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Chapter 13 Managing Medical Ofce Finances 251
Types of Checks
Certain kinds of checks are more “secure” than the personal checks patients may write to pay on their accounts.
Examples include the following:
Certied checks are written from the patient’s account
r
and stamped by the bank. The bank guarantees that
it’s holding enough money in the patient’s account to
pay the check.
Cashier’s checks are written by the bank and sold
r
to the customer for the amount of the check plus an
additional fee. This process gives the receiver of the
check condence that it is good.
Money orders are not true checks, but they do guar-
r
antee payment just like cashier’s checks. Banks, the
U.S. Postal Service, stores and businesses sell these to
customers.
Writing Checks
Another of your administrative duties may be handling accounts payable—that is, paying the ofce’s
bills. Accounts payable usually include such things as
follows:
Rent and utilities
r
Refunds to patients and insurance companies
r
Payment for supplies and services
r
Repayment to the ofce’s petty cash fund
r
Employees’ salaries
r
Taxes
r
Accounts payable can be paid by check or electronic transfer. You may produce these checks on the
computer or write them by hand. In either case, you
probably won’t be signing the checks, and if you will
be signing checks your signature must be listed at the
bank as an authorized agent. In most ofces, the ofce
manager, business manager, or physician signs the
accounts payable checks. Some ofces require two signatures on checks, especially if they’re over a certain
amount.
Here are some points to remember when you prepare
accounts payable checks.
Be sure you make the check payable to the correct
r
name of the person or business.
Place the current date on the check.
r
Enter the payment amount in both words and
r
numbers.
Put the reason for the check on its memo line for
r
reference.
Record the date, check number, amount of the check,
r
and who it’s payable to in the checking account
register.
Subtract the check’s amount from the register
r
balance.
Post the payment to the appropriate category or
r
account in the ofce’s nancial records.
If you are preparing checks by hand, be sure your
handwriting is clear.
In addition to the checkbook register, the ofce should
keep a logbook of all checks written. Along with the
date, number, and amount of the check, the log should
include why the check was written—for example, ofce
supplies, payroll taxes, monthly credit card bill, and so
on.
Bank Statements
Banks mail a monthly statement to account holders.
This statement shows all account activity since the previous statement. It lists the following information:
All checks written and their amounts
r
All deposits made and their amounts
r
All electronic transactions
r
Any service charges
r
You must reconcile each monthly statement. This
means you must compare it with your ofce records
for the account. The main ofce record you’ll use is the
checkbook register. You would follow these steps:
1. Compare the amounts of all checks and deposits
listed on the statement with their listing in the register. Verify that the information is identical.
2. Make a check mark in the register for each check the
statement shows has been paid by the bank.
3. Make a check mark in the register for each deposit
the statement shows was received by the bank.
4. Total all deposits that have no check marks in
the register. Add that total to the ending balance
shown on the statement. This is the revised ending
balance.
5. Total all the checks that have no check marks in the
register. Subtract that total from the revised ending
balance you calculated in step 4.
6. Subtract from the register balance any fees and
charges shown on the statement that are not recorded
in the register. (Enter these fees and charges in the
register so the register is balanced.)
7. The balance you reach in step 6 should equal the
balance you reached in step 5. If it does not, there
is a problem. Check your math and make sure the
numbers are all correct. If no errors in the math are
found, there could be a problem with your checking
account.
Figure 13-5 is a sample of a reconciliation sheet used
to check the account balance for accuracy.
Reconciliation of the ofce banking account is an
important monthly task.
252 Section III Administrative Medical Assistant Skills
1.
Subtract any fees or charges that appear on this statement from your checkbook balance.
2.
Add any interest paid on your checking account to your checkbook balance.
3.
List the checks you have written that have not been paid (these checks did not yet
appear on your bank statement). You can also include in this list any withdrawals you
have made since the ending date of the banking statement that do not appear on
the statement.
Check Number
6217
6218
6219
Total
4. If you have entered deposits or other additions to your checkbook that do not appear
on the statement, list them here:
Date
12-8-15
Total
5.
