How to Use The Ledger
- Dylan Nigh
The Ledger is a record of all financial transactions for a patient, including charges, payments, and insurance claim statuses.
This guide is designed to give you a basic overview of the functionality in the Ledger. We'll cover posting charges and payments, creating and managing claims, posting insurance payments, and other useful tools to give you more precise control over your patient's ledger. We'll also talk a little about where the Ledger pulls information in MacPractice.
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Ledger Overview
First, we'll review the most important elements of the Ledger window. We'll cover the most important elements and what they're used for.
LedgerÂ
The center of the window is devoted to the Ledger itself. The Ledger will display whatever is selected in the Ledger Sidebar. Depending on the View Options set, this will display charges, payments, claims, adjustments, comments, and any clinical items you have set to view.Â
Ledger items are color-coded. You can review and adjust the color coding by navigating to the References Ability > Ledger Colors.
With a line item selected, MacPractice will highlight in yellow all items that are connected to it. For example, if a payment has been applied to a charge, if you select either the payment or the charge, the other item will be highlighted.
Ledger SidebarÂ
Also referred to as the Incident Sidebar. In the Ledger Sidebar you can navigate between Treatment Plans, the Account Ledger, or the patient's Incidents, denoted by the folder icon. Each Incident can contain Transactions, which is the ledger view seen in the screenshot above, and/or Treatment Plans, which allow you to create a set of charges that don't impact the Account Balance until you move them into Transactions.
Drop down Menus
Incidents Drop Down Menu:Â This menu, located immediately above the Ledger Sidebar, can be used to create and manage Incidents and Treatment Plans.
Charges Drop Down Menu: This menu allows you to post new charges, and to reverse charges from Transactions to a Treatment Plan, or move Treatment Plan charges to Transactions.
Payments Drop Down Menu:Â This menu allows you to post patient payments, insurance payments, and custom payment types designated in the References Ability > Payment Types.
Other Drop Down Menu:Â This menu contains many options, such as the ability to post adjustments, comments, and refunds. You can also manually set the status of a claim and export an incident's ledger into an Excel file.
Print Drop Down Menu:Â This menu allows you to create insurance claims. It also allows you to print a variety of items, most importantly Incident and Account Statements, and also Treatment Plans, Predeterminations, Inventory Receipts, etc.
View Options Drop Down Menu: This menu allows you to customize what items are visible on the Ledger window. You can filter the options to only include specific items, and also customize what clinical items will appear in the ledger.
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Ledger Balance TableÂ
At the bottom of the ledger window, you'll see the Ledger Balance Table. This section will display the Patient Portion and Insurance Portion balance, and what portions are due since 0-30 days, 31-60 days, etc. This allows you to note the status of the Account in a quick glance.
Posting Charges
New charges are entered by clicking on the Charges drop down menu and selecting New Charges. This will bring up the Charge Window.
There's a lot to this window, but we'll cover just the basics. For a complete overview of each element of the Charge Window, please refer to our Charge Window At a Glance - Interactive article.
First, you'll want to ensure the correct Fee Schedule is selected in the upper left hand corner of the Charge Window. All of your pre-set procedure codes pull from References > Fee Schedules, so if a code you're looking for is missing, that would be the first place to look.
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Next, you'll want to enter one of your Procedure codes into the Code field. You can either type in the Code, or you can click the search icon to bring up a search box.Â
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The Provider and Office fields will pull automatically from first the Code in the Fee Schedule if one is set, and if not it will pull from the Patient Tab in the Patient Ability. These fields are required. Be sure to review they are accurate before continuing on!
In the lower left of the Charge Window, you can also add Diagnosis codes to the charge by clicking the Diagnosis tab. You can either type in the diagnosis code into the prompts, or click the search button to pull up a search window.
If any information is missed when entering charges, it’s always possible to go back and edit existing Charges by double-clicking the charge in the Ledger Window. Be aware that any changes made will not be reflected on claims that have already been submitted.
