Clinic Doctor Settlement Audit Checklist

A clinic can count the cash drawer correctly and still calculate a doctor’s share incorrectly. Free follow-ups, discounts, mobile payments, refunds, patient dues and backdated rule changes all break a cash-only calculation.

The objective of a doctor settlement audit is reproducibility: another authorized person should reach the same payable amount from the same closed period, active rule and supporting records.

Quick answer: freeze the settlement period, identify the rule version that applied to each service date, reconcile completed eligible activity to billing and verified payments, show every exclusion and adjustment, obtain separate approval and preserve the final statement with its payment reference.

What a doctor settlement statement must prove

Question	Evidence in the statement
Which work is included?	Closed period, doctor, branch, eligible visit and service types
Which rule was used?	Percentage or fixed rule, basis, effective date and version
What reduced the base?	Approved discount, refund, cancellation, free follow-up and other exclusions
What remains unpaid?	Patient due or unsettled channel amount, handled according to the written basis
How was the payable calculated?	Gross base, exclusions, eligible base, doctor share, adjustments and prior balance
Who approved and paid it?	Preparer, approver, timestamps, payment method and reference

Define the settlement rule before calculating

“Doctor gets 60%” is not a complete rule. The clinic must define what the percentage applies to and when it takes effect.

Choose one calculation basis per rule

• Completed-service basis: the share becomes eligible when an approved visit or service is completed, even if the patient has not fully paid.
• Billing basis: the share applies to the final approved bill after defined discounts and reversals.
• Collection basis: the share applies only after the clinic verifies receipt of funds through cash, card, bank or mobile payment.
• Fixed amount: the doctor receives a fixed amount for each eligible visit, session or service under the agreement.
• Mixed rule: different service types use different bases. Each line must identify its own rule instead of combining them into one unexplained percentage.

The agreement should also state how new and follow-up visits, complimentary care, discounts, refunds, consumables, tax or withholding, home visits and packages are handled. This article does not choose those commercial terms; it shows how to record the clinic’s approved terms consistently.

Version every rule

Keep a rule name, version, effective-from date, optional end date and approver. A new percentage must not be applied to services completed before its effective date. If the agreement is corrected retrospectively, record a formal adjustment with the approval and affected period rather than rewriting history.

Step-by-step doctor settlement reconciliation

1. Freeze the period and cut-off

Record the start date, end date and cut-off time. After preparation begins, late transactions should enter a controlled reopen or the next period’s adjustment queue. Otherwise the payable amount can change while the doctor is reviewing it.

2. Build the eligible activity ledger

Start from completed visits and services—not from the cash total. Each line should include the service date, branch, visit or service type, status, approved price and the rule version effective on that date. Cancelled, draft and duplicate records should be identifiable, not deleted from history.

3. Reconcile billing events

Match eligible activity to invoices or receipts. Show approved discounts, complimentary items, voids and credit notes separately. A discount should not simply make the original price disappear, because the doctor needs to see whether it affected the settlement base under the agreement.

4. Reconcile funds by payment source

For collection-based rules, separate cash, card, bank, mobile payment, due collection and advance use. Keep the external transaction reference where one exists. A payment marked “sent” by a gateway or a patient screenshot is not the same as verified settlement in the clinic’s account.

5. Link refunds and reversals

A refund should point to the original charge and prior settlement treatment. If the doctor’s share was already paid, the correction may become a clearly labelled negative adjustment in a future statement. Do not delete the original line or silently lower a later visit.

6. Calculate, approve and lock

Calculate the eligible base, doctor share, clinic share, prior balance, approved adjustments and net payable. The preparer checks line completeness; a separate authorized person reviews exceptions and approves. After payment, record method, amount, time and reference, then lock the statement.

Worked settlement example

The following is a hypothetical example to demonstrate the calculation—not a recommended commercial rate.

Item	Amount	Treatment
Completed consultation charges in the period	৳120,000	Starting activity total
Approved discounts that reduce the rule base	−৳5,000	Shown by reason and approver
Refunded consultation from this period	−৳3,000	Linked to original receipt
Eligible settlement base	৳112,000	৳120,000 − ৳5,000 − ৳3,000
Doctor share under the active 60% example rule	৳67,200	৳112,000 × 60%
Prior overpayment adjustment	−৳2,000	Linked to the approved earlier statement
Net payable	৳65,200	৳67,200 − ৳2,000

If the agreement is collection-based and part of the ৳112,000 remains unpaid by patients, that unpaid amount must stay outside the current eligible base until collected. If the agreement is completed-service-based, the treatment may be different. The statement should say which basis it used instead of making the reader infer it.

