Foot clinic bookkeeping: treatment, orthotics, and retail on one visit

One visit, three tax treatments

Clinical care from a chiropodist or podiatrist is exempt, a custom orthotic made to measure and supplied on prescription is zero-rated, and everything else on the shelf — insoles, orthopedic footwear, compression socks, foot-care products — is taxable retail. Blending the three into a single revenue line hides the number a foot clinic actually needs: how much orthotics and retail revenue each assessment generates.

We map the POS and invoicing setup to these four lines once, so a visit that bundles a treatment, an orthotic order, and a retail sale splits correctly by default. See the difference between zero-rated and exempt supplies for the underlying rule this table applies.

Insurer pre-authorizations sit in limbo until they don't

Extended health plans routinely require a predetermination before approving a custom orthotic claim, which means a patient can be fitted and the lab invoice paid weeks before the insurer confirms what it will actually cover. We book the pending predetermination as a memo item rather than a receivable until it is approved, then convert it to a proper receivable against the confirmed coverage — so the accounts receivable aging report reflects claims that are actually collectible rather than a mix of confirmed and still-pending amounts that inflate the number. Plans also vary widely in what they require before approving a claim — some ask only for a receipt, others want a biomechanical assessment on file — and a clinic that tracks which plans slow-walk approvals can flag a patient's coverage before the fitting appointment rather than after the lab bill has already landed.

Orthotic labs turn every pair into a job-costed sale

A custom orthotic starts with a cast or a 3D scan sent to a lab — sometimes in-house, often external — and the lab's invoice is the direct cost of that specific patient's order, not a general supply expense. We match lab invoices to the orthotic sale they belong to, so gross margin per pair is a real number, and we track remakes and adjustments as their own cost line, since a rising remake rate is a clinical and margin signal the P&L should surface rather than bury inside a general supplies account. Clinics that cast in-house on a scanner rather than sending a physical mould still generate a lab cost on the manufacturing side, and we treat the scan-and-manufacture workflow the same way for job-costing purposes — the difference is in the clinical process, not in how the invoice should hit the books.

• WSIB and auto-insurer claims — workplace foot injuries and, less often, motor-vehicle claims follow their own billing and reconciliation cycle, separate from extended-health assignment billing.
• Retail inventory counts — periodic counts of insoles, footwear, and foot-care products catch shrinkage before it shows up as an unexplained variance at year-end.
• Associate and room-renter splits — where clinicians work on a percentage split or pay room rent, we calculate the split from the ledger each period rather than from a running spreadsheet someone has to remember to update.
• Multi-clinic consistency — a chiropodist running two locations gets one chart of accounts across both, so combined performance is one report away rather than a manual merge of two spreadsheets.

Equipment, imports, and the bigger picture

Gait-scan systems, sterilization equipment, and shockwave units are capitalized at full landed cost, including freight, duty, and the exchange rate on the payment date where the vendor bills in USD — common, since several orthotic labs and equipment suppliers operate out of the US and invoice accordingly. If your background includes US podiatric medical school, US student debt, or a US retirement account from time spent training there, our cross-border tax guide for foot clinics covers the reporting side. For what our monthly close actually includes for every client, see our bookkeeping services.