Billing a patient with insurance coverage

When you bill a patient who has insurance coverage registered in Usystems, the invoice automatically captures which portion of the bill is the insurance company's responsibility and which is the patient's. This separation makes it easy to track claims and patient payments separately.

Before you start

• The patient must have an active insurance plan registered in their record (see "Assigning insurance coverage to a patient").
• You need permission to create invoices (typically: billing staff or administrator).
• The services or products being billed must be set up in the system.
• Know the service dates and the patient's cost-share amount (copay, deductible, or coinsurance), if any.

Steps

1. Go to Invoices → New Invoice. Open in Usystems

2. Select the patient as the customer.

3. The system will automatically populate the patient's registered insurance information.

4. Add the services or products provided, with their quantities and rates.

5. Review the line-item amounts. The system will display the insurance-eligible portion and any patient copay or deductible.

6. If the insurance covers only part of a service, the system will show the split: e.g., "Insurance: 80%, Patient: 20%."

7. Enter any patient-only charges (not covered by insurance) on separate line items marked as "Patient responsibility."

8. Add any patient copay, deductible, or coinsurance amounts as separate line items.

9. Review the invoice summary, which will show the total owed by the insurance company and the total owed by the patient.

10. Save and finalize the invoice.

The system will create separate records for the insurance claim and the patient's bill, making it easy to send the claim to the insurance company and track the patient's payment separately.

Accounting impact

• Insurance charges are recorded as a receivable from the insurance company (Asset: Insurance Receivable, typically under Accounts Receivable).
• Patient charges are recorded as a receivable from the patient (Asset: Accounts Receivable – Patients).
• Copays and deductibles may be collected immediately from the patient or deferred depending on your clinic's policy.

Tips & common mistakes

• Verify coverage limits before billing: some insurance plans have annual limits, exclusions, or waiting periods. Confirm with the insurance company or policy document before billing a large service.
• Don't assume the patient knows their cost-share: communicate clearly with the patient about how much they will owe after insurance processes the claim.
• Update insurance deductibles if they reset: many plans reset deductibles at the start of the year. Update the patient's record to reflect the current deductible.
• Keep documentation of coverage: attach or reference the insurance policy or EOB (Explanation of Benefits) to each invoice for easy reconciliation when the claim is paid.