Understanding A Patient's Ledger

PATIENT LEDGER

A patient's ledger is the section of a patient file that houses all payments the patient has made as well as all charges for products purchased, and for services provided to the patient. 

Sections of this article include:

• Quick Review Of Ledger
• Charges Tab 
  • How to change the responsibility of a charge
  • How to delete or edit a charge
  • Write Off
  • Rebill
• Payment Tab
  • How To Post A Payment
  • Incoming & Outgoing Transfers
  • How To Complete a Patient Refund
  • How To Delete Patient Payment
  • Viewing EOBs Attached to Patient

Quick review of patient ledger:

 Open a patient file and click on the Ledger tab

Within this display of charges, you can change the arrangement of the Date, Type, Description, Charges and Credits column. To do this, click and hold onto a column, then drag it where you want it placed.

The width of each column can also be adjusted by placing your mouse on the line between columns, and then click and drag the line to where you want to move it.

This list will default to showing charges from oldest to newest. To change the display to newest to oldest, check 'Sort newest to oldest' box.

To see more details of a charge you can select the 'Display breakdown' box which will show Patient Balance and Payer Balance of the charge.

 

Columns displayed here and what they indicate:

• Charges column indicates the price of the charges for that date of service. This displays the Price indicated on Price List. 
• Credits column indicates that a write off was done on that date of service.
• Patient Balance indicates the total amount that the patient owes for that case.
• Payer Balance indicates the total amount that the insurance owes for that case. *If the amount is in () that means the amount is a credit, which can result from a payer write off after a payment has already been made.*
• Case Balance indicates the total amount due for that particular case, for the patient.

Charges Tab

This is where you can see every CPT code that was charged to the patient on every date of service within a specific case.

 

The columns on this page can be moved around to suit your needs. You can click and drag columns to a different place and also adjust the width of each column by clicking on the line between columns and dragging it over.  

Columns can be 'Pinned' to the left of the screen, so that when scrolling to the right to view information, that column will stay in place and not go out of view. To do this, click on the thumb-tack icon to the right of the Header Name within a column, then the pinned columns will turn to a cream color.

Some charges may be highlighted in different colors to indicate a time frame on past due amounts:

• Green will show any past due balance that is less than 30 days past due.
• Yellow will show any past due balance that is 30 - 60 days past due
• Orange will show any past due balance that is 60 - 90 days past due.
• Red will show any past due balance that is greater than 90 days past due

A '+' to the left of a charge indicates that:

• There is an EOB entered into the system with that DOS/charge on it
• Or there is a modifier attached to that charge/CPT
• Or a write off was applied to the charge

The charges screen can be filtered by Date Range, Treating Provider and Billing Provider.

By clicking the scroll bar at the bottom of the screen and scrolling to the right, you will be able to see the rest of the columns that are visible.

To add or remove columns from this page, click the paper icon to the left of the column headers. Place a check mark in the box next to the column that you want to be visible. Remove the check mark if you do not want to see the column be displayed.

Here is a list of the columns within the charges tab and what they indicate:

•  Date: Date of appointment that the charge was applied, or date that the OTC charge was applied
• Patient Owes: Amount of patient responsibility for the charge
• Patient Paid: Amount that was applied to this charge, that the patient paid (When the patient makes a payment towards their account, money will always automatically go towards the oldest charge first. This cannot be changed and helps to prevent charges from going unpaid.)
• Description: Displays the CPT code and full description
• Charge: The amount set for this charge, that was put into the clinic's Price List
• Fee Schedule Charge: The amount set for this charge, that was placed into the Fee Schedule, that this patient is associated with
• Units: The quantity of the charge. This is especially useful when selling supplements/health products and this is edited when adding in the charge in the appointment screen (under the Units column) when adding in an OTC charge, or in the Fee Schedule and Price List
• Fee Schedule Tax: Total amount of sales tax, based on the Fee Schedule's price for the charge (so the sales tax amount after the fee schedule's write off)
• Total Schedule Tax: This is the total amount of sales tax based on the Price List's price for a charge (sales tax of the charge before Fee Schedule write offs)
• Total Charge: Total amount of charge based on the Price List price for the charge
• Fee Schedule Total Charge: Total amount of charge based on the Fee Schedule price for the charge
• Fee Schedule Write Off: Total amount that was written off by the Fee Schedule
• Billing Provider:  Billing Prover on the charge, can be changed by double clicking the charge > Billing information tab
• Treating Provider: Treating Provider on the charge, can be changed by double clicking the charge > Billing information tab
• Primary Owes: Total amount that the primary insurance owes for the charge
• Secondary Owes: Total amount that the secondary insurance owes for the charge
• Tertiary Owes: Total amount that the tertiary insurance owes for the charge
• Balance: Total amount that is still owed on the charge, from all insurances and the patient, added together
• Patient Charge: Total amount that the patient owes on the charge
• Primary Payer: The name of the primary insurance that is in the patient's file
• Primary Payer Charge: Amount that was charged to the primary payer
• Primary Paid: Amount that the primary payer has paid towards the charge
• Primary Write Off: Amount that has been written off from the primary's responsibility
• Secondary Payer: The name of the secondary insurance that is in the patient's file
• Secondary Payer Charge: Amount that was charged to the secondary payer
• Secondary Paid: Amount that the secondary payer has paid towards the charge
• Secondary Write Off: Amount that has been written off from the secondary's responsibility
• Scheduled Clinic: Clinic that the appt was scheduled under
• Total Write Off: Total amount of all write offs on the charge

