Choosing well
What to know: Accountants for liberal and medical professions in Belgium
Medical VAT changed in 2022
Until 31 December 2021, the VAT exemption under article 44 of the Belgian VAT Code followed the status of the provider: a doctor was exempt, full stop. Since 1 January 2022 it follows the purpose of the act. Only care with a therapeutic purpose stays exempt; everything else (aesthetic medicine, certain expert opinions, some certificates) became taxable. A practitioner who does both has since been a mixed taxable person: charging VAT on part of the activity, deducting costs partially, and keeping the split. It is the first thing to check with an accountant who claims to specialise in medical professions.
Under convention, outside it, or partly
Whether to sign the INAMI convention is not only about fees. A practitioner who signs gains access to the INAMI social status, an annual premium earmarked for a supplementary pension or death and disability cover, which one who does not sign forfeits. That premium is not ordinary income: its tax treatment and its place in the second pension pillar are settled when it is paid, and a mistake there follows the practitioner to retirement. Partial convention status, in turn, means separating time slots, with the consequences that has for billing.
Income that does not arrive when expected
Third-party payment shifts collection weeks past the treatment, and the health insurance funds do not all pay at the same pace. A lawyer is paid after proceedings whose length is not theirs to control, an architect as a site moves through its phases. The consequence is the same: the accounting result and the cash position drift apart durably, which makes the advance tax payments hard to size, while paying too little carries an automatically computed surcharge.
Professional expenses: flat rate or actual
A self-employed individual chooses each year between the statutory flat rate and actual expenses. The second demands rigour (a practice at home, a car, equipment whose deductibility varies) but almost always becomes the better option once the activity equips itself. Switching between the two, like incorporating the practice, is decided on projections rather than on the year just closed: exactly the calculation an accountant runs for a client before the question arises.
What the code of conduct forbids
A last point, often discovered too late. Several professional orders restrict sharing fees with a non-member, regulate advertising and limit the company forms available, a doctor cannot always house the practice in any structure, and some professions may only join forces with peers. An arrangement that is optimal for tax but forbidden by the order is an arrangement to do again. A practice that knows the sector asks the conduct question before the tax one.