2801 PR.02 Patient Account Collections in Clinical Practices

Revision Date: 
January 25, 2023


1.      Overview

2.      Internal Roles and Responsibilities

3.      Patient Account Collection Intake

4.      Running the Epic Cash Drawer Report

5.      Running the Daily Enterprise Cash Drawer Closing Detail Report

6.      Payment Storage

7.      Delivery of Deposits

8.      Verification of Daily Deposit

9.      Record Retention

1. Overview

This procedure supports Policy 2801 Depositing and Recording University Funds and describes the appropriate practices for patient account collections in clinical practices.  Yale Medicine (“YM”) clinical practices collect co-payments – payments for elective services, including any applicable Connecticut sales tax and pre-paid fees – at the time of service.  Additionally, attempts are made to collect any outstanding self-pay balances.  Clinical practices issue Epic generated receipts to patients who present payments at the time of service.  The practices store collected funds in a secure safe until remitted to YM’s Payment Processing office at 100 Church Street South, Suite D-100.

2. Internal Roles and Responsibilities

Clinical practices must clearly define the staff responsible for the following functions:



Collection of Funds

This can be the responsibility of any staff who check-in patients or schedule follow-up appointments.

This role collects payments from patients, verifies all applicable payment information is entered into the Epic Cash Drawer Module, and provides the patient with an Epic Cash Drawer receipt indicating the amount of the payment.

Deposit Preparation (“Preparer”) 

*The Preparer cannot be the same person as the Reviewer

The deposit Preparer validates the types of payments received and the amount for each patient where a payment was collected.

The Preparer is also responsible for running the Epic Cash Drawer report only after the Reviewer verifies all of the payments collected.  This report reconciles the patient receipts with the Cash Drawer. 

Review of Daily Deposits (“Reviewer”)

The Reviewer checks the Preparer’s payment batch on paper and the Preparer’s Cash Drawer screen.

Once reconciled, the Reviewer instructs the Preparer to complete the process of closing the Cash Drawer and the Reviewer runs the daily Enterprise Cash Drawer Closing Detail report and ensures the total payments collected agrees with the Epic Cash Drawer report.

Daily Deposit Reviewer and Preparer

The Reviewer must sign the daily Enterprise Cash Drawer Closing Detail report.  In addition, the Reviewer and Preparer must sign the Epic Cash Drawer report and retain a copy of both reports along with the payment receipts.

In addition, they must send this report with the entire deposit to the location specified in the row below.  Prior to the report and funds being sent, they must be safeguarded, as stated in Policy 2801 Depositing and Recording University Funds.

Daily Deposit Delivery to Safe or Courier

Practices located at 789 and 800 Howard Avenue must deliver their daily deposits to the Yale Physicians Building (800 Howard Ave) Lower Level hopper safe in room #80.  Two staff members must deliver the cash bag to the safe.

All other practices must deliver cash bags via courier to the Payment Processing Office at 100 Church Street South, Suite D-100.

Payment Processing Office Review      

The Payment Processing staff validates the Epic Cash Drawer report and daily Enterprise Cash Drawer Closing Detail reports and signs off that it is in balance.  They then return a signed copy of the Epic Enterprise Detail report to the clinical practice site – this is the practice’s copy to keep.  The clinical practice attaches the signed report to the batch and stores it for 1 year.  If reports do not match, Payment Processing contacts the clinical department Reviewer and Preparer to notify them that there is a discrepancy.  

Clinical Services Charge Reconciliation 

YM clinical department billing staff ensure that all billable services rendered to patients are accurately recorded in the system of record.

Missing charges are electronically sent to an Epic work queue and reviewed by Department billing office staff. 

Segregation of Duties:

The segregation of certain functions such as initiating, authorizing, recording, and reconciling transactions is essential for proper internal controls.  The amount of segregation possible within a clinical practice depends on the size and structure of the practice.  Clinical practice managers must ensure that one person does not have control over all parts of a transaction.

