How to View a Patient Reference Ledger

The Reference Ledger provides an alternative view of patient financial activity, organizing charges, payments, adjustments, and balances by a Reference Date tied to when services were delivered. 

By grouping charges, payments, discounts, write-offs, and refunds according to the treatment or visit they relate to, the Reference Ledger provides a clear view of patient balances and makes it easier to track how accounts have been reconciled over time.

To access the patient's Reference Ledger, from the Patient tab, select Financials > Reference Ledger. 

The Reference Ledger is separate from the standard Patient Ledger, which remains unchanged. The Reference Ledger is read-only; distribution and reference date changes can be made from the standard Patient Ledger. 

The Reference Ledger includes one row per Reference Date and Accounting Location and displays the amount charged, how much has been distributed/applied, and the amount that is still outstanding. The list is in descending order by Reference Date (i.e., most recent listed first).

Click on a Reference Date to view all of the transactions that are attributed to that date. 

Each transaction displays its full original amount and the portion that landed on this Reference Date, whether through payment distribution, an associated fallback date (i.e., Acceptance Date), or manually assigned Reference Date.

Tip: Click the blue arrow icon under the Actions column to jump to the transaction within the regular Patient Ledger. 

For example, you can use the arrow icon to navigate to a payment transaction and then distribute it to a provider or services. When a payment is applied, the applied part moves to the charge's date automatically. A Reference Date set on a payment only affects the part that is still unapplied.

Note: For multi-location practices, activity is split by date and Accounting Location. A payment taken at one location and applied to a charge at another appears under the charge’s location.

Reference Date rows are color coded, allowing you to see if the treatment / visit is fully reconciled at a glance:

• Red means that the transactions associated with the date are completely uncovered / unpaid for (there are no payments or credits applied).
• Green means the balance has been fully reconciled; the transactions associated with the date are completely covered / paid for (debits offset by credits).
• Yellow/amber means that the balance has been partially applied or paid. Any unapplied amount from a credit on a date also counts against that date’s balance, so a row can show a credit (negative) balance.

Reference Date Determination for Different Transaction Types 

The method used to set the Reference Date varies based on the transaction type: 

• Procedure-based charges always use the procedure's date of service. 
  Note: Users will be able to manually assign a Reference Date for procedure-based charges that deviate from the Service Date, when applicable, in a future update of Sensei Cloud.
• Payments, discounts and write-offs appear under the date of the charges they are applied to.
  Note: A payment split across two visits appears under both, and any amount not yet applied appears under the date it was received (i.e., the payment acceptance date).
• Fees and other non-procedure charges use their own service date unless a different Reference Date is set. 
• Refunds are treated like a charge and use their own service date unless a different Reference Date is set. They do not follow the payment that they refunded.

Note:

-- A payment taken on a different day from the visit shows on its own row until it is applied; once applied, it moves under the visit's date.
-- Unapplied money on a date counts against that date's charges in the row totals.

Tip: Select Show Audit View under the Filter Transactions to display all posted transactions, including those that are involved with removals or corrections.

Manually Updating a Reference Date

You can change a Reference Date using the Correct Information / Update Entry option when adjusting payments, adjustments, or non-procedure charges (e.g., fees) from the normal Patient Ledger. 

Note: You cannot currently update the Reference Date for procedure charges, but this is expected in a future update. 

To change the Reference date for a transaction: 

1. From the Patient Ledger, select the applicable transaction.
2. Select Adjust This [Transaction Type] (e.g., Payment). The Adjustment window is displayed.
   
3. Select Update Entry for cases where you are not updating other key information, namely the Amount, or select Correct Information if in addition to updating the Reference Date, you are updating the amount/payment type, etc. 
4. Update the Reference Date field.
   Note: 
   -- A Reference Date cannot be set in the future. 
   -- Clearing the Reference Date field returns the transaction to its default date.
5. Click Adjust [Transaction Type].