Statement of account template for facility accounts: every invoice, payment, and balance on one page
Overview
A statement of account lists one customer's activity for a period: the opening balance, each invoice, each payment and credit, and the closing balance, with the unpaid amount split by how late it is. It reminds the customer what is open. It adds no new charges and never takes the place of the invoice, which is the document a payables office approves.
On this page
How to use this statement
A statement is the one-page picture of a customer’s account. The invoice template bills the rides, and this page shows where the account stands after those invoices and the payments against them. The guide to facility billing explains when to send one.
- Write one statement per customer account. A facility with twelve residents on your vans gets one page, and its lines are invoice numbers, not riders. A family on a standing series gets the same page with a line for each ride date.
- Build it from your ledger. Every figure comes from invoices and payments you have already recorded. If this month’s opening balance is not last month’s closing balance, find out why before sending anything.
- Put a person on the page. Print the name, phone, and email of whoever answers questions and takes payments, so a clerk with a mismatch calls someone instead of waiting.
- Attach it to follow-up. Each past-due letter goes out with the current statement, so the customer sees every open invoice and not only the one you wrote about.
The statement
Header
| Item | Entry |
|---|---|
| Company legal name and DBA | |
| Billing address, phone, and email | |
| Statement date | |
| Period covered | From (date) to (date) |
| Contact for questions and payments |
Customer and account
| Item | Entry |
|---|---|
| Customer name | |
| Account number or the customer’s vendor number | |
| Accounts payable contact and email | |
| Terms from the signed agreement (for example, net 30) |
Summary of the period
| Item | Amount |
|---|---|
| Opening balance | $ |
| Plus new invoices | $ |
| Minus payments received | $ |
| Minus credits | $ |
| Closing balance | $ |
Activity
One row for each invoice, payment, or credit, in date order, with the balance after each row.
| Date | Document | Charges | Payments and credits | Balance |
|---|---|---|---|---|
| Opening balance | $ | |||
| $ | ||||
| $ | ||||
| $ | ||||
| $ |
Balance by age
Count from the due date printed on each invoice. The five lines must add up to the closing balance.
| Age | Amount | Invoice numbers |
|---|---|---|
| Current (not yet due) | $ | |
| 1 to 30 days past due | $ | |
| 31 to 60 days past due | $ | |
| 61 to 90 days past due | $ | |
| Over 90 days past due | $ |
Payment slip
Print this at the foot of the page so a clerk can send it back with a check or attach it to a bank transfer.
| Item | Entry |
|---|---|
| Customer and account number | |
| Statement date | |
| Invoice numbers being paid | |
| Amount enclosed | $ |
| Check number or transfer reference | |
| Send to | Company name and billing address |
Footer text
- This statement summarizes the account. It does not add any charge. Every amount appears on an invoice you have received.
- If a line does not match your records, write the invoice number and reply with the problem within the number of days your agreement allows.
- A ride that Medicaid pays for goes to the program or broker and never appears on this statement.
An example, with made-up numbers
A senior living community pays net 30. On September 1 it owes two invoices: 1031 for $4,210.00 and 1036 for $1,905.00, so the opening balance is $6,115.00. Invoice 1036 is dated August 26 and due September 25.
| Date | Document | Charges | Payments and credits | Balance |
|---|---|---|---|---|
| Sept 1 | Opening balance (invoices 1031 and 1036) | $6,115.00 | ||
| Sept 8 | Payment, check 5518, for invoice 1031 | $4,210.00 | $1,905.00 | |
| Sept 15 | Invoice 1044, rides Sept 1 to 15 | $3,740.00 | $5,645.00 | |
| Sept 19 | Credit CM-07, late pickup on invoice 1044 | $85.00 | $5,560.00 | |
| Sept 30 | Invoice 1052, rides Sept 16 to 30 | $4,120.00 | $9,680.00 |
The summary reads: opening balance $6,115.00, plus invoices of $7,860.00, minus a payment of $4,210.00, minus a credit of $85.00, for a closing balance of $9,680.00. On September 30, invoice 1036 is five days past due, and invoices 1044 and 1052 are not yet due.
| Age | Amount | Invoice numbers |
|---|---|---|
| Current (not yet due) | $7,775.00 | 1044 (after the credit, $3,655.00), 1052 ($4,120.00) |
| 1 to 30 days past due | $1,905.00 | 1036 |
| 31 to 60 days past due | $0.00 | |
| 61 to 90 days past due | $0.00 | |
| Over 90 days past due | $0.00 |
The ages add up to $9,680.00, matching the closing balance. The account has one overdue invoice and no old ones, so the statement goes out as a reminder and needs no letter yet.
