Turn Charges Into a Scheme-Priced Invoice

Once a patient’s billable work has accrued as Open charges, the billing clerk gathers them into an invoice — the grouped bill presented for settlement. The invoice can be priced in more than one currency and, crucially, against a scheme (a payer’s tariff), so the same test or drug is priced the way that payer has agreed to pay for it. This page walks through assembling and issuing one.

Who / when: the billing clerk, after a patient’s charges have accrued (see Auto-Aggregate Consumed Services Into Charges). A charge is one billable line; an invoice groups charges for settlement; a scheme is a payer (such as an HMO — Health Maintenance Organisation — or the NHIS, the National Health Insurance Scheme) whose tariff sets the agreed price per service. A UHID is the patient’s permanent Unique Health Identifier. We’ll follow Amina, a billing clerk.

1. Amina (billing clerk) — opens Bill → Charge Capture and confirms the patient’s Open charges are present and correct (by UHID).
2. Amina — opens Bill → New Invoice and selects the patient. Their Open charges populate the invoice lines automatically.
3. Amina — chooses the currency and the applicable scheme so each line is priced against that scheme’s tariff. Payers are maintained on Bill → Payers and their tariffs on Bill → Tariffs; if the right scheme or price is missing, that is where it is set up.
4. Amina — reviews the line items. Each line carries its audit trail back to the clinical event that raised it, so she can confirm what is being billed and for how much.
5. Amina — issues the invoice. The patient’s balance rises and the invoice appears on Bill → Overview in the Unpaid state.

Note

Scheme pricing is the difference between a self-pay price and an insurer price. By choosing the payer scheme at this step, you make every line reflect that payer’s agreed tariff rather than the standard rate — which keeps the later claim clean.

Tip

To open the invoice’s detail later, click its row in Bill → Overview — there is no separate “invoice detail” tab. The detail view is also where the revenue-cycle adjustments live (void, credit note, estimates, payment plans), covered in Void, Credit, Estimate and Plan in the Revenue Cycle.

What happens next

The issued invoice is now ready to be settled or claimed. A cashier collects against it in Take a Payment, Deposit or Refund. If the patient has insurance cover, the covered portion is submitted to the payer — see Submit an HMO Claim and Post Remittance. For corrections and flexible arrangements, see Void, Credit, Estimate and Plan in the Revenue Cycle.

Follow the trail

• Previous: Auto-Aggregate Consumed Services Into Charges · Settle a Final Bill at Discharge
• Next: Take a Payment, Deposit or Refund · Submit an HMO Claim and Post Remittance
• Related: Void, Credit, Estimate and Plan in the Revenue Cycle · Produce the Final Bill on Discharge