> ## 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 consultations, lab tests, clinical procedures, and inpatient stays - and how the system tracks what has and has not been billed.

Every service provided at the clinic needs to reach an invoice: consultations, lab tests, procedures, inpatient bed charges. If something is not invoiced, the clinic does not get paid. This page explains how billing works, what to do each day to keep invoicing up to date, and how the system helps you track what is pending.

***

## Before You Start

* You need the **Healthcare Administrator** role to create and manage invoices.
* Billing items must be linked to appointment types, lab test templates, and procedure templates.
* Healthcare Settings must be configured for your billing preferences.

***

## What Gets Billed at a General Clinic

| Service                          | When It Is Billed                                                 |
| -------------------------------- | ----------------------------------------------------------------- |
| Patient Registration Fee         | At first registration (if configured)                             |
| Consultation (Patient Encounter) | After the encounter is submitted                                  |
| Lab Test                         | After the test is ordered (pre-pay) or after results are approved |
| Clinical Procedure               | After the procedure is completed and submitted                    |
| Clinical Procedure Consumables   | Either as part of the procedure fee or separately                 |
| Diagnostic Report / Observation  | After the report is approved (if billable)                        |
| Inpatient Bed Charges            | Daily charge during admission                                     |
| Inpatient Doctor Visit           | Each time the doctor visits an admitted patient                   |
| Medication (Inpatient)           | Drug costs during admission                                       |

***

## The Billing Workflow

```
Service is provided
(Consultation, Lab Test, Procedure, etc.)
         │
         ▼
Record is submitted in the system
         │
         ▼
Service appears as unbilled
(in Appointments to Bill count or filter = Invoiced No)
         │
         ▼
Billing team creates a Sales Invoice
Links it to the patient (customer record)
Adds all billable services for this visit
         │
         ▼
Payment collected (cash, card, insurance)
Invoice submitted
         │
         ▼
Invoiced field ticks on each service record
```

***

## Registration Fee

If your clinic collects a fee when a new patient registers:

1. In Healthcare Settings, tick **Collect Fee for Patient Registration** and enter the fee amount
2. When a new patient record is saved, a payment collection popup appears automatically
3. The front desk collects the fee and records the payment

***

## Billing for Consultations

The "Appointments to Bill" number card on the workspace shows how many completed appointments still need invoicing.

**How to invoice a completed appointment:**

1. Open the Patient Appointment record
2. Click **Create Invoice** or go to Sales Invoice → New
3. Link the invoice to the patient's customer record
4. The consultation fee auto-fills from the Appointment Type billing item
5. Add any other services from the same visit (lab fees, procedure fees)
6. Collect payment and submit the invoice
7. The appointment's **Invoiced** field ticks automatically

***

## Billing for Lab Tests

Lab tests can be invoiced in one of two ways, depending on your clinic's policy:

**Pre-payment (before processing):**

* When the doctor orders the lab test in the consultation, the front desk creates an invoice before the sample is collected
* If "Process Service Request Only If Billing Status Is Paid" is on, the lab only starts the test after the invoice is paid
* Use this when your clinic requires payment before services are rendered

**Post-payment (after results are available):**

* The front desk invoices the test after results are entered and approved
* Use this when patients are billed at the end of the visit for everything they received

To find unbilled lab tests: go to Lab Test list and filter by **Invoiced = No**.

***

## Billing for Clinical Procedures

Each Clinical Procedure record has an **Invoiced** field. Procedures where Invoiced is unticked are awaiting billing.

If consumables are billed separately (set in the Clinical Procedure Template):

* The procedure fee and the consumable cost appear as separate line items on the invoice
* The **Consumption Invoiced** field tracks whether consumable costs have been billed

***

## Billing for Diagnostic Reports and Observations

Billable Observation records have an **Invoiced** field. The billing rate is set on the Observation Template.

To find unbilled observations: go to the Observation list and filter by **Invoiced = No**.

***

## Billing for Inpatients

For admitted patients, billing typically happens at discharge and covers the full stay:

* **Bed charges**: set up as a service unit billing item in Healthcare Settings (Inpatient Visit Charge Item)
* **Doctor visit charges**: the rate per visit is on the Healthcare Practitioner record or the Healthcare Settings
* **Medications**: drug costs are added as separate line items
* **Lab tests and procedures**: invoiced as normal per test/procedure

At discharge, the billing team creates a consolidated invoice for the entire stay.