What a statement cannot do
A statement is a summary of invoices already sent, and it has three limits.
- It cannot replace the invoice. A federal buyer pays against a proper invoice, and 5 CFR 1315.9(b) lists what one carries: the vendor’s name, the invoice date, the contract number or other authorization, an invoice number, a description with price and quantity, taxpayer ID and banking information unless agency procedures say otherwise, and a contact. A statement sums up several invoices and usually leaves out the contract number and the description, price, and quantity for each ride, so send the invoice itself and use the statement as a reminder.
- It cannot add a charge or a term. A late fee, a rate, or a payment term that first appears on a statement will be disputed. The fee belongs in the signed facility agreement first, and the invoice template makes the same point about invoices.
- It cannot carry clinical detail. For a family payer, share only what relates to their role in the rider’s care or its payment. Use account numbers and first names, and leave diagnoses and Medicaid IDs off.
When your balance and the customer’s do not match
A mismatch usually traces to one of four things: an invoice the customer never received, an invoice waiting in an approval queue, a payment in transit, or a line the customer disputes. The activity rows let a clerk find which one quickly.
- Ask the customer to reply with the invoice numbers it cannot match, in writing.
- Resend those invoices, not the statement, and note the date and the address you sent them to.
- Record a payment the day it arrives, and apply it to the invoices named on its payment slip or in the customer’s payment notice. The guide on how facilities pay invoices covers matching deposits to invoices.
- For a disputed line, credit it only after you agree the ride was short or late, and show the credit on the next statement with its own number.
The accounts receivable guide covers the follow-up rhythm once an invoice is truly late.
Statements in HealthRide
In HealthRide, a facility invoice builds itself from completed trips, priced from that facility’s rates, and goes out as a secure link with a pay-online button. Each payment, whether card, check, or cash, is matched to the invoice it settles, and the past-due list shows which facilities to follow up with. That puts the invoices and payments a statement lists in one place. See invoicing and payments.
Frequently asked questions
- Does a statement of account replace the invoice?
- No. An invoice bills a stated set of rides, and it is what the customer's payables office approves. A statement summarizes the account over time: every invoice, payment, and credit with a running balance. That makes it a reminder and a reconciliation tool, so a customer still pays against invoices and uses the statement to check that both sides agree.
- How often should I send a statement?
- Send one a month, on the same day, to each customer with an open balance, and attach one to every past-due letter. Close the month first: post every payment, credit, and corrected invoice so the closing balance matches your ledger. A customer with no balance and no activity does not need one.
- How should the unpaid balance be aged on a statement?
- Count the days past due from the due date printed on each invoice, and use the same count for every account. A common set of columns is current (not yet due), 1 to 30 days past due, 31 to 60, 61 to 90, and over 90. The columns must add up to the closing balance, or the statement is wrong before it is sent.
- Can a statement include Medicaid or broker rides?
- No. When Medicaid covers a ride, the provider takes the state's payment, plus any cost sharing the plan charges the member, as the whole amount (42 CFR 447.15), so the ride is billed to the program or the broker. A statement lists only what a facility or private payer owes your company directly under your own agreement or booking.
- How much should a statement show a family member who pays?
- Dates, a trip reference, and the amounts, and nothing clinical. Where HIPAA covers your company, 45 CFR 164.510(b) lets a covered entity share with a family member the protected health information directly relevant to that person's involvement in the rider's care or payment for it, when the rider agrees or does not object. A statement stays inside that line when it uses the rider's first name or an account number instead of a diagnosis or a Medicaid ID.
- How long should I keep statements?
- File each one with the invoices and payments it summarizes. The IRS gives 3 years after the return is filed as the usual period for income tax records, and 7 years when a bad debt deduction is claimed. A facility agreement or a broker contract can require longer, so use the longest period that applies.
