Billing & RCM

A patient's account

The two balances, what each claim actually paid, and printing a statement the patient can understand.

8 min · Billing & RCM, Administrators, Front desk · lesson v1

The patient's Billing tab — inside their chart, not the top-level Billing tab — is where an account is actually understood and settled.

Two balances, not one

  1. Billing summary leads with two tiles:

    • Insurance balanceExpected from payers
    • Patient balancePatient responsibility due

    Then the stats: Total billed, Insurance paid, Adjustments / write-offs, Patient responsibility, Patient paid, Claims filed.

    Screenshot pending capture

Keeping those two apart is most of the job. A patient who "owes $600" when $520 of it is waiting on a payer is a patient about to receive a statement they will rightly be angry about.

Where a self-pay discount is configured you also get: Self-pay / prompt-pay discount (15%): the patient balance would be $X if it applies — set in Admin → Statements & discounts.

Reading a claim

  1. Claims (n) gives you, per claim: Claim #, DOS, Payer, Billed, Ins. paid, Adjust., Pt. resp., Ins. due, Status.

    That row is the answer to nearly every patient billing question. Billed is what you asked for; adjustment is the contractual write-down; insurance paid is what arrived; patient responsibility is the deductible or coinsurance left behind; insurance due is what is still outstanding.

    Screenshot pending capture

Everything billed lists the charges themselves — Date, CPT, Description, Units, Amount, Status — and Billing by appointment groups the same money by visit, with per-visit stats including the plainly-worded Insurance didn't pay and Patient owes.

Taking money

Collect a payment is the same payments panel the front desk uses at check-in and check-out.

Chips: Copay: … (or not verified), Open balance, Collected this visit. Quick-fills: Copay $25.00, Full balance $140.00, Both $165.00.

Choose a type (Copay, Balance, Self-pay, Deposit, Other) and a method (Cash, Card, Check, Other). Fill in the reference — the placeholder follows the method, Check # or Card last 4. Then Collect $25.00.

Void on any payment row asks Why void? before it will confirm, and the row is then marked · VOIDED — wrong amount. Voiding and re-taking is always the right move over a compensating second payment.

Statements

Print statement opens the statement to print or save as a PDF. If nothing happens, the browser blocked it: The statement window was blocked — allow pop-ups for this site and try again.

What the statement says is configured in Admin → Statements & discounts — a header note (how to pay), a footer note (financial-responsibility boilerplate), and the self-pay percentage.

Insurance on file

The Insurance section is where coverage is set and eligibility is checked. Pick the payer from the list rather than typing it — the hint tells you why: Payer ID {id} — from the practice payer list (Admin → Payers). A typed payer name has no payer ID behind it, and the claim is more likely to fail.

Check eligibility (live 270/271) runs the real check. Read the banner: a Sandbox response means the demo returns active coverage for any input and is not a verification.

What usually goes wrong

Quoting a total. Break it into the two balances before you say a number out loud.

Chasing a patient for the payer's share. Look at Ins. due first.

Skipping the payment reference. Reconciliation is a future person's problem — usually you.

Assuming the self-pay discount applied. It shows what would happen. Somebody has to decide.

Check yourself

No score, no account — just make sure you can answer these before you move on.

  1. A patient asks why they owe $180 when the visit was "covered". What's on screen to answer that with?

    Show the answer

    The claim row breaks it out — Billed, Ins. paid, Adjust., Pt. resp., Ins. due. "Covered" usually means the payer paid its share and left a deductible or coinsurance. The row shows exactly where the $180 came from, which is a far better conversation than a total.

  2. What does a balance payment settle first?

    Show the answer

    The oldest open balance. The panel footer says so — Balance payments settle the oldest open balance first. You don't choose the charge. If a patient insists on paying one specific visit, that needs handling outside this control.

  3. The banner mentions a self-pay / prompt-pay discount. Does it apply automatically?

    Show the answer

    No — it shows what the balance would be if it applied: the patient balance would be $X if it applies. It's a prompt to have the conversation, and the percentage is set in Admin → Statements & discounts.