Forms - Anatomy of a Statement

Account Number
The Account Number box reflects the account number as assigned to the Patient's account. The same account number will be assigned to each patient on the same account. For more on how Account Numbers are created, please see the documentation on Patients - Adding a New Account.

Statement Date
The Statement Date box reflects the date the Statement was created in the Ledger or Statement Manager. This date cannot be manually adjusted. 

Statement Account Address
The Statement Account Address box reflects the statement addressees' name and address as set in the Patient ability > Account tab > Statement Information tab. This can be the Patient Address, Primary Address, or Secondary Address on the Account.


For more on how the Account tab can interact with a statement form, please see the Patient Account Tab - Statement Information documentation.

Finance Charge Information
The Finance Charge box reflects the percentage per month of the finance charge applied to the current statement. The Annual Percentage Rate box reflects the percentage of annual finance charges applied to the account. The Past Due Days field reflects the number of past due days in which a Finance Charge will be added to the account. This date is calculated from the Statement Date. Payments and other credits are deducted from the Previous Balance before computing the Finance Charge.

The Finance Charge and Annual Percentage Rate boxes will be blank if there are no finance charges applied.

Finance Charges, Annual Percentage Rates, and Past Due Days will only be applied on statements printed through the Statement Manager. These boxes are only present on Statement Forms that include Financial Charge information.


For more on how finance charges and Annual Percentage Rates are used with statement forms, please see the Statement Manager - Finance Charges documentation.

Credit Card Information

The Credit Card box includes fields for credit card remittance, including Account Number, Security Code, Credit Card Expiration Date, and the Name on the Card fields. The Please Charge box allows the patient to select the specific credit card type for credit card remittance, while the Amount Remitted box allows a patient to add the amount to pay towards the statement.

These boxes are only found on statements that include Credit Card Information forms.

Statement Message

The Statement Message box reflects a message that can be set per account or as a global setting for all patients. When printing Incident statements from the Ledger, the Statement Message will be set in the Accounts tab of the Patient Ability.

For more information on setting the Statement Message in the Account Tab, please see the documentation on the Patient Account Tab - Statement Information.

When printing Account statements, the Statement Message is set in the Accounts tab of the Patient Ability, or in the Statement Message box in the Statements node in the Managers Ability if Print Global Statement Message or Replace Account Statement Message are checked. Otherwise, both Statement Messages will be printed on the statement.

This box can also be populated by the A/R Message as set in the Statement Message box of the Statements node in the Managers Ability if Print A/R Message or Replace Account Statement Message and Global Statement Message is checked. If Otherwise append A/R Message at the end is checked, both messages will print in the Statement Message area of the statement.

For more information on Statement Messages added through the Statements Manager, please see the Statement Message Tab documentation.

Date Column

The Date column on the statement lists the procedure date of line items on the Ledger.

 

Description Column

The Description column lists the description as listed on the Ledger for each item on the statement. For codes, descriptions are set in the Fee Schedule. For payments and other transactions, the description is a brief description of the transaction, such as the reference number and amount of a payment.

Code Column

The Code column reflects the procedure code for each statement item as shown in the ledger. The Code column is only found on the Statement Code and Diagnosis form.

 

Diagnosis Column

The Diagnosis column will print up to four diagnoses codes as associated with each statement item in the ledger. The Diagnosis column is only found on the Statement Code and Diagnosis forms.

Patient Name Column

The Patient Name column reflects the first and last name of the patient for each item on a statement. This column is useful for Account statements on multiple patient accounts.

Provider Column

The Provider column reflects the provider associated with each item on a statement. This will be the provider as listed on the individual line item within the Ledger. For example, charges will reflect the provider listed in the New Charge window while payments will list the provider listed in the Payment window. 

Charges Column

The Charges column reflects the amount of each charge included on the statement.

 

Insurance Pending Column

The Insurance Pending column reflects the estimated amount insurance is expected to pay for each charge on the statement.

 

Insurance Portion Column

The Insurance Portion column reflects the amount added to the Insurance Portion for each item on a statement.

Patient Portion Column

The Patient Portion column reflects the amount within the Patient Portion for each item on a statement.

Payments/Credit Column

The Payments or Credits columns reflect the item payment amount of each item included on the statement. Some statement forms will list this column as Credits, while others will list this column as Payments. The resulting information is the same and is listed on each Statement Form.

Balance Column

The Balance column reflects a running balance for each item on a statement.

 

Expected Insurance Total

The Expected Insurance Total reflects the total amount of expected insurance from the Expected Insurance column. This total box is only available on the Statement Expected Insurance Forms.

Grand Total

The Grand Total box reflects the Statement Account Balance prior to the subtraction of any Pending or Expected Insurance.

Insurance Portion Total

The Insurance Portion Total of a statement reflects the total Insurance balance of all items on the statement.

Minimum Amount Due Total

The Minimum Amount Due Total is used on Statement Forms that calculate totals with Installment Amounts.

Installment Amounts can be set on the Account tab in the Patient Ability. For information on using Installment Amounts with your statements, please see the Patient Account Tab - Statement Information documentation.

Patient Portion Total

The Patient Portion Total area of a statement reflects the total amount on the statement within the Patient Portion of the patient's Ledger.

Please Pay This Amount

The Please Pay This Amount box reflects the amount which is owed by the patient. The Please Pay This Amount box is present when an Installment form is not used.

Depending on the form used, this amount could be calculated from the Balance or the Total less any Pending or Expected Insurance.


Total Balance

Total Balance is used on Statement Forms that calculate totals with Installment Amounts. The Total Balance box will reflect the total balance of the statement, while the Minimum Amount Due box will reflect what is due now per the Installment.