• Should statements wait for insurance to run its course? (Yes/No)
• Should pending insurance amounts be subtracted from amount due? (Yes/No)
• After how many days should responsibility pass from slow insurance payers to responsible party?
• What is the minimum number of days that should elapse between statements runs for any one responsible party?
• Print referring provider on statement instead of rendering provider? (Yes/No)
• Should charges sent to a collection agency be excluded from statement? (Yes/No)
• Statement message if insurance does respond within alotted time
• General statement message
• Billing questions phone numbers
• A series of settings indicating what credit card types are accepted.

As is apparent from these settings, the shift of responsibility from insurance to patient occurs automatically: either statements follow insurance results or they do not, and even if they do, only for so long; statements do not wait indefinitely for insurance. The statement does not dun the patient with increasingly severe messages depending on age of amounts due. For that, or for any other reason, special messages can be created for just one person, to print at the bottom of the statement, or even with individual lines of the statement, generally to provide additional information in special cases.

Statements can be run as often as daily, with no one recipient receiving a statement any more often than indicated by the minimum statement interval specified in the settings. When statements are printed as a batch the statement date and statement-reported amount due are added to a list under the patient's account. Users can therefore see the dates and amounts of all statements generated for a given account. 

Statement design can be hard to get right; there are tradeoffs in all directions. Because of the welter of information to be displayed, medical statements can be confusing. For instance, how is a statement simultaneously to show bulk payment amounts (covering multiple service lines) and individual payment application amounts toward specific service lines? Or how is a statement to show in one set of clear numbers for a given service line the totals charged, adjusted, paid and remaining--and, at the same time, show individual application amounts with their sources and types? If one is not careful a mix of bulk and per-application amounts can obscure the logic of the statement math.

We manage these issues by devoting one statement line to one procedure code, and, on that line, in separate columns, provide total charged, total adjusted, total paid, and total remaining. Then we provide another column, at the far right, naming the individual amounts, amount types, and parties who affected the balance of that line. This added column even lists the copay, coinsurance, deductible, and allowed amounts as indicated by one or more insurance payments. A listing of bulk payment amounts (not broken out by the lines to which they were applied), with check dates and sources prints on a statement supplement, separate from the statement itself, and printed only for individual cases. We cram a lot of information on the statement but without overworking it. Our practices have indicated few complaints and few calls from confused patients. Here is an example of the statement and the statement supplement.