state filings. Accurate returns, no planning, no monthly visibility. Fits agencies under roughly $100K of net income with simple payer mixes — a stage most growing agencies exit quickly.
Bookkeeping + tax — $8,000–$15,000/year
Monthly close, reconciliations, statements, plus the returns. The question to ask at this tier: is the chart of accounts built for home care? A generic close delivered monthly is still generic.
Full service with advisory — $15,000–$30,000+/year
Everything above plus quarterly tax projections, owner-salary review, margin and overtime reporting, and cash forecasting. At $1M+ of agency revenue with multiple payers, this tier typically pays for itself in avoided payroll-tax waste, caught margin drift, and financing readiness — but only when the advisory work actually happens on a calendar rather than existing in the engagement letter.
How RTW.ai Prices It
We publish pricing rather than quoting after a call: healthcare-practice subscriptions run $697 to $2,297 per month depending on tier — bookkeeping through CFO advisory — with tax preparation priced à la carte (S-corp packages from $1,497) and a 15% subscriber rate. The published numbers are the numbers; see pricing.
The Evaluation Question
Whatever you pay today, ask for last month’s gross margin by payer and your current overtime percentage. If your accountant can produce both quickly, the engagement is structured for your industry. If not, the fee — high or low — is buying transaction recording, and the operating questions are going unanswered.
Related: Bookkeeper vs. CPA for a Home Care Agency · The Complete Tax & Accounting Guide for Home Care Agency Owners
Common questions
How much should a home care agency budget for accounting and tax work?
Typical market ranges: $2,500–$6,000 per year for tax preparation only (S-corp return plus owner 1040), $8,000–$15,000 per year for monthly bookkeeping plus tax work, and $15,000–$30,000+ per year for full-service engagements that add advisory, cash forecasting, and margin reporting. Where an agency lands depends mostly on transaction volume, payer mix complexity, payroll size, and how much judgment work is included beyond recording transactions.
Why does home care bookkeeping cost more than generic small-business bookkeeping?
Because the books have to carry more structure to be useful: revenue split by payer, direct care labor separated from overhead so gross margin is visible, receivables aged by payer against billing deadlines, and hours-based measures like overtime percentage. An agency running multiple payers with weekly caregiver payroll generates both more volume and more reconciliation work than a same-revenue consulting firm.
What should be included in a monthly accounting engagement for a home care agency?
A monthly close on a fixed calendar, financial statements with gross margin by payer, direct-labor and overtime reporting, receivables aging by payer, reconciled bank and credit card accounts, and — in advisory tiers — quarterly tax projections, an annual owner-salary review, and a cash forecast. If the deliverable is only a reconciled P&L with one revenue line, you are buying data entry, not a financial function.
Is a flat monthly subscription or hourly billing better for an agency?
Flat monthly pricing generally serves agencies better: the work is genuinely recurring (weekly payroll, monthly close, quarterly taxes), and hourly billing penalizes you for asking questions — exactly the behavior an agency owner in a compliance-heavy industry should not be discouraged from. Hourly still makes sense for one-time projects like cleanups, late S-corp elections, or diligence work.
What does it cost to fix messy books versus keeping them clean?
Cleanup projects for an agency with 12–24 months of miscategorized or unreconciled activity commonly run $2,000–$10,000+ depending on volume and payer complexity — often approaching a year of what maintenance bookkeeping would have cost. Agencies usually buy cleanups at the worst moment: preparing for a loan, a license audit, or a sale, when the timeline is short and leverage is low.
We publish our prices.
No discovery call required to find out what you'd pay. Healthcare-practice subscriptions run $697 to $2,297 per month depending on tier, with tax prep priced à la carte. View pricing — and start today if it fits.
By Askia Roberts, CPA · GA License #CPA038784 · RTW Advisors