Enter the ending balance from your statement here:
Add the total deposits from Step 4:
Subtract the total from Step 3:
Total (this should equal your checkbook balance):
If these balances do not equal your checkbook balance:
s
Check the addition and subtraction in your checkbook
s
Check the amount of each transaction in your checkbook with the amount shown on
your statement
s
Check to see that all transactions from your previous statement have been accounted for
s
Call your bank manager for assistance
Amount
Amount
32.94
50.00
119.24
202.18
592.00
592.00
9542.91
+
–
592.00
202.18
9932.73
Figure 13-5 Checking account reconciliation. (Reprinted from Kronenberger J, Ledbetter J.
Lippincott Williams & Wilkins’ Comprehensive Medical Assisting. 5th ed. Philadelphia, PA: Wolters
Kluwer; 2016.)
C
O
G
ORDERING SUPPLIES
Like all businesses, one of your ofce’s goals is nancial
success. You’ve already read how billing, collections, and
bookkeeping practices contribute to this goal. Keeping
the ofce’s expenses well managed is also required to
help the practice nances.
There are many ways to save money when buying
ofce supplies. Here are just a few of them.
A purchasing cooperative (co-op) allows the ofce to
r
join with others in buying supplies. The co-op’s members benet from the lower prices that go with large
orders.
Some suppliers offer price discounts for prompt
r
payment.
Large warehouse-type sellers and companies with dis-
r
count catalogs also offer low prices.
Finding the best deals can take time. But the savings
can be worth the effort, especially for items you use a lot.
There are things other than cost to consider in decid-
ing what and where to buy. Consider the following:
All supplies should be high quality, not just inexpen-
r
sive. Many ofces use several suppliers to get this mix
of good quality and good price.
Ofce supply companies often deliver for free. Ofce
r
warehouse chains may charge a delivery fee or require
a minimum order for free delivery.
Receiving and Paying for Supplies
Arriving supplies should always have a packing slip that
lists the items the delivery contains. Always compare the
packing slip to the actual contents received. This is a
check to make sure the order is accurate and complete. If
all items were received, initial the slip. Place all packing
slips in a bills-pending le so they can be compared to the
Chapter 13 Managing Medical Ofce Finances 253
invoice, or bill, when it arrives. If the supplies were paid
for in advance, place the packing slip in the appropriate
accounts-paid le. If any items were missing, mark them
on the packing slip, and contact the company. Invoices
for supplies and other bills the ofce has not yet paid
should be kept in a bills-pending le. This will help prevent them from being lost or misplaced. Bills may be paid
daily, weekly, bimonthly, or monthly. Generally, ofce
policy will determine how often accounts payable checks
are written. Figure 13-6 is a medical assistant checking in
supplies received in the ofce.
Verify receipt of all items shipped by comparing the
packing slip to the contents received. Check each item
as received and circle any items not received. Follow up
immediately on items that are listed as shipped yet not
received. Make note of any items listed as on back order
and be sure to watch for their arrival. Packing slips
should be stored safely to be used to compare against
the billing statement.
Petty Cash
Most ofces keep a petty cash fund to make small purchases. For example, suppose you run out of le folders
and need more right away. Since it will take time to get
more from your ofce supplier, you could buy a box at
a local store to use until the new supply arrives. You
would take money from petty cash to pay for this small
purchase.
The value of a petty cash always remains the same.
This means that when you take money out, you replace
it with the receipt for money spent. The cash remaining
in the fund and the total of the receipts should always
equal the set value of the fund.
The petty cash fund usually is renewed once a month.
This is done by writing and cashing an accounts payable
check for an amount that equals the total of the receipts
in the fund. The receipts are removed and led, and the
money from the cashed check is put in the fund.
C
O
G
Many medical ofces hire an outside service to maintain
and process payroll records and issue pay checks to the
staff. But in some ofces, these checks will be written by
a medical assistant or ofce manager.
ing schedules:
PAYROLL
Generally, paychecks are issued on one of the follow-
Weekly (52 pay periods per year)
r
Biweekly (26 pay periods per year)
r
Monthly (12 pay periods per year)
r
Your employer decides the pay period in your ofce.
Usually, all the employees are paid on the same schedule.
