At reception: ring it up or put it on account?
When a practice should ring a visit up at the reception till and when it should invoice the patient's account, and what each choice does in the books.
By Achekam · · 5 min read · For Healthcare businesses in South Africa, Nigeria, Kenya
Every patient leaving a consultation reaches the same fork at reception. Some pay there and then, by card, cash, QR code or mobile money, and want a receipt. Others are billed: their scheme will pay, or their employer, or they have an arrangement to settle at month-end. The receptionist has to choose, many times a day, between ringing the visit up at the till and putting it on the patient's account.
The choice is not cosmetic. A till sale and an account invoice create different records, post to different accounts, and in a dispensing practice they treat stock differently. This article sets out what each does in Achekam so the practice can decide its rules once, rather than leaving reception to improvise.
Patients who pay on the day
For a patient paying in full at the desk, the till is the natural route. It sits under Commerce & POS and comes with the Point of Sale add-on; a practice without the add-on neither sees the till nor can use it.
The till has one firm rule: the server refuses any sale that is not paid in full. For cash, it records the money handed over and the change given. That suits private patients who settle on the spot, but it means the till is never the place for a patient paying part now and part later.
Patients billed later or through a scheme
For a patient whose scheme, HMO, insurer or employer will pay, or who settles on account, the visit becomes an invoice. Invoices start as drafts, which can be changed or deleted; issuing one takes the next number in the sequence and posts it to the ledger as debtors, sales and output VAT.
From then on, the invoice can be paid in pieces. Payments are recorded against one invoice or spread across a patient's invoices, and a part payment leaves the invoice part-paid, which is exactly what happens when a scheme pays and the patient settles the shortfall. Credit control, on for new workspaces, e-mails overdue reminders and a monthly statement to patients with a balance, never charges anyone, and records whether each e-mail went out.
What a till sale posts
Every till sale that reaches the server posts a balanced journal in the same step:
- The payment to its own account by method: cash to 1050, card and QR to 1060, EFT to 1000, M-Pesa to 1070.
- Revenue to 4000, and output VAT to 2150.
- Cost of sales against inventory at each product's cost price, for anything taken from stock.
And the stock moves too: a till sale takes the sold quantity off stock in the same step, at the till's location. For a dispensing practice, that means a medicine rung up at the till comes off the dispensary's count and its cost lands in cost of sales, without anyone doing anything extra.
What an account invoice posts
An issued invoice posts debtors, sales and output VAT. Two details differ from the till, and both matter at reception:
- One revenue account. All invoice revenue posts to a single account, Professional Services Revenue (4100), and a line cannot name another sales account. A practice that bills some visits at the till and others on account will see its fee income split between 4000 and 4100 in the management accounts. Add them together when you read total fees.
- No stock movement. Invoice lines are typed in and cannot be picked from the practice's product list, so invoices do not move stock or post cost of sales. A medicine dispensed and put on a patient's invoice leaves the dispensary count unchanged and its cost out of cost of sales.
That second point is the one dispensing practices miss. If medicines regularly go on account, agree with your accountant how the stock and cost of those items will be corrected each month, or keep dispensed items on the till wherever you can.
A worked example in words: a scheme patient is seen and given a course of tablets from the dispensary. Reception invoices the consultation and the tablets to the patient's account, because the scheme will pay. The invoice is right for the patient and the scheme, but the dispensary count still shows the tablets on the shelf. At month-end the practice manager lists dispensed items that went on account, and the accountant adjusts stock and cost of sales for them.
Charging a till sale to an account customer
There is a middle route for some customers. A till sale can be charged to a trade customer's account, which writes a receivables invoice and checks the account's hold and credit limit, unless a supervisor or manager overrides it with a reason. Trade customers are created on the Wholesale screen, which needs the Wholesale add-on.
For a practice, that suits institutional customers rather than individual patients: a care home or a company clinic that collects supplies and settles monthly. Because the sale goes through the till, the stock moves and cost of sales is posted, and the account side is followed up like any invoice. Another industry's version of the same idea is described in trade counter sales on account.
The practice's rules, in one table
| Patient or customer | Route | Why |
|---|---|---|
| Private patient paying in full today | Till | Receipt on the spot, stock and cost posted |
| Patient whose scheme or employer pays | Invoice | Part payments and follow-up |
| Patient settling at month-end | Invoice | A debt that credit control follows |
| Institution collecting supplies on account | Till, charged to account | Stock moves; credit limit checked |
Whichever route a visit takes, the patient should leave with a document: a till receipt, or an invoice that tells them what happens next. What a good reception receipt shows is covered in giving patients a proper receipt at reception. ACCA's article on trade receivables and revenue explains how credit sales create trade receivables and how irrecoverable debts are accounted for, which is the side of the books every account patient sits in.
Decide the rules once, write them on the wall behind reception, and check the monthly list of dispensed items that went on account. The fork at the desk then becomes a habit instead of a judgement call.
General guidance only, not advice on your own circumstances. Tax and payroll rules change: check the current position with the authority or your adviser.
