Daily financial management in the ambulatory care setting is most important to the functioning of the office as it directly affects overall accounting and bookkeeping procedures. Bookkeeping, the actual daily recording of the accounts or transactions of the business, is the major part of this accounting process.
One aspect of this recordkeeping in a medical practice is maintaining patient accounts. Coded encounters mentioned earlier should identify any and all products and services for which the patient and/or third-party payer will be charged. The money owed to the office by third-party payers or patients is known as accounts receivable, and must be carefully monitored. Good record keeping is needed to ensure that the physician is paid for services and that patients are properly credited for payments made. Accounts receivable balances should be managed to ensure that cash is flowing into the office to cover expenses and generate a level of profit for the practice.
The other important aspect of bookkeeping is maintaining a record of accounts payable. Accounts payable are amounts of money due for goods and services provided to the practice office. Payroll costs are an example of an accounts payable item. Additionally, charges for rent, utilities, consumable supplies, and housekeeping are other examples of accounts payable. The office manager, accountant, or medical assistant may be asked to keep track of incoming bills and assist with sending in payments to keep the payable accounts up to date.
Historically, the most common method of tracking patient accounts was through a pegboard system, but with the move to electronic records and the advancement of computer technology, most offices now manage accounts through computerized programs. Converting from manual to computerized recordkeeping is initially expensive, requires thorough retraining of staff, and takes a great deal of time at the beginning. However, it offers great versatility and reduces the need to record and re-record entries. A well-prepared medical assistant needs to be fully versed in both bookkeeping systems. When changing over from manual to computerized, both systems should be run simultaneously for at least 60 days.
The pegboard system consists of day sheets, ledger cards, charge slips, and receipt forms. All of the forms have matching columns that align and are held in place on the pegboard when the system is in use. The forms are generally filled out in multiple copies (e.g., carbon copies), which permit entering (or posting) such information as charges, credits, or adjustments onto the day sheet, charge slip or receipt, and the patient’s ledger card simultaneously.
When pegboard systems were more popular, a day sheet was used to list or post each day’s charges, payments, credits, and adjustments. At the end of each business day, the day sheet was balanced to provide a complete picture of all financial activity for that day. Those balances carried over from day to day provided the accumulated data needed for month-end closing.
Receipts are generated when patients pay on their accounts. Adjustments are entries made to change the patient's balance, but they do not represent charges or payments.
A software management program offers many advantages in managing patient accounts. The program automatically creates a charge slip at the time of each patient’s visit. After the physician’s examination, the program calculates the charges for the monthly billing statement. The management program also creates and updates the ledger; adds new names to the list of patients and to the daily log; and transfers data to produce insurance forms, statements, lists of checks received each day, and deposit slips. The program also automatically ages the accounts at each billing cycle and creates billing statements. The computerized patient ledger contains personal information about each patient, including name, address, and telephone number; the person responsible for payment; and all insurance carriers.