How to Delete or Edit a Charge

All the way to the right of the charge you will find the option to edit or remove a charge. To remove the charge simply click the red X to the right of the charge.

To edit a charge, you can either click the green pencil icon to the right of the charge or double click the charge to open the edit page.

General Tab:

This page displays the allocation of money responsibility for the charge. In the picture above, the patient owes $30.00 (on the left) and the primary owes $49.00 (on the right) for this particular charge.

How to change the responsibility of a charge:

This is where you can change the responsibility of a charge if needed, by deleting an amount from one side, and putting that amount into the 'Responsibility Breakdown' box on the other side.

For example, in the picture below, I deleted the 30.00 from the patient responsibility box and typed in 0.00, and then I added that 30.00 to the payer responsibility box, which already had 49.00, by deleting 49.00 and replacing it with 79.00 (30.00 + 49.00 = 79.00). So now the primary payer is responsible for $79.00 of the charge, and the patient is responsible for $0.00 of the charge. When you move money responsibility like this, the amount in all of the 'responsibility' boxes, must equal the total amount of the charge.

How to add a write off:

You can also add a write off from this page. To see more on how to complete write off's, please click HERE.

Billing Information Tab:

Under the Billing Information tab on this page, you can change some of the information related to this charge.

You can change the Treating Provider, Treating Clinic, and Billing Provider of this charge by clicking the drop-down boxes next to these options.

If you place a check mark on any of the boxes to the right of 'Billing Hold', then this charge will not show on that document. For example, if you check 'Patient Receipt', then whenever you print a Patient Receipt, this charge will not show up on it.

The ICD Mapping section is where you can deselect ICD codes that you do not want to be associated with this charge.

Click Cancel or OK to get back to the charges screen.

Rebill

The Charges tab is where you can perform a rebill for a charge/charges for a patient. To see how to complete a simple rebill (does not indicate that it's a corrected claim) please click HERE. To see how to complete a rebill that indicates that it is a correct claim, please click HERE.

The Bulk Write off button allows for a clinic to write off an amount from multiple charges at once. To see more information about Bulk write offs please click HERE.

The Delete write off button allows for the removal of a bulk write off

Payments Tab

This page shows the clinic all payments made by the patient, incoming and outgoing money transfers from their account, and refunds.

How to post a payment

The Post button is how staff can post a payment to a patient's account.

After clicking the Post button, type in the amount of the payment, then choose a date the payment is to be made on, the clinic it will post to, and the type of payment it will be. If it is a credit card, choose Credit, and fill in all of the required information. Then click Post. The payment will show at the bottom of the list in the Payments tab.

Please reach out to support for more information on Integrated Merchants

Outgoing and Incoming Transfers:

To see how to complete credit transfers, please click HERE.

How to complete a patient refund

 Select to highlight the payment that you want to refund. Then click Refund button.

You will be asked if you are sure, select OK. Then fill in the required information in the next box and click Post Payment button to complete.

 Credit Forward

The Credit Forward area allows you to bring a credit in, for a patient, from your previous software for reasons such as pre-payment for care, supplements purchased but, have not received etc. To see information about Credit Forward please click HERE.

Deleting a Patient Payment 

To delete any payment, refund, or money transfer on an account, select the line item you want to be deleted and click Delete button, then select 'Yes' in the pop up box. If you delete any payments or refunds, they will not show up on your Day Sheet Report.

 Viewing EOBs Attached to Patient

At the bottom of the page is a section that shows EOB's that have been put into the system that are attached to this patient. If you scanned the EOB and saved the image, you can view it by selecting the eob and then clicking the View button

If you have any questions about a patient's ledger please see the information below to contact support, and we will be happy to answer any questions.

- Support Information -

 If you have any questions or need assistance with this process please contact Support by:

Live chat: Click the 'Support Portal' button in your main toolbar (on left-hand side) within your software, click the green 'Support' box in bottom right of screen.

***This has the fastest response time***

Phone: [phone]

Email: [e-mail]

Business hours: Monday-Friday, 8:00am-6:00pm CST