Medical office accounting software is the practice's billing books, and it is easy to confuse with three other things: the general ledger the accountant keeps, the practice management suite that charts and schedules, and the billing product that sends the claims. The billing books sit between them: every charge billed, every remittance posted against its claim with the contractual adjustment and the patient share, every patient balance, every write-off with its reason, and the month's totals the accountant's ledger is built from. This page sets out what the billing books hold, how they reconcile to the bank and to the ledger, what the month-end close looks like for a small practice, and what the claims register on this site keeps toward it.
What the billing books hold
Charges by date of service and provider; payments by payer and by patient, each posted against the claim it paid; contractual adjustments per line; write-offs with a reason, bad debt and courtesy and timely-filing separately; patient balances and the statements sent; and refunds to payers and patients. Every entry ties to a claim on the register, which is what makes the books auditable: a payment with no claim behind it is the entry an auditor asks about first.
Reconciling to the bank and to the ledger
Each remittance posted in the books equals a deposit in the bank, and the month's postings equal the month's deposits; a difference is an unposted remittance or a deposit nobody recognized. The month's charges, payments, adjustments and write-offs then go to the accountant's ledger as totals by category, not claim by claim, and the ledger's accounts receivable equals the register's outstanding balance. The claims cycle worksheet on this site takes those month totals and returns the collection rates and days in A/R.
The month-end close for a small practice
Every remittance received in the month posted line by line, which the EOB reconciliation worksheet here works for one line. Every denial in the month recorded with its code. Patient statements run from the balances. The write-offs approved by the owner with the reasons. The bank reconciled to the postings. The totals exported to the accountant. A practice that closes this way every month has its year-end figures on the first of the month; one that does not reconstructs them in March.
What the register keeps toward it, and what it does not do
Eobify Pro keeps the claims register with the posted EOBs, the adjustments, the denials and the patient balances, and exports the month's totals under the practice's name; it is the billing books' claim-level half. It is not the general ledger, does not run payroll and does not file the practice's tax return, which stay with the accountant. The claim form's field list, in the NUCC instruction manual, is the shape every charge in the books started as.
A remittance posted, and the entries it makes
One 835 arrives covering nine claims and a deposit of $2,840. For each claim line the books record the allowed amount, the contractual adjustment as the difference from the charge, the payer's payment, and the patient's share as deductible, coinsurance or copay. Two lines carry CO 16 with zero payment; they are recorded as denied with their remark codes and nothing is adjusted. One line carries a PR 96; its amount moves to the patient's balance with the advance notice on file noted. The nine claims' payments add to $2,840, which is the deposit, and the remittance is closed. The EOB reconciliation worksheet on this site is that arithmetic for one line; the books are it for every line, every day, tied to the deposit it produced.
Refunds, recoupments and the entries nobody likes
A payer that paid twice takes the second payment back from a later remittance as a recoupment, and the books have to show both the original payment and the reversal against the right claim, or the later remittance will not balance to its deposit. A patient who overpaid a copay is refunded, and the refund is an entry against the visit, not a negative payment. A payer that reprocesses a claim at a different allowed amount produces an adjustment to an adjustment. Each of these is a line with a reason, and each is where a practice's books drift from the bank when they are done as a lump. The register keeps them against the claim, dated, so the accountant's question in April has an answer in the record.
Write-offs: who approves them, and why the reasons are kept apart
A contractual adjustment is not a write-off; it is the contract. The write-offs are the rest: a claim that met the filing limit unworked, a balance the practice forgave, a patient account sent to collections and closed, a small balance not worth a statement. Each carries a reason and an approver, because they mean different things: timely-filing write-offs are a billing failure the denial queue should have prevented, courtesy adjustments are a policy, bad debt is a collections decision. A month's write-offs read by reason are the practice's own audit, and books that keep one write-off account cannot produce it.
Questions people ask about medical office accounting software
Is medical office accounting software the same as the practice's accounting system?
No. The billing books hold the claim-level postings, balances and write-offs; the accounting system holds the general ledger built from their monthly totals. The two reconcile at month end.
How does a remittance reconcile to the bank?
Each remittance's total posted against its claims equals the deposit it produced. The month's postings equal the month's deposits, and a difference is either an unposted remittance or an unrecognised deposit.
What write-off reasons should the books keep separately?
Contractual adjustments from the EOB, timely-filing write-offs, courtesy adjustments and bad debt, each with a reason and an approver, because they mean different things about the practice's billing.
What goes to the accountant each month?
The totals: charges, payments by payer and patient, contractual adjustments, write-offs by reason, refunds and the outstanding balance, exported from the register rather than retyped.