Five payers, one bank account
Your practice-management system (Jane, Cliniko, Practice Perfect) records what was treated and what it was worth. The bank shows something different: lump-sum insurer deposits covering many patients, card settlements net of processing fees, and auto-insurance payments that relate to invoices submitted a month ago. Books that copy the bank feed will always be wrong about revenue, receivables and tax, all at once.
We reconcile the clinic by payer channel instead. Each channel gets its own revenue account, its own receivable and its own month-end check:
| How the clinic gets paid | What the books must catch |
|---|---|
| Auto insurers via HCAI | OCF-21 invoices matched to insurer payments claim by claim, with partial payments and adjustments posted, not buried |
| Extended health direct billing | TELUS Health eClaims deposits arrive in batches; each batch clears against individual patient claims |
| WSIB programs of care | Set program fees on WSIB's own remittance rhythm, tracked separately from private rates |
| Private pay at the desk | Card deposits land net; processing fees get their own expense line instead of vanishing into revenue |
| Massage, kinesiology and retail | Taxable lines kept in separate accounts, because they carry 13% HST while physiotherapy does not |
One more balance most physio books ignore: prepaid visit packages. A ten-visit block sold in January is not January revenue; it is a liability that converts to revenue one appointment at a time, and until then it is money you would owe back if the patient moved away. We carry package balances as deferred revenue and reconcile them against the appointment record, so the statements never flatter a strong sales month at the expense of the months that deliver the care.
HCAI money is the slowest dollar in the clinic
Motor-vehicle-accident work runs on its own rails. Treatment plans go to the insurer as an OCF-18 through HCAI, minor injuries are capped at $3,500 under the Minor Injury Guideline, and invoicing happens on the OCF-21, which the insurer pays on its own cycle and sometimes only in part. A clinic doing serious MVA volume can easily have six figures sitting between treatment delivered and cash received.
So we treat MVA receivables as a managed asset, not a mystery. The books carry them by insurer and by claim age, approved-but-unbilled treatment is visible, and short-payments get posted as identified adjustments so patterns show up. When one insurer's payments drift from 30 days to 60, you find out from the monthly report, not from a cash crunch. Where the clinic holds an FSRA service provider licence for direct payment, we keep the licence entity and the billing entity aligned, a detail that goes wrong surprisingly often after an incorporation or sale.
Tax gets coded at the source, not repaired at year-end
Physiotherapy delivered by a licensed physiotherapist is HST-exempt; massage therapy, kinesiology and retail products under the same roof are taxable at 13%. The only sane way to live with that mix is to map every service item in Jane to the right ledger account and tax code once, then let each day sheet post itself correctly. Untangling a year of blended revenue in April is expensive; coding it right in the software is free.
The same discipline covers the cost side. Because the exempt core recovers no input tax credits, most of the 13% you pay on rent, software and supplies is a real cost, and any credits the taxable lines do allow depend on clean, separated records. Our books make that split, and the corporate tax filing built on them defends it.
One engagement, day sheet to financial statements
Inside End-to-End Accounting, the whole cycle runs under one roof: QuickBooks Online as the ledger, Dext capturing supplier bills, Plooto handling payment approvals, and payroll for your physiotherapist assistants, front desk and admin team, with source deductions remitted on schedule. Clinical software stays clinical; we take its reports, not its job.
We also set a small day-end habit with your front desk: balance the day sheet against the terminal batch and the cash drawer before closing, and flag any claim HCAI rejected that day while the visit is still fresh. Five minutes at 6 p.m. saves hours at month-end, and it is the difference between books that report the clinic and books that chase it.
The monthly deliverable is short on purpose: revenue by payer channel, receivable days by payer, wages as a share of collections, and cash position, with a note on anything that moved. Year-end becomes a handoff instead of a project, and if the CRA asks questions about the exempt-taxable split, CRA Audit & Review Support works from records we already know. We run this rhythm for rehab clinics across Mississauga and the GTA, and it starts with a free 15-minute discovery call and a written quote.
