> ## Documentation Index
> Fetch the complete documentation index at: https://docs.bizaxl.com/llms.txt
> Use this file to discover all available pages before exploring further.

# Billing and Finance

> How to invoice patients for eye examinations, investigations, optical dispensing, surgical procedures, and inpatient stays - and how to track what is pending.

Every service at your eye care center needs to reach an invoice: eye examinations, OCT scans, visual field tests, fundus photography, cataract surgery, LASIK, intravitreal injections, and all post-operative follow-ups. If something is not invoiced, the center does not get paid. This page explains how billing works and how to use the system to stay on top of it every day.

***

## Before You Start

* You need the **Healthcare Administrator** role to create and manage invoices.
* Billing items must be linked to Appointment Types, Clinical Procedure Templates, and Lab Test Templates.
* Healthcare Settings must be configured for your billing preferences.

***

## What Gets Billed at an Eye Care Center

| Service                                                        | When It Is Billed                                                                  |
| -------------------------------------------------------------- | ---------------------------------------------------------------------------------- |
| Patient Registration Fee                                       | At first registration (if configured)                                              |
| Eye Examination (Consultation)                                 | After the encounter is submitted                                                   |
| Refraction Fee                                                 | After the refraction is completed (can be part of the examination fee or separate) |
| Clinical Investigation (OCT, Visual Fields, Photography, etc.) | After the investigation is submitted                                               |
| Pre-operative Assessment                                       | After the pre-op visit is completed                                                |
| Surgical Procedure                                             | After the procedure is completed and submitted                                     |
| Surgical Consumables (IOL, sutures)                            | As part of surgical billing or separately                                          |
| Intravitreal Injection (drug cost)                             | The drug cost may be billed separately from the procedure fee                      |
| Lab Tests (blood glucose, CBC, culture)                        | After the test is ordered (pre-pay) or after results                               |
| Inpatient Bay/Room Charges                                     | Per hour or per day during surgical admission                                      |
| Post-operative Follow-up Consultations                         | After each post-op appointment                                                     |

***

## The Billing Workflow

```
Service delivered
(Examination, Investigation, Surgery, etc.)
         │
         ▼
Clinical record submitted in the system
         │
         ▼
Service appears as unbilled
("Appointments to Bill" count rises, or Invoiced = No)
         │
         ▼
Billing team opens Sales Invoice → New
Links to patient customer record
Adds all services from this visit
         │
         ▼
Patient pays (cash, card, insurance, corporate)
Invoice submitted
         │
         ▼
Invoiced field ticks on each clinical record
```

***

## Billing for Eye Examinations

The "Appointments to Bill" number card shows completed appointments not yet invoiced.

**To invoice a completed eye examination:**

1. Open the Patient Appointment record
2. Click **Create Invoice**
3. The consultation fee auto-fills from the Appointment Type billing item
4. Add any investigations ordered at the same visit (OCT, visual fields, etc.)
5. Collect payment and submit the invoice
6. The appointment's **Invoiced** field ticks

***

## Billing for Investigations (OCT, Visual Fields, etc.)

Each Clinical Procedure (investigation) has an **Invoiced** field.

To find unbilled investigations:

1. Go to Clinical Procedure list
2. Filter by **Invoiced = No**

Add the investigation to the same Sales Invoice as the consultation for the same visit.

***

## Billing for Surgical Procedures

Surgical billing is typically more complex and may involve multiple billing components:

| Component                        | How to Bill                                                               |
| -------------------------------- | ------------------------------------------------------------------------- |
| Surgeon fee                      | Main billing item on the Sales Invoice                                    |
| OT facility charge               | Separate line item                                                        |
| IOL cost                         | Separate line item (if not bundled) or separate invoice                   |
| Anaesthesia fee                  | Separate line item or separate invoice (if anaesthesiologist is separate) |
| Pre-operative investigation fees | Billed at the pre-op visit                                                |
| Post-operative consultations     | Billed at each follow-up visit                                            |

For insurance-covered surgical patients:

* Get pre-authorization from the insurance company before the procedure
* Note the authorization code in the clinical notes or the appointment record
* The invoice is submitted to the insurance company with supporting documents

***

## Billing for Intravitreal Injections

Intravitreal injections are typically billed as:

* Injection procedure fee
* Drug cost (which can be significant - e.g., anti-VEGF drugs like Bevacizumab or Ranibizumab)

If the drug cost is significant and tracked separately from the procedure fee, set up two billing items: one for the procedure and one for the drug. Add both to the same invoice.