Deductions and Withholdings
Writing payroll checks requires more than just knowing each employee’s pay rate. A number of amounts are
deducted from employees’ pay. Here are the common
payroll deductions.
Health, life, or disability insurance premiums
r
Employee contributions to the company-sponsored
r
retirement plan
Court-ordered withholdings to pay a debt the employee
r
owes
Federal taxes
r
In most states, state income tax must be withheld,
too. Many cities and towns also tax the earnings of people who live or work there.
Federal Taxes
Figure 13-6 MA checking in supply order. (Reprinted
from Kronenberger J, Ledbetter J. Lippincott Williams
& Wilkins’ Comprehensive Medical Assisting. 5th ed.
Philadelphia, PA: Wolters Kluwer; 2016.)
The federal taxes you must withhold from employees’
paychecks are as follows:
Federal income tax (FIT)
r
Social Security (also known as FICA)
r
Medicare
r
254 Section III Administrative Medical Assistant Skills
All three of these withholdings are based on the
amount of the employee’s earnings. In general, the
greater the employee’s pay, the larger the amount that
is withheld. FICA tax is based solely on the amount
earned without regard to their marital status or number
of dependents.
The size of the FIT withholding is affected by the
employee’s marital status and by the number of exemptions the employee claims. This information is contained
on the employee’s W-4 form. If an employee does not
have a W-4 form on le, you must withhold FIT at the
highest rate, that is, the tax rate for a single person
with no dependents. It is extremely important that all
employees have a W-4 on le.
Each employee must complete a federal W-4 form on
the rst day of hire. The W-4 form contains the employee’s name, address, Social Security number, marital status, and number of exemptions she claims. In general,
employees can claim one exemption for each person
who depends on their income. An employee’s dependents usually are her spouse or minor children.
Employee Records
No matter who does your ofce payroll, the ofce
should have a personnel le on each employee. The le
should contain the following items and information:
Employee’s original job application or resume
r
Job references
r
Salary or hourly rate at time of hire
r
Dates and amounts of pay raises
r
Performance reviews and evaluations
r
All employee withholding authorization forms, such
r
Pension plan, health, and life insurance paperwork
r
Vital facts such as employee’s date of birth, name of
r
spouse, address and phone number, and name and
daytime phone number of an emergency contact
person
Calculating Federal Withholdings
You can easily nd out how much of federal taxes to
withhold from each employee’s check by using tax
tables provided by the U.S. Internal Revenue Service
(IRS). Combined tax tables found in IRS publications
for businesses calculate the withholding for FIT, Social
Security, and Medicare for you.
The tables tell how much to withhold for weekly,
biweekly, monthly, and other payroll periods. Your
ofce’s payroll period and the marital status of the
employee will determine which table to use. If an
employee’s wages are greater than the highest bracket
on the table, you will have to use one of the other
methods described in the publication to calculate the
withholding.
Employer Taxes
An employer must match the amount withheld from
each employee’s check for Social Security and Medicare.
Suppose, for example, that you withhold $150 from an
employee’s check for these taxes. The ofce must pay
$300 to the IRS—$150 for the employee’s withholding
and $150 for the employer’s match.
Each pay period, or at least once a month, you will
write an accounts payable check to the IRS for the
federal taxes you have withheld from employees’ pay
checks. This check will be for the total of the following
amounts:
Federal income tax withheld from employees’ pay
r
Medicare tax withheld from employees’ pay plus the
r
employer’s matching contribution
Social Security tax withheld plus the employer’s
r
matching contribution
The medical ofce’s accountant will give you the
federal deposit forms you will need to include with the
check.
The ofce’s accountant will calculate how much federal unemployment tax (FUTA) your employer must
pay. This tax is paid either quarterly (every 3 months)
or once a year. Most states also require employers to
pay a state unemployment tax. The accountant also will
calculate how much this state tax will be.
Study Skill
This chapter has many new terms related to
nances and money that may be new to you. This
would be a great time to make some ash cards to
study these terms so you are clear on the difference
between them. Students frequently get confused
about accounts receivable and accounts payable as
well as credits and debits. If you understand these
terms, you will be a great asset to the medical ofce
on your externship and into employment.
