Occupational therapist bookkeeping: SABS, WSIB, and assessments, one ledger

Three payers, three collection rhythms

An occupational therapy practice can be paid by SABS through the auto insurer, by WSIB for an injured worker, by a one-time medical-legal assessment fee, and by a private or extended-health client, often in the same week. Auto-insurer work runs through the HCAI portal: an OT submits an OCF-18 treatment and assessment plan, an adjuster reviews it before funding is approved, and the receivable can sit open for weeks while that review runs its course. WSIB pays treating providers against its own published fee schedule, at rates the practice does not set, but on a steadier clock than an insurer's discretionary approval. Medical-legal assessments — a one-time report commissioned by an insurer or a lawyer — are usually invoiced flat and paid fastest of the four, because there is no ongoing plan of care to negotiate.

Each stream needs its own revenue and receivable account, aged on its own schedule, because each one goes wrong differently: an HCAI plan stuck in adjuster review, a WSIB invoice rejected over a fee-code error, or a private balance the front desk forgot to collect at the visit. We reconcile the practice's scheduling platform against bank deposits every month, then age the open SABS and WSIB balances separately so a slow insurer never hides inside a healthy-looking total.

A home visit has its own cost ledger

Mobile and home-based practice adds a cost line a clinic-based OT never sees: the visit itself. Drive time between appointments is not billable, but it consumes the day, and mileage between a home office or clinic and each client's address needs a CRA-compliant mileage log if the vehicle is going to support a real deduction rather than a guess at year-end. Equipment carried into the home — grab bars, adaptive utensils, transfer boards, a home-safety assessment kit — is either billed through to the client, resold at a small markup, or absorbed as a practice cost, and the books need to say which for every item, not just the ones large enough to notice.

Once travel time and mileage are tracked against each visit, a practice can see its real cost per home visit rather than treating every booked hour as equally profitable. A visit forty minutes each way costs roughly the same drive-time overhead whether the client pays privately or through WSIB — exactly the number a fee-schedule negotiation or a scheduling decision actually needs.

Exempt treatment, taxable everything else

Occupational therapy rendered to a patient by a COTO-registered occupational therapist is exempt from GST/HST, whatever the payer — SABS, WSIB, or private pay. What is not automatically exempt is a medical-legal assessment commissioned by an insurer or a lawyer: because that report is produced to inform a third party's decision rather than to protect or restore the patient's own health, CRA treats many of these assessments as a taxable supply made to the party that ordered it. Adaptive equipment sold to a client at a markup is ordinary taxable retail, the same as any other product sale. None of that changes what treatment revenue owes — it stays exempt — but a practice doing steady assessment or equipment-sale work should watch its taxable revenue against the $30,000 small-supplier threshold long before it assumes an all-exempt practice never has to register.

Associate and contractor splits belong in the ledger

Many OT practices bring in additional COTO-registered therapists as associates on a percentage split of what they bill, rather than as employees. The books need three numbers for every associate, every month: gross revenue they billed, the split owed to the practice, and the net paid out to them, kept apart from any employee's straightforward wage account. That same record is what a CRA classification review or a WSIB audit will ask for first if the contractor arrangement is ever questioned, so it is worth building correctly the first time rather than reconstructing it under pressure.

If US-trained OTs or US continuing education are part of your practice's picture, the filings and deduction questions live on our cross-border tax page for occupational therapists. For the mechanics of the monthly close itself, see our bookkeeping services page.