Treating international patients is a clinical problem your team has already solved. Getting paid for it is a finance problem most clinics solve late, badly, and in a spreadsheet. A patient pays a deposit in euros from a British card, arrives, pays a balance in cash or by card at reception, then asks for an invoice their insurer will accept. Three currencies, two payment rails, one exchange rate that moved between the deposit and the surgery — and a bookkeeper who wants a single number for the month.
None of this is hard once the rules are written down. It only hurts when each coordinator improvises.
Pick one currency to quote in, and stick to it
The most common mistake is quoting in whatever currency the patient asked in. It feels helpful. It means your quotes, your bookings, and your bank statement are denominated in three different things, and no one can reconcile them without a spreadsheet of daily FX rates.
Quote in one currency — for most European-facing clinics that is the euro — and let the patient's card issuer or bank handle the conversion. That pushes FX risk to the party that already prices it, keeps your revenue line clean, and stops the argument where a patient insists they were quoted €3,200 and the charge landed at £2,790. If you must show a second currency, show it as an indicative figure next to the real one, and say so in writing.
Where clinics genuinely need local-currency pricing — a domestic price list alongside an international one — keep them as two separate price lists with two separate review cycles. Do not derive one from the other with a rate you updated in January.
The three moments money moves
Cross-border cases have a predictable payment shape. Write it into your SOP and the accounting follows almost automatically:
- Deposit at booking. Typically 10–20% of the package. Its job is to make the calendar slot real and to cover your cancellation exposure — not to fund the treatment.
- Balance at or before arrival. Charge it before the patient boards, not at reception. A balance collected at the clinic on day one is a balance you are negotiating on day one.
- Extras during the stay. Additional nights, a second graft session, a revision. These are the line items that never make it into the original quote, and they are the reason your booking total and your bank deposit disagree.
Every extra should be added to the quote as a line item and accepted by the patient before it is performed. If your quote is a PDF someone re-exports by hand, this will not happen. If your quote is a live document the patient can see and approve, it happens by default.
Settlement timing is not payment timing
A card payment that succeeds today is not money in your account today. Card networks and payment processors hold funds through an authorization, capture, and settlement cycle; on top of that most processors run a rolling reserve or a payout delay for merchants in categories they consider high chargeback risk. Medical travel is such a category, because the service is delivered weeks after the money is taken and in another jurisdiction.
Plan your cash flow around the payout date, not the payment confirmation. Two practical consequences: don't promise a supplier — a hotel, a lab, a transfer company — that you'll pay them from a deposit that hasn't settled yet, and don't refund a cancelled patient out of a balance that is still in transit. Refund from working capital and let the payout reconcile itself.
On GetClinic: payments taken through the portal roll up into payouts with a downloadable statement per period — every booking, every line item, the commission deducted, and the net transferred. Commission is only ever charged on bookings that are confirmed and paid through the portal, so there is nothing to accrue for enquiries that went nowhere.
What your accountant actually needs
Bookkeepers reject clinic records for boringly consistent reasons. A statement they will accept without a follow-up email contains all of the following, per transaction:
- A stable reference that ties the payment to a booking, a patient, and an invoice — one ID that appears in all three systems.
- The gross amount, in the currency charged, plus the currency the patient's card was billed in if they differ.
- Fees and commission as separate lines, not netted into the total. Revenue is gross; commission is a cost of sale. Netting them understates both.
- The date of the transaction and the date of the payout — they fall in different months often enough to matter at year end.
- Refunds and chargebacks linked to the original charge, not entered as standalone negative revenue.
If you are producing this by hand each month, you will drift. Take the statement your payment provider or platform generates, and make it the source of truth — then reconcile your internal records to it, not the other way round.
Commission, VAT, and what counts as revenue
Two entries that clinics routinely book wrong. First, platform or agency commission is an expense, not a discount. A €4,000 booking with 12% commission is €4,000 of revenue and €480 of cost of sale — not €3,520 of revenue. Book it net and your margin analysis, your price reviews, and your VAT base are all quietly wrong.
Second, the tax treatment of medical services for non-resident patients varies by jurisdiction, and the treatment of the non-medical parts of a package — hotel nights, transfers, translation — often differs from the medical parts within the same invoice. This is exactly why itemized quotes matter beyond patient trust: an itemized quote is already an itemized invoice, and an itemized invoice is what lets your accountant apply the right treatment line by line. Get the split right with a local advisor once, then encode it in your package templates so no coordinator has to remember it.
The month-end routine
Cross-border finance stays sane when it is a fifteen-minute routine rather than a quarterly excavation. At the close of each period: pull the payout statement, match it to your booking list, investigate any booking with no matching payment and any payment with no matching booking, and file the pair. Two categories of exception will appear every month — a deposit for a patient who hasn't travelled yet, and an extra that was performed but never added to the quote. The first is normal and should sit in deferred revenue. The second is money you have already lost, and the only fix is upstream: quote the extra before you do it.
Clinics that get this right don't have better accountants. They have fewer currencies, one place where a booking's numbers live, and a statement that comes out of the system instead of out of someone's head.