Checklist template

Co-pay and cash collection controls for clinics

A ready-to-use checklist with 115 items in 6 sections, covering Collection, Receipts, Cash drawer, Reconciliation, Deposits, Refunds. Use it as-is in Bindy, or adapt it to your own standards in minutes.

  • 6 Sections
  • 115 Items
  • 97 Yes / No checks
  • 6 Scored ratings
  • 127 Points

Use this template How audits work

1. Collection 20 items

  1. The co-pay amount is taken from the eligibility response, not from what the patient reports Yes / No 1 pt
  2. The co-pay was requested at check-in for each of 3 patients observed Yes / No 1 pt
  3. Outstanding balances appear on the registrar's screen at check-in Yes / No 1 pt
  4. Each payment is posted to the patient's account at the moment it is taken Yes / No 1 pt
  5. Each employee posts payments under a personal login Yes / No 1 pt
  6. No password is written down at the front desk Yes / No 1 pt
  7. A co-pay not collected is recorded with a reason code Yes / No 1 pt
  8. Waiving a co-pay requires a manager's documented approval Yes / No 1 pt
  9. Co-pays due yesterday that were not collected Number
  10. Self-pay discounts follow the company's published schedule Yes / No 1 pt
  11. Each payment plan is documented on an agreement signed by the patient Yes / No 1 pt
  12. Payments are accepted only at the front desk, never in exam rooms Yes / No 1 pt
  13. Checks are made out to the clinic's legal name Yes / No 1 pt
  14. Checks are stamped "for deposit only" when received Yes / No 1 pt
  15. No card number is written on paper at the front desk Yes / No 1 pt
  16. Card payments taken by phone are keyed directly into the terminal Yes / No 1 pt
  17. Card terminals are inspected for tampering at the frequency set by company policy, with a log Yes / No 1 pt
  18. Payments received by mail are opened and logged by two employees Yes / No 1 pt
  19. Share of co-pays collected at the time of service last week (%) Number
  20. Collection at check-in observed during the visit Rating
    • Requested and posted for every patient 5 pts
    • Requested but posting delayed 3 pts
    • Not requested or not posted 1 pt

2. Receipts 20 items

  1. A system-generated receipt was offered for each payment observed Yes / No 1 pt
  2. The receipt shows the date, the amount, the method of payment and the employee Yes / No 1 pt
  3. A sign at the front desk tells patients they should receive a receipt for every payment Yes / No 1 pt
  4. Manual receipt books are used only when the system is down Yes / No 1 pt
  5. Manual receipt books are pre-numbered Yes / No 1 pt
  6. Unused manual receipt books are kept locked by the manager Yes / No 1 pt
  7. Every number in the manual receipt book in use is accounted for Yes / No 1 pt
  8. Voided manual receipts are kept in the book with all copies Yes / No 1 pt
  9. Manual receipts were entered in the system after the last downtime, with the receipt number noted Yes / No 1 pt
  10. Receipt numbers on yesterday's system report run in sequence without gaps Yes / No 1 pt
  11. Voiding a receipt in the system requires manager rights Yes / No 1 pt
  12. Each void of the last week shows a reason Yes / No 1 pt
  13. Receipts voided last week Number
  14. The void report is reviewed weekly by someone who does not take payments Yes / No 1 pt
  15. 5 cash receipts sampled were each traced to a posting on the patient's account Yes / No 1 pt
  16. The method of payment on 5 receipts sampled matched the tender in the day's close Yes / No 1 pt
  17. Front desk logins cannot change the date or amount of a posted payment Yes / No 1 pt
  18. The report of deleted and adjusted payments is reviewed monthly by the manager Yes / No 1 pt
  19. No unapplied payment older than the company limit remains on the unapplied payments report Yes / No 1 pt
  20. Control of receipts Rating
    • Every payment receipted and traceable 5 pts
    • A few gaps, each with a written explanation 3 pts
    • Missing receipts or unexplained voids 1 pt

3. Cash drawer 19 items

  1. Each cash drawer is assigned to one employee per shift Yes / No 1 pt
  2. The opening float equals the fixed amount set by company policy Yes / No 1 pt
  3. The opening float count is signed by the employee at the start of the shift Yes / No 1 pt
  4. The drawer is locked whenever its employee leaves the desk Yes / No 1 pt
  5. The drawer is out of patients' reach Yes / No 1 pt
  6. A surprise count during the visit agreed with the float plus the cash receipts posted Yes / No 1 pt
  7. Difference found in the surprise count (dollars) Number
  8. The drawer holds no personal money, IOUs or cashed personal checks Yes / No 1 pt
  9. Cash above the limit set by company policy is moved from the drawer to the safe Yes / No 1 pt
  10. The safe is locked at the time of the visit Yes / No 1 pt
  11. The safe combination is known only to the employees on the authorized list Yes / No 1 pt
  12. The safe combination was changed after the last authorized employee left Yes / No 1 pt
  13. Cash is locked in the safe overnight, not left in the drawers Yes / No 1 pt
  14. Large bills are checked with a counterfeit detection pen or device Yes / No 1 pt
  15. Petty cash is kept apart from the cash drawers Yes / No 1 pt
  16. An over and short log is kept by employee Yes / No 1 pt
  17. Shortages above the company limit in the last 3 months were each investigated in writing Yes / No 1 pt
  18. A camera covers the front desk cash handling area, where company policy requires one Yes / No 1 pt
  19. Security of cash at the front desk Rating
    • Locked, assigned and counted 5 pts
    • Locked and assigned, with a count or signature missing 3 pts
    • Shared or unlocked drawers 1 pt

