Five ways in, five reconciliations
Treating the bank feed as the truth is the classic foot-clinic bookkeeping failure, because almost nothing lands in the account on the day the care happened. Each stream needs its own routine, and each routine answers a different question:
| Revenue stream | How the money arrives | What we reconcile |
|---|---|---|
| In-clinic foot care | Card batches, net of processing fees | Day sheet to terminal batch to bank, daily |
| Nursing-home contract | Monthly invoice, paid on the home's cycle | Rounds delivered to invoice to receivable aging |
| Mobile home visits | E-transfer and portable terminal, on the road | Visit log to deposits, matched weekly |
| Custom orthotics | Deposit at casting, balance at dispensing | Patient credits released as pairs go out the door |
| Retail insoles and footwear | Point of sale, with 13% HST collected | Taxable sales kept on their own income line |
The separation is structural, not cosmetic. Exempt care, zero-rated custom orthotics and taxable retail behave differently at filing time, so the chart of accounts keeps them apart from the first entry, and the taxable lines stay watchable against the HST registration threshold all year.
The orthotic claim file is bookkeeping now
Extended-health insurers have tightened orthotics claims across the industry, and dispensing a pair now means being able to produce a complete file on request: the prescription, the biomechanical assessment findings, a record of the casting or 3D scan, the lab invoice showing what was fabricated and from what, the dispensing date, and a paid-in-full receipt. A clinic that answers an insurer audit in a day keeps its patients' claims flowing; one that reconstructs files for weeks watches reimbursements stall and referrals cool.
So we build the paper trail into the money trail. Every dispensed pair ties to its lab invoice in the books, which does two jobs at once: the claim file always matches the ledger, and the clinic finally knows its true cost per pair instead of a blended guess. Casting deposits get equal care, because a deposit is not revenue yet. It sits as a patient credit until the pair is dispensed, which keeps refunds clean when a remake drags or a claim is declined.
Foot-care nurses: T4, T4A or invoice
Clinics that run long-term-care and mobile rounds usually do it with foot-care nurses, and how each nurse is engaged decides the paperwork. A nurse on scheduled shifts using clinic equipment belongs on payroll, with CPP, EI and a T4. A genuinely independent nurse who owns her instruments, sets her own schedule and serves other clients invoices the clinic and receives a T4A for fees for services. The contract label settles nothing; the working facts do, and a CRA reclassification arrives with retroactive premiums, penalties and interest attached. We review the arrangement against the facts before issuing slips, and we keep the slips consistent with the arrangement year after year.
Exempt care rewires the cost side
Foot-care services are HST-exempt, so the practice recovers none of the 13% it pays on rent, sterilization supplies, software or the autoclave. We record those costs HST-inclusive because that is what they genuinely cost; books that quietly assume recoverable tax flatter every margin on the page. The orthotics bench and the retail wall carry their own cost lines for the same reason their revenue does: their HST logic is different, and blending them hides both the bench's real margin and the moment the taxable side starts to matter.
What month-end looks like
All of it runs inside End-to-End Accounting: bookkeeping, payroll for reception staff and employed nurses, financial reporting and tax filing under one roof, on QuickBooks Online with Dext capturing lab and supplier bills. Month-end lands as a short report by stream: what the chairs earned, what the rounds earned, what the bench cleared per pair, and which receivables are aging. Year-end then flows straight into Corporate Tax Filing from numbers that already reconcile. And when a letter arrives about a slip, a claim or a review, CRA Audit & Review Support answers it from records we already keep. We run this rhythm for foot clinics across Mississauga and the GTA, scoped in writing after a free 15-minute discovery call.
