Professional Medical Professional Invoice Template

A compliant medical invoice must include specific information required by regulations and insurance companies while being clear to patients.

• Practice name, address, and contact information
• Provider NPI (National Provider Identifier)
• Tax ID or EIN
• State license number
• Patient name and date of birth
• Patient account number
• Date(s) of service
• Place of service code
• CPT/HCPCS procedure codes
• ICD-10 diagnosis codes
• Number of units per service
• Charge amount per service
• Insurance information (if billing patient)
• Amount billed to insurance
• Patient responsibility (copay, deductible)
• Payment due date and options

Follow these proven practices to ensure compliance, reduce claim denials, and maintain healthy cash flow.

• 1Verify insurance eligibility before appointments
• 2Use correct and current CPT/ICD-10 codes
• 3Bill insurance within filing deadlines
• 4Clearly explain patient financial responsibility
• 5Collect copays at time of service
• 6Send patient statements within 48 hours of EOB
• 7Implement a consistent billing cycle
• 8Follow up on unpaid claims within 30 days
• 9Document all services with clinical notes
• 10Offer payment plans for large balances
• 11Keep billing and clinical records separate
• 12Review claims for errors before submission
• 13Stay current on billing code updates

Medical pricing is typically based on established fee schedules, Medicare rates, and market considerations.

• Office visit (new patient): $150-$300
• Office visit (established): $75-$175
• Specialist consultation: $200-$500
• Therapy session (45-60 min): $100-$250
• Physical therapy: $75-$150 per session
• Lab work: $50-$200+ depending on tests
• Imaging: $100-$1,000+ depending on type
• Minor procedures: $200-$1,000
• Medicare benchmark: 100-120% of Medicare rate
• Private pay discount: 20-40% off standard fees
• Sliding scale based on income (if applicable)

Clear payment terms help manage patient expectations while maintaining compliance with regulations.

• Insurance: File within payer-specific deadlines
• Patient copay: Due at time of service
• Patient balance: Net 30 after insurance processes
• Self-pay patients: Due at service or Net 15
• Payment plans: For balances over $500
• Interest: Check state laws before applying
• Collections: After 90-120 days, multiple contacts
• Good faith estimates: Required for uninsured (No Surprises Act)
• Accept multiple payment methods
• Consider patient financing options

Avoid these common billing errors that can lead to compliance issues, claim denials, and lost revenue.

• ✕Using outdated CPT or ICD-10 codes
• ✕Failing to verify insurance before service
• ✕Missing insurance filing deadlines
• ✕Inadequate documentation to support codes
• ✕Not collecting copays at time of service
• ✕Billing for non-covered services without ABN
• ✕HIPAA violations in billing communications
• ✕Upcoding or unbundling services
• ✕Not following up on denied claims
• ✕Unclear patient financial responsibility
• ✕Missing required modifiers on claims
• ✕Poor coordination of benefits