Chapter 13 Managing Medical Ofce Finances 255
Procedure 13-1 Posting Charges, Payments, and Adjustments
Purpose: To maintain proper accounting of all charges,
payments, and adjustments within the practice for management of the practice A/R (accounts receivable).
Equipment: Computer system equipped with medical
practice accounting software, current fee schedule, completed encounter forms, and current coding books (ICD,
CPT, and HCPCS).
1. Log into the practice accounting software and insure
that the current date appears on charge entry screen.
2. As patients checkout, verify that all billing and
insurance information was updated at check in.
3. Enter each procedure, using the appropriate code
for service, and charge (charges may automatically
appear if they have been loaded into the software
by procedure code).
4. Calculate patient’s responsibility and collect this
amount (or if collected at check in, insure that it is
applied to current charges).
5. Enter the payment type and payment amount using
appropriate payment codes. For example, a patient
paying cash for their copay might be entered at PPC
or patient payment cash. Each ofce will determine
the payment types and codes they will use.
6. Save the changes made to the patient’s account.
7. Offer the patient a receipt, print the receipt and
explain that the remaining balance will be sent to
insurance for processing. Be sure they understand
any remaining balance following insurance payment will be their responsibility.
8. Once payment is received from insurance, post the
payment (using the appropriate payment code)
using the EOB as your guide. Sometimes it’s helpful to highlight the nal payment amount for each
account in one color and the allowable fee or
adjustment (if already calculated for you) in a different color.
9. Calculate the amount of the adjustment (amount
charge − allowable fee). Enter this amount as an
adjustment to the account.
10. Bill for any remaining balance.
Procedure 13-2 Managing Accounts in Collection
Purpose: To ensure proper handling of accounts sent to
collections. Accounts should be adjusted when sent to
collections. Credit adjustments will need to be made as
payments are received from the collection agency.
Equipment: Computer with medical practice accounting software, collection agency data sheets and listing of
delinquent accounts.
1. Determine which accounts will be sent to the collection agency.
2. Adjust each account individually. Each account will
have an adjustment equal to the total balance being
sent to collection. Tag the account as Collections so
no new charges will be allowed.
3. Gather all necessary information from each
account, to include all billing information and the
amount of each account. Submit this information
to the collection agency.
4. As payments are received on a collection account, a
reverse or credit adjustment will need to be made.
The adjustment should only be for the amount of
the payment.
5. Once the reverse adjustment has been made and
the account shows a balance equal to the amount
of the payment. Post the payment as a collections
payment.
256 Section III Administrative Medical Assistant Skills
Procedure 13-3 Processing an NSF (Nonsufcient Funds) Check
Purpose: To document and charge the account of the
nonsufcient fund payment along with fees to insure
proper restitution of the account.
Equipment: Computer with medical practice accounting
software, NSF check, and posted signage of fees charged
for returned checks.
1. Upon receipt of the NSF check rst post the amount
of the check back to the appropriate account using
a reverse or credit adjustment.
2. Enter a charge for the returned check fee. This is
entered as a charge as it is a new fee to this account.
3. Contact the patient by phone notifying them of the
returned check and fees charged. Make arrangements for payment in full. Set a clear deadline.
4. If unable to reach the patient by phone, send them
a certied letter with return receipt explaining the
situation. Give a clear deadline as to when the payment is due in the ofce to avoid further action.
5. When payment is received (cash, debit, or credit
card only), post to the account as a payment. Note
that the payment is for NSF plus fees.
6. If payment is not received timely, the check can be
sent to the prosecuting attorney’s ofce in your area
for collection or your ofce can send the account to
a collection agency.
Procedure 13-4 Reconciling the Ofce Bank Statement
Purpose: To maintain the nancial well-being of the
ofce practice through proper management of the practice banking account.
Equipments: Bank statement, reconciliation worksheet,
checkbook ledger, ending balance of previous bank
statement, calculator, and pen.
5. Add the amount of all outstanding checks, and
record the total on the reconciliation form.
