Invoicing
An invoice that says what was done.
One line for each thing the clinic did, the code that goes with it, and a balance that cannot disagree with the payments recorded against it.
- A line per item. Description, quantity, price, and the CPT or HCPCS code it came from.
- The status follows the money. Paid and partly paid are worked out from the payments, not typed in by hand.
- Nothing is deleted. A cancelled invoice is voided and kept, because a clinic’s books should not lose documents.
The document
What is on one.
An invoice carries a number of its own — INV-1042 and so on — and that number does not change once it has been given out. Underneath it: the patient, the date it was issued, a due date if the clinic sets one, the lines, any note, and the name of whoever raised it.
Tied to the visit it came from.
When an invoice is raised from a visit it keeps that link, so the care and the charge stay connected instead of living in two systems that have to be reconciled later.
Prices come from your own list.
Each line points back to an entry in Services and prices, so a price change is made once. A one-off charge can still be typed straight onto the invoice.
Diagnoses live on the invoice.
ICD-10-CM codes sit on the document rather than being read back off the note, because a biller sometimes codes differently from the clinician and the record has to say what was actually submitted.
Overdue is worked out, not flagged.
If a due date has passed and the invoice still counts towards a balance, it is overdue. Nobody has to remember to mark it.
Lines
Each line carries its own code.
This is the part that decides whether a claim is accepted. A line is not just a description and a price.
The code and where it came from.
CPT or HCPCS, taken from the procedure catalogue rather than retyped, with the code system recorded alongside it.
Modifiers per line.
Two-character modifiers — 25, 59, LT — belong to the line, not to the visit, because they change what the payer pays for that specific service. Most lines have none, and that is normal.
Each line points at its diagnoses.
A payer will not accept “the visit had a diagnosis somewhere”. Every service line points at the diagnoses that justify it, which is exactly what a claim needs.
Quantity and unit price kept apart.
Three of something at one price reads as three of something at one price, and the line total is arithmetic rather than a number somebody entered.
Status
The money decides what state it is in.
There are five states, and only two of them are anybody’s opinion.
| State | What it means | Counts towards a balance |
|---|---|---|
| Draft | Raised but not yet given to the patient | No |
| Issued | Given out, nothing received yet | Yes |
| Partly paid | Some money received, more outstanding | Yes |
| Paid | Settled in full | No |
| Voided | Cancelled, and kept on the books | No |
Paid and partly paid are not typed in. They are worked out from the payments recorded against the invoice, so the state can never contradict the money. Draft and voided are decisions a person makes, so those stand as chosen.
A balance is charges minus payments and never goes below zero. An invoice that is a draft, or has been voided, is not money anyone owes — so it stays out of the patient’s balance and out of the day’s outstanding total.
Payments
Recorded, never inferred.
Every payment against an invoice is a record in its own right: how much, by what method, when it arrived, a reference the clinic can reconcile against, and who wrote it down.
Any method the clinic takes.
Cash, card, check, bank transfer, an insurance payment — and anything else, because the list is open. A clinic will always have a method nobody thought to put in a menu.
A reference for reconciling.
A check number, a transaction id, whatever the bookkeeper needs to match a line on a statement to a line on an invoice.
A name against every entry.
Who recorded the payment is kept with it. Money moving through a practice should always have somebody’s name on it.
Part payments are ordinary.
Several payments can sit against one invoice, and the balance and the status both follow along on their own.
Why it is built this way
Books a practice can stand behind.
Two rules run through all of it. The first: a status is never allowed to disagree with the money, because the moment those two can drift, somebody has to audit them by hand. The second: documents are voided rather than deleted, because a cancelled invoice is still part of what happened, and books with holes in them are worth less than books with corrections in them.
The practical effect is that the patient’s balance on their chart, the outstanding figure on the dashboard, and the invoices themselves are the same numbers arrived at three ways — not three totals that have to be trusted separately.