Handle common exceptions without losing the audit trail

Exception	Safe treatment
Free follow-up	Use a defined visit type and settlement treatment; do not record a fake cash payment
Discount outside staff limit	Keep request, reason and separate approval before closing
Patient pays in the next month	Link the later receipt to the original due and include it under the documented basis
Refund after doctor was paid	Create a linked negative adjustment with reason and approval
Doctor works at two branches	Keep branch on every line and show branch subtotal plus consolidated total if required
Package spans several services	Allocate only by the approved package rule; do not guess a split during closing
Duplicate or wrong-patient receipt	Reverse through a controlled entry and preserve both original and correction
Rule changes mid-month	Split lines by effective rule version

Design an explainable closing statement

A useful statement can be reviewed without opening every patient file. Its cover section should show doctor, period, branch scope, calculation basis, rule version and status. The financial summary should show gross eligible activity, exclusions by type, eligible base, doctor share, adjustments, prior balance and net payable.

Keep a downloadable line-level appendix for authorized review, but minimize patient information in the copy sent outside the clinic finance system. A visit reference and service date may be enough for reconciliation; diagnosis and clinical notes do not belong in a payout statement.

Separation of duties and approval controls

Where staffing allows, the person who prepares the settlement should not be the only person who approves it, changes its rule and marks it paid. Use role-based access for rule maintenance, statement preparation, approval, reopen and payment confirmation.

For a small clinic where complete separation is difficult, add compensating controls: owner review of every exception, a locked statement PDF, external payment evidence and a monthly comparison of adjustments by user and reason. The control should match the risk without stopping normal work.

Related operational controls include daily cash closing and reconciliation, discount and refund approval, and clinic role-based access.

Numbers worth reviewing each month

Measure	Definition	Why review it
Unmatched eligible activity	Completed eligible lines without settlement treatment	Finds missing or duplicated work
Rule exception rate	Manually overridden lines ÷ settled lines	Shows where agreements or configuration are unclear
Post-close adjustment value	Value added or deducted after approval, by reason	Detects weak cut-off or late correction patterns
Settlement cycle time	Period end to approved statement and verified payment	Shows operational delay without hiding disputes
Unreconciled doctor balance	Approved payable not matched to payment evidence	Prevents “marked paid” without proof

Do not turn these into isolated targets. A team can make the adjustment count look better by hiding corrections. Review the underlying reasons and evidence instead.

A practical 30-day rollout

1. Week 1—document: list current doctor agreements, calculation bases, exceptions, rule owners and missing effective dates.
2. Week 2—pilot: close one prior period for one doctor from the activity ledger, invoice ledger and payment sources. Keep a parallel manual check.
3. Week 3—resolve: investigate unmatched lines, refund treatment, dues and rule conflicts. Correct source data through controlled entries.
4. Week 4—approve: publish the statement format, access roles, reopen procedure, payment evidence and monthly exception review.

Before changing a live finance process, review ChamberBD Clinic features, the clinic software buyer’s guide and current pricing, then test the settlement with real but access-controlled clinic records.

Scope and publisher note

This checklist is for clinic operations and financial control. It is not accounting, tax or legal advice. Doctor agreements, deductions and reporting obligations should be reviewed by the clinic’s authorized professional advisers.

Implementation checkpoint

Pilot one doctor and one closed period before clinic-wide rollout.

Accountable owner

Assign a finance preparer and a separate clinic owner or authorized manager as approver.

Evidence to keep

Keep the rule version, eligible visit and service ledger, discounts, refunds, adjustments, statement approval and payment reference.

Minimum review note

Resolve unmatched lines before approval and review post-close adjustments and rule exceptions every month.

Frequently asked questions

Should doctor settlement be based on billing or collection?

Use the basis written in the active agreement. The statement must label whether each rule uses completed service, billed value or verified collection and must not mix bases silently.

How should patient dues affect doctor settlement?

Follow the documented rule. If payout is collection-based, unpaid value normally remains pending; if it is service-based, the clinic must show that treatment consistently and separately.

Can an approved settlement be edited?

Do not overwrite it silently. Use a controlled reopen before payment or a linked adjustment after approval, keeping the original statement, reason, requester and approver.

What evidence should a doctor receive?

Provide the period, rule version, eligible activity summary, exclusions, refunds, adjustments, calculation, prior balance, payable amount and payment reference without exposing unnecessary patient details.