Specifically, a segregation of duties must exist between the following:

  • Collection of funds and/or Preparer of the Epic Cash Drawer report cannot be the Reviewer of daily Enterprise Cash Drawer Closing Detail report;
  • Preparer of daily Enterprise Cash Drawer Closing Detail report cannot be the deliverer of locked bag to courier or YPB hopper safe;
  • Collection of funds cannot have access to the patient’s encounter after the patient is seen by the physician;
  • Collection of funds cannot have access to Professional Billing charge capture in Epic;
  • Preparer or Reviewer cannot have access to the Professional Billing charge capture; and
  • Reviewer of daily Enterprise Cash Drawer Closing Detail report cannot have collection of funds roles.

Under extenuating circumstances, if the segregation of duties is not possible, other procedures must be developed that will reduce the risk associated with inadequately segregated duties.  These procedures must be approved by the Yale School of Medicine (“YSM”) Controller’s Office at ysmcontroller@yale.edu.

3. Patient Account Collection Intake

The clinical practices store patient payments and receipts in a secure location, consistent with Policy 2801 Depositing and Recording University Funds that states, “Cash items must be held in a locked, fireproof device until deposited. If receipts exceed $500 per day on a frequent basis, the device should also be immovable and other security measures should be taken.”  Access to the safe should be granted to no more than three individuals designated by the practice manager.

The types of payments collected are cash, personal check, money orders, travelers’ checks, and credit/debit cards.

When a patient presents for his/her appointment, clinical practice staff will attempt to collect copayments or prepaid fees.

In the event the Epic system is unavailable, a receipt should be manually prepared with the following information:

  • Date of service
  • Patient name
  • Epic MRN (Account Number)
  • Physician name
  • Clinical department name & Epic department
  • Name of person accepting payment
  • Amount of payment
  • Type of payment
  • Check number (if applicable) or last 4 digits of credit card (if applicable)

Cash (Currency or coins only) payments of $100 or above:

  • All cash payment receipts of $100 or above must be co-signed by another member of the practice staff.  The co-signer is stating that they have reviewed & matched cash payment with receipt, agreeing the name, date, and amount of cash.
  • All cash payments of $2,000 or above require two co-signers, one of whom witnesses placement of the payment in the safe.
  • For cash payments that exceed $5,000, call the Yale Police dispatch immediately at 432-4400 to arrange for pickup.  Practices must also inform the Payment Processing office of any large cash payment delivery by phone by calling 737-1858 or 785-5220.
  • Each clinical practice is required to report certain transactions involving more than $10,000 cash to the IRS and the Financial Crimes Enforcement Network on Form 8300.  For help contact 737-1858 or 785-5220.
    • If a clinical practice receives more than $10,000 in cash in one transaction or in two or more related transactions within any 12-month period, they must file Form 8300.
    • For purposes of Form 8300, cash is defined as U.S. and foreign coin and currency received in any transaction or a cashier’s check, money order, bank draft, or traveler’s check.  Cash does not include a check drawn on the payer’s own account, such as a personal check, regardless of the amount. 

Voided Receipts

Under certain circumstances, voided receipts are required – for example, if a staff member entered more or less than the amount the patient paid, or a wrong payment source was chosen.

  • To void a payment, the following is required:
    • voided amount
    • reason
    • comment – should include notation that the void was approved by the manager
  • If Credit Card (MasterCard, Discover, VISA, and American Express)/Debit Card is used, a credit transaction for the voided charge must be run on the credit card machine.  Provide the two-part receipt printed from the authorization machine to the patient for signature and have the patient sign the receipt.
  • Both the initial and voided patient receipts should be sent in the cash bag with that user’s Cash Drawer accompanied by the initial card charge slip and the credited credit card charge slip.