Once you have completed entering in the Charge information, click on the Save button in the lower right to save the Charge to the Ledger.Â
Posting Patient Payments
To post a Patient Payment, click on the Payments Drop Down Menu, and select the appropriate Patient Payment type. This will bring up the Payment window. In this article we'll cover the basics of how to use this window.
For a complete overview of all elements, please refer to our Payment Window At A Glance - Interactive article.
Patient Payments can be posted with or without a Charge, but if there is no Charge available, you cannot apply a payment, as there is no item to apply the payment to.
Any Charges with a remaining balance will be present as an option in the Payment table. Select the appropriate charge and enter the amount from the Payment that should be applied to the charge in the "Payment" column.
Alternatively, you can leave the Payment fields blank and save the payment without applying it to any charges. This is useful if you wish to have a credit on the account that can be applied to future procedures.
You can use the "Apply to Selection" button if you wish to apply the full amount to a selected Charge. Â
If no Charges are selected, the "Apply to All" button will apply the Payment to every charge listed starting at the top and going down until the full amount is applied or until all of the charges have been covered. Any remainder will remain unapplied.
Unapplying Payments
If a payment is applied to a charge and needs to be unapplied, you can unapply the payment by clicking on  the payment in the Ledger, then select "Unapply Selected Payment" in the Other Drop Down Menu. This will retract any amount of the payment that has been applied.
The payment should now appear in red on the ledger if the colors are still set to default.
If you need to partially unapply the payment, you can double click the payment line item to re-open the Payment Window, and then manually adjust the Payment column entry for the appropriate Charge to the desired amount.
Creating Insurance Claims
Insurance Claims may be created for Charges that have been posted to a patient's Ledger. In order to create an Insurance Claim, the account must have an insurance company added to their Primary/Secondary tab on the Patients Ability, and it must be enabled on the selected patient in the Patient tab of the Patients Ability.
For more information on adding Insurance, please refer to our Primary & Secondary Tab - Insurance and Patient Tab - Insurance articles.
To create a claim for a set of Charges, select the Charges that you wish to include on the claim and click on the "Print" drop down menu. Select the "Create Insurance Claim" option. This will bring up the Claim Creation window.
The top part of the Claim Creation Window will display a line item for each claim that will be generated. Sometimes, if each Charge has a different provider/facility/lab, Claims will be split to accurately submit the appropriate information for each Charge. Insurance information will pull from the Primary/Secondary tab and the Patient tab of the Patients Ability.
The "Insurance Carrier"Â field will determine the insurance company listed on the Claim, with the "Other Insurance" field will list the other insurance on the claim as well.
The "Form / Template" field will determine what form the insurance claim will be printed on. If you have eClaims active on your license, you can also choose to submit this claim as an eClaim here. If the form you wish to use is not present, you can search through the available forms in References > Forms.
The "Accept" checkbox is to determine whether benefits being assigned to the provider will be accepted.
The "Secondary" checkbox determines whether this is a claim submitted to secondary insurance or the primary insurance.
The bottom part of the Claim Creation Window lists all the charges to be included on the claim.
Once you've reviewed all the fields, clicking "OK" in the lower right will create the claim and prompt you to print off the claim. Before printing, we advise that you click on the "PDF" drop down in the lower left and select "Open PDF in Preview". This will open up a digital copy of the claim form which you can review and print once you are satisfied with the results.
If you ever need to refer to a previously printed claim, you can double click the line item in the Ledger to bring up a preview of the claim.
For more information on the Claim Creation Window, please refer to our Claim Creation Window  article.
Posting Insurance Payments
Once the Insurance Company has paid the claim, you will need to post an Insurance Payment. Posting Insurance Payments is very similar to posting a Patient Payment. You will need to select "New Insurance Payment" from the Payments Drop Down Menu in the Ledger, after clicking on the claim this payment is for.
The Check # and the Amount of the check will be entered here at the top left of the window, and can then be applied to each charge listed by typing into the Payment column fields for the appropriate Charges.
You should review the "Payment From" menu to ensure the Insurance Company that issued the payment is correct.