If "Allow Discharge Despite Unbilled Healthcare Services" is off in settings, billing must be complete before the Inpatient Record can be submitted for discharge.

***

## Fee Validity (Free Follow-ups)

When a patient pays for a consultation, they may be entitled to free follow-up visits within a specified number of days:

1. After payment, the system creates a **Fee Validity** record
2. On the follow-up appointment, the system checks if a valid Fee Validity exists for this patient and practitioner
3. If valid: consultation fee is waived
4. If expired: normal fee applies

**Fee Validity statuses:** Active, Expired, Completed, Cancelled

Configure in Healthcare Settings:

* Turn on **Enable Free Follow-ups**
* Set **Valid Number of Days** (e.g., 7 days for a free follow-up)
* Set **Number of Patient Encounters in Valid Days** (e.g., 2 free follow-ups)

***

## Healthcare Settings: Billing Configuration

| Setting                                   | What It Controls                                               |
| ----------------------------------------- | -------------------------------------------------------------- |
| Collect Registration Fee                  | Whether to charge for new patient registration                 |
| Registration Fee                          | Amount charged for registration                                |
| Show Payment Popup                        | Whether a payment popup appears at billing moments             |
| Enable Free Follow-ups                    | Whether follow-up visits within a period are free              |
| Valid Number of Days                      | Duration of the free follow-up window                          |
| Inpatient Visit Charge Item               | The billing item for doctor visits to inpatients               |
| Out Patient Consulting Charge Item        | The billing item for outpatient consultations                  |
| Clinical Procedure Consumable Item        | The item used to bill procedure consumables                    |
| Allow Discharge Despite Unbilled Services | If off, billing must be cleared before discharge               |
| Process Service Request Only If Paid      | If on, lab/procedure orders only start after invoice is paid   |
| Create Lab Test on SI Submit              | If on, lab tests are created when a Sales Invoice is submitted |

***

## Monitoring Billing

### Appointments to Bill (Number Card)

This is your most important daily billing metric. Check it every morning. When it reaches zero, all completed appointments for the day are invoiced.

Found on: Healthcare workspace, top number cards.

### Unbilled Lab Tests

Go to Lab Test list → filter by Invoiced = No → check daily.

### Unbilled Procedures

Go to Clinical Procedure list → filter by Invoiced = No → check daily.

### Unbilled Observations

Go to Observation list → filter by Invoiced = No → check at end of each day.

***

## Troubleshooting

**An appointment shows in "Appointments to Bill" but billing says no invoice was created**
The appointment was completed without an invoice. Open the appointment and create the Sales Invoice.

**The Invoiced field on a consultation did not tick after creating the invoice**
The Sales Invoice must be submitted (not just saved) for the Invoiced field to update. Submit the invoice and check again.

**A patient was discharged but some charges are still showing as unbilled**
Either "Allow Discharge Despite Unbilled Services" was on (which permits discharge even with outstanding charges), or some services were missed. Check the patient's unbilled records in each list and invoice them.

**The fee validity is not being applied to the follow-up appointment**
Check that "Enable Free Follow-ups" is on in Healthcare Settings. Also verify that the follow-up appointment is with the same practitioner that the original consultation was with (Fee Validity is practitioner-specific).

***

## Best Practices

* Invoice completed appointments the same day - the longer you wait, the easier it is to miss something
* Use the "Appointments to Bill" number card as your daily completion checkpoint - zero means billing is caught up
* For inpatients, do a billing review every 2-3 days rather than leaving everything to discharge day
* Turn on "Process Service Request Only If Paid" if your clinic requires upfront payment before services are delivered
* Always link the Sales Invoice to the patient record (via the Customer field) - invoices that are not linked cannot be found in patient history

***

## Related Features

* [Appointments](/health-wellness/general-clinic/appointments): Appointments are the primary outpatient billing trigger
* [Laboratory](/health-wellness/general-clinic/laboratory): Lab tests have their own billing workflow
* [Clinical Procedures](/health-wellness/general-clinic/clinical-procedures): Procedures and consumables are billed separately
* [Inpatient Management](/health-wellness/general-clinic/inpatient-management): Inpatient billing is done at discharge