Medical lab and imaging bookkeeping: OHIP timing, two fees, one scan

OHIP billing is where the books actually start

A claim for an ultrasound, an x-ray, a bone-density scan, or cardiac testing moves through submission, adjudication, and payment on a cycle that regularly runs several weeks behind the day the patient was scanned, and a share of every batch comes back held or rejected — a health-card mismatch, a coding error, a duplicate claim against another provider. Recording revenue only when the OHIP deposit lands hides that lag entirely and makes a growing facility look like it is standing still. We record the claim as a receivable on the date of service, adjust it to the remittance advice once adjudicated, and reconcile the resulting deposit line by line — so a held claim is chased while the visit is still fresh in the scheduling system, not written off eight months later as stale.

One scan, two fees — and only one of them is yours

Diagnostic imaging separates a technical fee, which covers the facility, the equipment, and the technologist's time, from a professional fee for the radiologist's interpretation of the images. Many IHFs bill OHIP for the technical component directly and contract separately with one or more radiologists for reads, which makes the interpretation fee a direct cost of that specific study rather than a general professional expense — we track it the same disciplined way an orthodontic practice tracks a per-case lab bill, matched to the study it belongs to rather than lumped into overhead. Where a reading radiologist is also a shareholder or otherwise related to the facility, the contract and the payment terms need to be documented on an arm's-length basis, since a related-party fee that drifts from market rates draws exactly the kind of scrutiny a straightforward third-party contract does not.

Equipment: a lease payment or a CCA claim, and the ITC that mostly isn't there

An ultrasound unit, an x-ray room, or a bone densitometer is a six- or seven-figure asset, financed either through a lease — an ordinary operating expense — or outright ownership, which instead generates a capital cost allowance claim on the corporation's T2; see our tax services page for medical labs and imaging clinics for how that claim is structured. Either way, most of the HST paid on the purchase or lease is not recoverable, because OHIP-insured diagnostic services are exempt basic health care services for GST/HST purposes, which blocks the input tax credits a taxable business would otherwise claim on equipment this expensive. We track that blocked HST as its own line on every major purchase, not because it can be recovered, but because it belongs in the real cost comparison between leasing and owning.

Technologist payroll and cost by modality

CMRITO-registered technologists, on-call differentials, and overtime run through ordinary payroll — the detail lives on our payroll page for medical labs and imaging clinics — but for bookkeeping purposes, we also allocate technologist and equipment cost by modality: ultrasound, x-ray, bone density, and cardiac testing rarely carry the same margin, and a facility running several service lines under one roof needs that breakdown to see which one is actually carrying the others.

Month-end close and what crosses the border

Each month closes with OHIP receivable aging by claim status, interpretation-fee payables reconciled to radiologist contracts, the equipment lease or CCA schedule, and technologist payroll cost by modality. Where equipment or service contracts are priced in US dollars, we book them at the invoice-date rate and true up the difference as a currency gain or loss rather than letting it blur into the equipment budget — the same discipline covered in how to record USD transactions in Canadian books. Our cross-border tax guide for medical labs and imaging clinics covers US equipment purchases and radiologist reads in full, and our bookkeeping services page shows what the monthly close includes for every client.