You can also select a specific "Incident" or "Outstanding Claim" from here, if you hadn't selected the claim before posting the payment.
The Allowed column is where the total amount that insurance has agreed to pay is entered.
The Write-Off is the contractual write off agreed upon with the Insurance Company for In-Network Providers, This is typically the difference between the Allowed Amount and the Fee Amount.
Any remaining charge fee remaining after the insurance payment is applied is shifted over to the Patient Portion if all Insurance Claims have been paid for the charge.Â
Issuing Refunds
To issue a refund, you must first unapply the portion of the payment that is to be refunded. (See: Unapplying Payments) in order to be refunded. Once the payment portion is unapplied, simply select the payment line item and then select "Refund" from the Other Drop Down Menu.
The contents of the Refund Reference # field will be displayed next to the refund line item on the ledger. Many offices use the Reference # as an explanation field to determine the reason of the refund.
The "By Credit Card" checkbox is used in conjunction with AuthPayX. If this is checked and the payment being refunded was a credit card payment processed by AuthPayX, this will refund that credit card via AuthPayX. If you do not have AuthPayX enabled, this checkbox is only for reference.
If you are refunding an Insurance Payment, there will be two additional options available:
Refund Credit to Provider will allow you to assign the unapplied refunded portion of an insurance payment to a specific Provider. By checking this box, a list of your Providers will appear, where you can then apply that refund to be credited to that provider. This is used in situations when there might be an Insurance Overpayment.
Refund Credit to Patient will create a Negative Adjustment to provide a credit on the patient account which can be then applied to any open Charge.
If an Insurance refund goes back to the insurance company, neither box needs to be checked.
Printing Statements
When you create a claim, you can use the Claim Creation Window to print off a Statement by checking the "Print Statement" option at the top of the window, then selecting the statement form you wish to use. This is useful if you tend to print off a statement immediately after entering the charge and payment and creating the claim.
Otherwise, you can use the Print Drop Down Menu in the Ledger to print off a statement. You have several options available within the Print Menu.
Print Incident Statement:Â An Incident Statement will print all items that are listed within the current Incident in the Ledger if no ledger items are selected.
If ledger items are selected, an Incident Statement will print only those selected ledger items. If you only want to give a patient a statement with the charges and payments they care about, this is an excellent option.Print Account Statements:Â An Account Statement will display all ledger items on the Account, dependent on the date range set in Preferences > Statements > Statement Printing.
Print Today’s Transactions: This option will print off all transactions that occurred on this day.
Print Patient Payment: This will print all patient payments posted on this Account. You can choose what date range you wish to print.
You can customize facets of how Statements appear by adjusting Preferences, most of which can be found in Preferences > Statements. For more information on all the Preferences that can impact Statements, please refer to our Statement Preferences article.
For printing Statements for all Accounts, please refer to our How To Set Up And Use Statements Manager article.Â
Positive And Negative Adjustments
Adjustments allow you to manually adjust the balance of an Account without affecting deposits or production. Â This can be useful in situations where you want to provide a discount to services rendered, or assign a late fee to a particular account, or several other reasons.Â
A Negative Adjustment subtracts from the total being charged to a patient. A Positive Adjustment will add a higher amount to the patient’s charge.
To post either a Positive or a Negative Adjustment, click on the Other Drop Down Menu and select the desired  Adjustment.
Posting Positive Adjustments require having a Charge selected. The Positive Adjustment will "create a space" in the Charge by the amount of the Adjustment, so you can apply payments to that adjustment.
Negative Adjustments don't require having a Charge selected, and they are handled very similarly to payments. You enter the amount, and then you can choose to apply the adjustment to any open charges.Â
We strongly encourage that you utilize Adjustment Types to broadly define what each Adjustment is for. You can add Adjustment Types on the fly by typing into the Adjustment Type prompt, or you can use the drop down menu to select a previously used Adjustment Type. Using Adjustment Types will also allow you to filter your reports by that Adjustment Type. This will make tracking Adjustments much easier.
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