4. Running the Epic Cash Drawer Report

This report reconciles the patient receipts with the Cash Drawer.  It should be utilized as follows:

  • The Preparer goes to Cash Drawer: Epic> Tools> Billing Tools> Cash Drawer.
  • In the Cash table, they enter the number of bills and coins that have been physically counted.
  • In the “Other” table, any checks, credit cards, or other non-cash payments are entered.  Each payment type must be entered in the payment source field and the amount paid in the Amount field.
  • The Reviewer must review the Cash Drawer, payments, and receipts and instructs the Preparer to complete the process. 
  • Click the Select All button in the Match Drawer Contents to Posted Payments section.  (The difference between the payments posted in the system during the day and the cash you recorded appears in the Difference field).
  • In the report, the Preparer enters the cash bag number and in the comment field, enters who the batch was reviewed by. 
  • The Cash Drawer must be closed at the end of each business day.
  • Ensure “Print Report when drawer is closed” is checked, lower right-hand corner of screen.
  • Ensure Preparer selects either cash, check, or credit card, as payment source only.

5. Running the Daily Enterprise Cash Drawer Closing Detail Report

This report is used to ensure the total payments collected agrees with the Epic Cash Drawer report.  It should be utilized as follows:

  • The Reviewer selects “Reports” – select my reports- select Library box which is on the left-hand side of screen.
  • In the search library field at the top type in Cash and select search.
  • Select report name Enterprise Cash Drawer Closing Detail.
  • Go to the right of the report name and select new report – this is how you will create your report:
    • Enter from/to date when the Cash Drawer was closed.
    • Click on the Service area box under criteria, go to the search box criteria and enter service area.
    • Click on Cash Drawer box under criteria, go to enter search value and enter name of the:
      • person. (last name, first name) enter (a report can only be run on one user at a time). 
      • the report can be saved to be used daily or run at the bottom of the screen.
  • This report takes the place of the Transmittal form and needs to be included in the deposit bag.   The Reviewer checks this report and signs this report.
  • The practice retains a copy of the completed report.  The original report is sent to the Payment Processing Office at 100 Church Street South, Suite D-100 with payments and receipts attached in the locked cash bag.

6. Payment Storage

Cash/checks, and credit/debit card receipts are attached to the corresponding Enterprise reports.

Funds, receipts, and original Enterprise Reports are placed in safe.

Prior to courier pick up, all collected items are placed in a locked bag after it is reviewed and signed.  YM cash bags are kept in the safe until pick up.

The cash bag is to be logged out in the Log book (with the specific cash bag #) when it is picked up by courier or delivered to YPB safe daily.

The address card on the locked bag is reversed to show the practice location.

7. Delivery of Deposits

Practices located at 789 and 800 Howard Ave. deposit bags daily in the central hopper safe in the basement of the Yale Physicians Building for cashier with University Police Officer pick-up.  Two people must take down the locked bag to the safe.

For other on-campus practices which includes all New Haven locations, courier pickup (to YM) of cash bags are collected daily or on a schedule that patient volume dictates.

Any cash collected in the practices after the courier pick up is placed in the safe at the end of the day.

8. Verification of Daily Deposit

The Payment Processing Office returns the signed daily Enterprise Cash Drawer Closing Detail report to the clinical practice within 24 hours (or very shortly thereafter depending on the pickup schedule).

The clinical practice deposit Reviewer checks the Payment Processing signed copy of the report against the practice’s copy of the report to verify that the report was received and not altered after the deposit left the practice.  The clinical practice Reviewer signs the Payment Processing office’s signed copy as evidence that it agrees with the practice copy.  This reconciliation must be done the same business day that the report is received back from the Payment Processing Office.

If a report for a daily deposit is skipped, and clinical department staff have checked with the Payment Processing office on its receipt, report the missing deposit to the Campus police, Internal Audit and YSM Financial Operations.  The police and internal audit will follow up with the investigation.

Returned cash bags are to be scanned into the Cash Bag Access database system as received.  Any cash bags not returned back to clinical practice after 5 days need to be reported to Payment Processing immediately.

9. Record Retention

Practices maintain copies of the Enterprise report and accompanying receipts in the practice, filed by month, for 1 year.

After 1 year, all documentation is sent to Archives or stored according to the clinical practice’s procedures.

Records should be maintained in accordance with Policy 1105 Retention of University Financial Records.