Invoicing for Doctors and Therapists: Billing in Healthcare

Invoicing in the healthcare sector is subject to special rules. As a doctor, dentist, physiotherapist, alternative practitioner, or psychotherapist, you need to know not only general invoicing requirements but also specific fee schedules and tax considerations. This comprehensive guide shows you how to bill correctly.

Special Features of Healthcare Billing

Billing for healthcare services differs fundamentally from other industries:

Fee Schedules as the Basis

Billing Channels

1. Insurance billing: Through the medical association with health insurance
2. Private billing: Direct with the patient or via billing service
3. Self-pay services: Individual health services (out-of-pocket)
4. Work accidents: Billing through workers' compensation

Understanding Fee Schedules

Fee schedules form the foundation of private medical billing:

Structure

Fee schedules contain all billable medical services with:

• Service code: Unique identification of the service
• Service description: Exact definition
• Point value: Basis for calculation
• Base fee: Point value × conversion factor

Multiplier Factors

Important: When exceeding the standard maximum rate, written justification is required!

Sample Invoice

Private Medical Invoice

Patient: John Smith
Date: January 15, 2026

Code  | Service                      | Factor | Amount
------|------------------------------|--------|--------
1     | Consultation                 | 2.3    | $45.00
5     | Symptom-related examination  | 2.3    | $45.00
250   | Blood draw                   | 1.8    | $18.00
3550  | Laboratory blood count       | 1.15   | $15.00

                              Total:         $123.00

Note: Billing according to medical fee schedule.
This invoice is due immediately.

VAT Exemptions for Healthcare Professionals

The Key Exemption

Most medical treatments are exempt from VAT:

Requirements:

1. Medical treatment: Medically indicated service
2. Qualification: Licensed healthcare professional
3. Therapeutic purpose: Diagnosis, treatment, or prevention

Exempt professions:

• Physicians and dentists
• Alternative practitioners
• Physiotherapists, occupational therapists, speech therapists
• Psychotherapists and psychologists (licensed)
• Midwives
• Podiatrists

Taxable Services

Mixed Services

When you provide both exempt and taxable services:

1. Clear separation: Separate invoices or line items
2. Input tax deduction: Only possible for taxable portion
3. Documentation: Maintain clean records

Required Information on Healthcare Invoices

General Requirements

Every invoice must include:

• Full name and address of the service provider
• Full name and address of the patient
• Invoice number (sequential)
• Invoice date
• Service date or period
• Type and scope of services
• Fee for the services

Special Requirements for Healthcare

For fee schedule billing additionally:

• Service code from the fee schedule
• Multiplier factor with justification (if above standard)
• Reference to the applicable fee schedule
• Diagnosis (in appropriate form)

For VAT-exempt services:

• Note: "VAT exempt pursuant to applicable regulations"
• Tax identification number required

Billing Self-Pay Services

Individual health services require special care:

Requirements for Self-Pay Billing

1. Written agreement: Before treatment!
2. Disclosure: Patient knows costs and that insurance won't pay
3. Adequate consideration time: At least 24 hours recommended
4. No pressure situation: Don't offer during emergencies

Billing for Physiotherapists

Private Patients and Self-Payers

As a physiotherapist, you can set your own prices for private patients:

Insurance Billing

For insurance patients, standard fee schedules apply:

• Billing via therapy prescription
• Co-pay by patient
• Billing with the respective insurance company

Digital Billing and E-Invoicing

Medical Billing Services

Many practitioners use billing services for:

• Invoice creation according to fee schedules
• Collection and reminders
• Statistics and reports

Cost: Typically 2-4% of the invoice amount

E-Invoicing in Healthcare

E-invoicing requirements also apply to healthcare in B2B contexts:

• Structured electronic formats for business customers
• Private patients can still receive PDF/paper
• Practice software should support e-invoicing

Collections for Patient Invoices

Healthcare-Specific Considerations

• Sensitive data: No diagnoses on collection notices!
• Neutral sender: No practice name mentioned with collection agencies
• Humane approach: Many patients have genuine payment difficulties

Recommended Collection Process

Common Mistakes to Avoid

In Fee Schedule Billing

• Multiplier without justification: Always justify when exceeding standard rates
• Analogous billing without marking: When no specific code exists, mark as analogous
• Ignoring target service principle: Only bill the target service, not every action

With VAT

• Input tax deduction for exempt services: Only deduct for taxable portion
• Mixing exempt and taxable services: Correctly tax reports, lectures, etc.

Checklist: Healthcare Invoicing

✅ Before treatment:

• [ ] Insurance status clarified?
• [ ] Self-pay agreement signed?
• [ ] Cost estimate for major treatments?

✅ On the invoice:

• [ ] All required information present?
• [ ] Service codes correct?
• [ ] Multiplier factors justified?
• [ ] Tax treatment correct?

✅ After invoicing:

• [ ] Copy archived?
• [ ] Payment receipt monitored?
• [ ] Collection system active?

Conclusion

Billing in healthcare is complex but manageable. With knowledge of fee schedules, VAT exemptions, and proper required information, you create legally compliant invoices that are accepted by patients and payers.

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