***

## Fee Validity (Free Follow-ups)

After a paid consultation, patients may qualify for free follow-up visits within a set period.

This is particularly relevant for:

* Post-operative follow-ups within the first month of cataract surgery (if included in the surgical package)
* Free review after starting a new medication (e.g., new glaucoma drops)

Configure in Healthcare Settings:

* Turn on **Enable Free Follow-ups**
* Set **Valid Number of Days**
* Set **Number of Encounters in Valid Days**

When the patient comes for the follow-up within the valid period, the consultation fee is waived automatically.

***

## Healthcare Settings: Billing Configuration for Eye Care

| Setting                                   | Recommended Value for Eye Care                                    |
| ----------------------------------------- | ----------------------------------------------------------------- |
| Collect Registration Fee                  | Yes (if your center charges a joining fee)                        |
| Show Payment Popup                        | Yes - front desk collects payment at time of visit                |
| Enable Free Follow-ups                    | Yes - especially for post-surgical follow-ups                     |
| Valid Number of Days                      | 30-90 days (match your post-op follow-up period)                  |
| Allow Discharge Despite Unbilled Services | No - billing should be cleared before discharge                   |
| Process Service Request Only If Paid      | Yes - for centers requiring upfront payment before investigations |
| Out Patient Consulting Charge Item        | Link to your consultation fee item                                |
| Clinical Procedure Consumable Item        | Link to a general consumable billing item                         |

***

## Monitoring Billing

### Daily Check

At the end of each day:

1. Check **Appointments to Bill** number card - should be zero
2. Go to Clinical Procedure list → filter Invoiced = No → clear any unbilled investigations
3. Go to Lab Test list → filter Invoiced = No → clear any unbilled tests

### Weekly Check

1. Run **Patient Appointment Analytics** report to verify appointment volume vs invoice count match
2. Review any credit notes or cancelled invoices

***

## Troubleshooting

**A completed surgical procedure is not appearing in billing**
Check that the Clinical Procedure record has been submitted (not just saved). Only submitted records can be invoiced. Submit the record and then add it to the Sales Invoice.

**The patient says they already paid for an OCT but the system shows Invoiced = No**
The payment may have been collected outside the system, or the invoice was not linked to the patient. Check the sales invoice list for this patient's customer record.

**Insurance requires the investigation to be pre-authorised but the doctor already ordered it**
The investigation can still be performed. Add a note to the Clinical Procedure record with the outcome (pre-auth pending, denied, or approved) and the insurance reference number. Submit the invoice to the insurance after receiving authorisation.

**The IOL cost is very high and the patient is querying the bill**
The IOL cost should be clearly itemised on the invoice as a separate line from the surgeon fee and OT charge. Open the Sales Invoice and confirm each line is described clearly.

***

## Best Practices

* Invoice on the day of the visit - eye care patients often have multiple services in one visit (examination + OCT + visual fields) and bundling these on one invoice is easier to manage same-day than chasing them later
* For surgical patients, collect pre-payment or insurance authorisation before the surgery date - having an outstanding large invoice creates collection problems post-surgery
* Set up a surgical package billing item for your most common procedures (e.g., "Cataract Surgery Package - Right Eye") that bundles the main components into one line - this simplifies invoicing and is easier for patients to understand
* Always record the IOL type and power in both the clinical record and the invoice notes - this is needed for warranty claims if an IOL needs to be replaced
* Post-operative follow-up fees should be discussed at the time of surgery, not at each follow-up visit - surprises at follow-up damage patient relationships

***

## Related Features

* [Appointments](/health-wellness/eye-care-center/appointments): Appointments are the primary consultation billing trigger
* [Clinical Investigations](/health-wellness/eye-care-center/clinical-investigations): Investigations are billed separately
* [Surgical Procedures](/health-wellness/eye-care-center/surgical-procedures): Surgical fees and consumables billing
* [Inpatient Management](/health-wellness/eye-care-center/inpatient-management): Day surgery billing at discharge
* [Laboratory](/health-wellness/eye-care-center/laboratory): Pre-operative lab test billing