Overview

The Account Ledger displays all financial activity for a client in one place, including charges, payments, adjustments, refunds, and balances.

Use the Account Ledger to review transaction history, track outstanding balances, and perform billing actions. It provides a summary of totals and a detailed, three-level view by encounter, service code, and transaction. You can also filter encounters by note status, focus on open balances, and take actions such as adding transactions, issuing refunds, reversing adjustments, transferring balances, and sending charges to collections.

Navigation

1. Go to the client’s Chart Face.
2. Click Account.
3. Locate the Account Ledger panel.

When Entries Appear in the Account Ledger

Account Ledger Summary (Collapsed View)

The Account Ledger panel displays key financial totals without expanding:

• Charges – Total billed amount for all encounters
• Paid – Total amount received from client and insurance
• Adjusted – Total amount written off or adjusted
• Client Balance – Amount owed by the client
• Insurance Balance – Amount expected from insurance
• Total Balance – Combined outstanding balance

Expanded Account Ledger View

When expanded, the Account Ledger displays detailed information organized into three layers, along with a Note Status filter.

Note Status Filter

Use the Note Status dropdown to filter encounters:

• Signed – Displays finalized notes ready for billing
• In Progress – Displays notes that are not yet completed
• Finished – Displays compiled notes not yet signed
  

By default, only the signed notes appear in the list. You can select In Progress or Finished notes from the dropdown.

Layer 1: Encounter Details

This layer provides a summary at the encounter level:

• Encounter – Date of service for the visit
• Clinician – Provider who rendered the service
• Note Status – Current status of the clinical note
• Charges – Total charges for the encounter
• Paid – Total payments applied to the encounter
• Adjustment – Total adjustments applied to the encounter
• Client Balance – Remaining amount owed by the client
• Insurance Balance – Remaining amount expected from insurance
• Total Balance – Combined outstanding balance for the encounter
• Billing Notes – Notes added by users when working on the claim

Layer 2: Service Code Details

Each encounter expands to show service-level details:

• Service Code – Procedure or billing code used for the service
• Charges – Amount billed for the specific service
• Paid – Payments applied to the service
• Adjustment – Adjustments applied to the service
• Client Balance – Remaining client responsibility for the service
• Insurance Balance – Remaining insurance responsibility for the service
• Total Balance – Total outstanding balance for the service

Layer 3: Transaction Details

Displays all financial transactions related to the encounter, including payments, adjustments, refunds, patient responsibility transactions, and denial transactions.

• Date – Date the transaction was recorded
• Payer – Entity making the payment (client or insurance)
• Type – Indicates whether it is primary insurance or client payment
• Source – Payment method or origin (e.g., cash, check, electronic)
• Reference Number – Identifier for the transaction (if available)
• Amount – Transaction amount
• Adjustment Code – Displays the adjustment or denial reason code associated with the transaction (for example, PR-45 or CO-29).

• Add Transaction – Record payments or adjustments
• Detail – View full transaction details
• Refund – Issue a full or partial refund of insurance or client payment
  
• Reverse - Reverse the insurance or client adjustement

Open Balances Toggle

Use the Open Balances toggle:

• When turned Off – Displays all transactions, including zero balance
• When turned On – Displays only outstanding balances
  

When toggle is turned off – Displays all transactions and balances, including zero balance

Actions Available in the Account Ledger (Layer 1)

Send Charges to Collections

• Select one or more encounters using checkboxes
• Use the action bar at the bottom
• Click Send to Collections
  

View Payment Breakdown

• Click the info icon in the Paid column
• View:
  • Client Paid
  • Insurance Paid
  • Total Paid
    

View Adjustment Breakdown

• Click the info icon in the Adjustment column
• View:
  • Client Adjusted
  • Insurance Adjusted
  • Total Adjusted
    

Add or View Billing Notes

• Use the billing note icon at the encounter level
• Notes entered here:
  • Are visible in billing and payment worklists
  • Sync across ledger and worklists
    

View Notifications

Icons indicate important events:

• Claim submitted (with date)
• Invoice generated
  

Actions Available in the Account Ledger (Layer 2)

Transfer Balance

• Available in Layer 2 under the Client Balance column
• Allows adjustment of the client balance
• Updates the insurance balance accordingly
  

Visual Indicators

• Outstanding balances appear in red for quick identification in layer 1 and layer 2.
  

Actions Available in the Account Ledger (Layer 3)

Refund Payment

Use the Refund option to return a payment to the insurance or the client. This option is available for both insurance and client payments.

To issue a refund:

1. Click Refund.
2. Enter the refund amount.
3. Click Refund Payment to complete the action.

Reverse Adjustment

Use the Reverse option to undo an adjustment applied to insurance or client balances. This option is available for both insurance and client adjustments.

To reverse an adjustment:

1. Click Reverse.
2. Enter the reversal amount.
3. Click Reverse Adjustment to complete the action. 

Move Payment to Unapplied 

Use the Details option to manage how a payment is applied.

From the Details view, you can:

• View encounters associated with the payment.
• Move applied amounts back to unapplied, if needed.
• Update the Posted Date, if needed.
  

Freeze Account

You can freeze an account to prevent any further billing activity, including adding charges, payments, or adjustments. This is useful when an account is under review or should no longer be modified.

When an account is frozen, the Account Ledger becomes read-only, and no financial transactions can be created or updated.

A confirmation toast message appears after the account is frozen, as shown in the screen below.

Unfreeze Account

You can unfreeze an account when you need to resume billing activity. Once unfrozen, you can add or update charges, payments, and adjustments in the Account Ledger.

When you unfreeze an account, a toast message appears, as shown in the screen below.

For detailed steps and considerations, see Freezing a Client's Account knowledge base aricle.

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