6. Compare all deposits listed on the bank statement
with those on the ledge. Please put a check mark by
each deposit that appears on both.
1. Compare the opening balance on current bank
statement with the closing balance of the previous
bank statement.
2. Check the bank statement for service fees, withdraws,
and automatic payments. Insure these all appear on
the ledger. If any are missing from the ledger, make
an entry notating the date and amount then subtract
from the ledger balance (this will be your current balance). Enter the current balance of the account, from
the checkbook ledger, on the reconciliation form.
3. Compare check entries on the bank statement with
the ledger. Please put a check mark by each cleared
check, and be sure to verify that check amounts are
the same.
4. Record any checks not cleared by the bank that
appear on the ledger (those without check marks).
7. Record any outstanding deposits that are listed on
the ledger, however, are not listed on the bank statements on the reconciliation form.
8. Total the outstanding deposits.
9. Add the total of outstanding checks to the starting
balance.
10. Subtract the total of any outstanding deposits from
the balance.
11. The balance on the reconciliation sheet should
match the balance on the bank statement.
12. If the balance do not match, double check your
you haven’t missed any fees, checks, or deposits.
Chapter 13 Managing Medical Ofce Finances 257
Preparing for Externship
While performing your externship, you need to overcome any personal challenges that may get in the way
of your success. Some students allow personal issues
to obstruct their path to completion of the externship.
Issues that may be the cause include not arranging
backup plans for transportation or child care. Prior
to starting your externship, decide the transportation required to get to the site and then think about a
backup plan if that transportation fails. For example,
if you drive a vehicle and have a at tire or dead battery, what will you do that day to get to the site? Ask
Chapter Recap
● The nancial health of a medical ofce is based on its
ability to collect the fees it charges.
● Credit arrangements, monthly billing, and attention
to the collection of aging accounts help keep ofce
nances running smoothly and efciently.
● Accurate posting of charges, payments, and
adjustments to patients’ accounts require attention
to detail.
● Checks should be immediately endorsed for deposit
into the ofce account.
family members for assistance if possible. What if you
have small children and the babysitter calls you in the
morning sick and unable to watch the children? What
do you do? Hopefully you have a backup plan for that
problem too. If you are unable to secure an alternate
plan for the problem, make sure you notify the site
right away and then call your school. Don’t give up
for the entire day. You may be able to nd a solution
to your problem in an hour or so and be able to get to
the site to complete the day. This solution will prove
to the site how serious you are about your externship.
● Patients should be informed of the approximate cost
of procedures prior to performing them.
● Always verify billing and insurance information prior
to each visit.
● W-4 forms should be obtained yearly for each
employee to insure proper taxes are withheld from
their earnings.
● Payments must be made to the IRS for employment
taxes at least monthly.
● Unemployment taxes must be paid quarterly or yearly.
Online Resources for Students
Resources for students available on thepoint.
lww.com include the following:
● Audio Glossary
● Animations
● Competency Evaluation Forms
Exercises and Activities
Certication Preparation Questions
1. The term debit in accounting means to:
a. add to an account balance.
b. subtract from an account balance.
c. adjust an account balance.
d. write off an account balance.
e. move the current balance forward.
● Harris CareTracker Case Studies
● Interactive Games & Activities
● Certication Preparation Question Bank
● Videos
2. The term credit in accounting means to:
a. add to an account balance.
b. subtract from an account balance.
c. adjust an account balance.
d. write off an account balance.
e. move the current balance forward.
258 Section III Administrative Medical Assistant Skills
3. The bookkeeping formula is:
a. previous balance + charges − payments = bal-
ance due.
b. charges + payments − adjustments = balance
due.
c. current balance + charges − payments − adjust-
ments = previous balance.
d. previous balance − payments − adjustments =
balance due.
e. previous balance + charges − payments −
adjustments = balance due.
4. Cycle billing means to:
a. divide active accounts into sections and bill
each section at different times throughout the
month.
b. bill all accounts on the 5th of each month.
c. rotate accounts each month so that accounts are
never billed on the same date.
d. divide active accounts and bill sections on differ-
ent days throughout the same week.
e. divide accounts by balance due and bill those
with the highest balance rst.
