Month end in an occupational health service
On the first working day of the month, someone exports last month's activity from the clinical system. Then the real work starts. One employer pays a monthly retainer plus a fee per management referral. Another pays per head for surveillance but separately for audiometry. A third has a DNA charge after the second missed appointment, but only for face to face. Most want invoices split by cost centre or site, each with its own purchase order number.
The spreadsheet that does this has grown over years, and only one person fully understands it. When she is off, invoicing waits.
Why billing is harder here than it looks
The clinical system records what happened clinically. It was not built to know the commercial terms of each contract. So the gap between 'an appointment took place' and 'this line on this invoice at this price' is bridged by people.
- Rate cards differ per employer and change at renewal, sometimes mid-year.
- Some activity is covered by a retainer, some is charged per item, some is capped.
- DNA and late cancellation charges have different rules per contract.
- Employers need cost centre, site and PO references on every line, and reject invoices without them.
- Additional work, such as a specialist report or an extra clinic day, is agreed by email and easily missed.
What slow, manual invoicing costs
Invoices go out late, so cash comes in late. Work is missed, particularly one-off items, and nobody knows it was never billed. Employers query lines that do not match their records, and each query means digging through the clinical system to prove what happened. And at renewal, you cannot easily show an employer what they used against what they paid.
| Contract term | Where it usually trips up |
|---|---|
| Retainer with inclusions | Items billed that were included, or the reverse |
| Per referral fee | Follow-up reviews priced as new referrals |
| DNA charge rule | Applied inconsistently between administrators |
| Site and cost centre | Lines on the wrong PO, invoice rejected |
| Mid-year rate change | Old rate used for part of the month |
How we build contract billing
- We record each employer's contract as data: rate card, inclusions, caps, DNA terms, effective dates, invoice grouping and PO rules.
- Completed activity is read from your clinical system on a schedule, with the employer, site, cost centre and activity type.
- Each item is priced against the contract in force on the date it happened, so a rate change mid-month is handled.
- Items that do not fit a rule, such as an activity type not on the rate card, go to an exception list instead of being guessed.
- Draft invoices are built per employer in the grouping they require, with PO numbers and supporting activity detail attached.
- Drafts are posted to Xero or QuickBooks through their APIs, for your finance person to review and send.
- A usage report per employer compares what they used with what the contract covers, ready for account reviews.
The supporting detail on each invoice shows activity by reference and type, not clinical content, so employers can check the lines without seeing anything they should not.
Month end afterwards
Invoicing becomes a review task rather than a construction project. Your finance person checks the exceptions, reads through the drafts and approves them. Anything that was done is billed at the right rate, and queries are answered from the attached detail rather than a search through the clinical system.
The spreadsheet, and the risk of the one person who understood it, goes away.
Is your month end like this?
- Invoices are built from a clinical system export in a spreadsheet.
- Each employer's terms are held in someone's head or a contract PDF.
- Invoices are rejected for missing PO or cost centre references.
- Extra work agreed by email sometimes never gets billed.
- Invoicing waits when one particular person is away.