5. The proper steps to take when handling a check
that has been returned for nonsufcient funds:
a. wait for the patient to return to the ofce and
then discuss it.
b. notify the patient, post the amount of the
returned check as an adjustment in brackets, and
post the service fee as a charge on the patient’s
account.
c. notify the patient, post the amount of the
returned check and fees as a charge on the
patient’s account.
d. post the amount of the returned check as an
adjustment and post the service fee as a charge.
e. post the amount of the returned check and ser-
vice fee as an adjustment with brackets.
6. Accounts payable refers to money that is owed:
a. to the ofce from patient accounts.
b. by the ofce to patients only.
c. to the ofce from other businesses.
d. by the ofce to all creditors.
e. by the ofce to their employees only.
7. Accounts receivable refers to funds that are payable:
a. by the ofce for services received.
b. to the ofce from patient accounts.
c. from employee payroll for taxes.
d. by the ofce to patients.
e. to the ofce from the IRS.
8. Employees should complete this form at the
beginning of each year or when a change that will
affect the amount they want withheld for taxes
changes:
a. W-2 form
b. 1099 form
c. W-4 form
d. 1040 form
e. I-9 form
9. Which of these are the withholding taxes
that employers are required to withhold from
employees’ earnings?
a. FIT, FICA, and Medicare
b. FICA, Medicare, and unemployment
c. Medicare, FIT, and unemployment
d. FIT, FICA, and unemployment
e. FIT and FICA
10. An adjustment made on an account reects a:
a. decrease in the balance from a payment.
b. increase in the balance due to an error.
c. decrease in the balance without a payment.
d. increase in the balance due to a charge.
e. increase in the balance due to interest.
P
S
Y
CareTracker Connection
Managing the Finances of a Medical
Practice
CareTracker Activities Related to
This Chapter
Case Study 10: Entering Coding, Billing, and
r
Payment Information
Perhaps no service is more expensive or has a more
complicated payment process than health care. The
complexity of most health insurance plans and the sheer
volume of transactions that take place in most medical ofces make it a challenge to determine who owes
what, who has paid and who hasn’t, and what the current balance is for any given patient. This is another
area in which integrated practice management and electronic health record systems, such as CareTracker, can
make a medical assistant’s life much easier. Because of
this integration, diagnosis and procedure codes that are
entered into a patient’s health record can be automatically imported into the practice’s nancial applications,
making accurate and timely billing much more feasible.
Chapter 13 Managing Medical Ofce Finances 259
Tasks discussed in this chapter that can be performed
in CareTracker include the following:
Establishing and maintaining a fee schedule
r
Entering patient charges, manually and in bulk
r
Generating claims
r
Performing billing and collection procedures
r
Entering payments from patients and third parties
r
Posting adjustments
r
Processing credit balances
r
Reversing charges
r
Processing refunds
r
Managing overdue accounts
r
Performing accounts payable functions
r
A task we’ll consider here is entering bulk charges for
patients.
Throughout the day in a medical ofce, medical assistants capture patient visit information, including diagnosis and procedure codes and their associated fees, when
they enter these data into CareTracker. Typically, all visits on a given day are grouped together in a “batch,” so
that visits and charges may be processed in bulk rather
than individually. To generate claims for payment, all
visits in a given batch must be entered as charges in the
system. One way to access these visits is via the Practice
tab of the Dashboard application found in the Home
module in CareTracker, as shown below.
Under Visit in the Front Ofce column of the Practice
tab of the Dashboard, nd the Missing Encounters section.
Clicking on the word “Charges” will cause the
Missing Encounters screen to display. By entering
today’s date and clicking on Go, all of the visits that
have been captured that still have charges waiting to be
entered will appear.
260 Section III Administrative Medical Assistant Skills
Bulk charges are entered for all patient visits recorded
on the same day. In the example above, each of these
four visits is on a different date, so each will be entered
Clicking on the Go button on the left side of the
screen, next to Appt Date, causes the Bulk Charges
screen for this date to appear.
separately by clicking on the Charges button to the right
of the visit. Clicking on the Charges button causes the
screen below to appear.