4. Reconciliation 19 items

  1. Each employee counts and closes their own drawer at the end of the shift Yes / No 1 pt
  2. A system close report is printed for each user Yes / No 1 pt
  3. Cash counted is compared with the cash total on the close report Yes / No 1 pt
  4. Checks counted are compared with the check total on the close report Yes / No 1 pt
  5. The card terminal settlement report agrees with the card payments posted Yes / No 1 pt
  6. Payments made through the patient portal are included in the daily reconciliation Yes / No 1 pt
  7. A second person verifies the count and signs the closing sheet Yes / No 1 pt
  8. The day is reconciled by someone other than the person who posted the payments, or by the manager at a single-employee front desk Yes / No 1 pt
  9. Each variance is written on the closing sheet with an explanation Yes / No 1 pt
  10. Closing sheets for the last 7 working days are all on file and signed Yes / No 1 pt
  11. Days with a variance among the last 7 working days Number
  12. Each of 10 visits sampled from yesterday's schedule shows a co-pay posted or a reason code Yes / No 1 pt
  13. Every batch in the system is closed on the day it was opened Yes / No 1 pt
  14. Batches left open from previous days Number
  15. The adjustments and write-offs report is reviewed monthly by the manager Yes / No 1 pt
  16. Writing off a patient balance requires approval at the level set by company policy Yes / No 1 pt
  17. Bank statements are reconciled to deposits each month by someone outside the clinic's front desk Yes / No 1 pt
  18. Reconciliation records are kept for the retention period set by company policy Yes / No 1 pt
  19. Daily reconciliation Rating
    • Complete, verified and signed every day 5 pts
    • Done but missing a second signature 3 pts
    • Days missing or variances unexplained 1 pt

5. Deposits 18 items

  1. A deposit is prepared for each working day Yes / No 1 pt
  2. The deposit slip lists the cash total and each check Yes / No 1 pt
  3. The deposit is prepared by one employee and verified by a second, with both signatures Yes / No 1 pt
  4. Deposits are sealed in numbered tamper-evident bags Yes / No 1 pt
  5. The bag number is written on the deposit log Yes / No 1 pt
  6. Sealed deposits are kept in the safe until they leave for the bank Yes / No 1 pt
  7. Deposits reach the bank within the number of days set by company policy Yes / No 1 pt
  8. Date of the last bank deposit Date
  9. Cash and checks awaiting deposit in the safe (dollars) Number
  10. The deposit is carried to the bank in a plain, unmarked bag Yes / No 1 pt
  11. The bank-validated receipt is attached to the closing sheet Yes / No 1 pt
  12. Bank-validated amounts matched the closing sheets for the last 5 deposits Yes / No 1 pt
  13. The deposit log shows no working day without a deposit or an explanation Yes / No 1 pt
  14. Armored carrier pick-ups are signed for in the pick-up log, where a carrier is used Yes / No 1 pt
  15. Checks deposited by scanner are scanned on the day received Yes / No 1 pt
  16. Scanned checks are kept locked until shredded after the hold period set by company policy Yes / No 1 pt
  17. Bank notices of deposit discrepancies are sent to the manager, not to the employee who prepared the deposit Yes / No 1 pt
  18. Deposit handling Rating
    • Daily, verified and matched to the bank 5 pts
    • Verified but late 3 pts
    • Unverified or unmatched deposits 1 pt

6. Refunds 19 items

  1. No patient refund is paid from the cash drawer Yes / No 1 pt
  2. Each refund has a request stating the reason, the amount and the approver Yes / No 1 pt
  3. The person who approves a refund is not the person who took the payment Yes / No 1 pt
  4. The refund function of the card terminal requires a manager password Yes / No 1 pt
  5. Card refunds are made to the card used for the original payment Yes / No 1 pt
  6. Refunds of cash payments are made by check to the patient's address on file Yes / No 1 pt
  7. 5 refunds sampled each matched an original payment on the patient's account Yes / No 1 pt
  8. The refund report shows the last four digits of the card refunded Yes / No 1 pt
  9. The refund report is reviewed monthly by someone outside the front desk Yes / No 1 pt
  10. Refunds issued last month Number
  11. The credit balance report is reviewed each month Yes / No 1 pt
  12. Patient accounts with a credit balance Number
  13. Credit balances are refunded within the time set by company policy and local regulation Yes / No 1 pt
  14. Overpayments by insurers are returned through the billing office Yes / No 1 pt
  15. A front desk employee asked described the refund process correctly Yes / No 1 pt
  16. Corrective actions from the previous review have been completed Yes / No 1 pt
  17. Name of the clinic manager Short text
  18. Overall control of co-pay and cash collection Rating
    • Every payment receipted, reconciled and deposited with duties separated 5 pts
    • Controls in place, with gaps in signatures or timing 3 pts
    • Cash unaccounted for or controls not followed 1 pt
  19. Corrective actions required Comments

About this template

This checklist is part of the Bindy template library. Yes / No checks score 1 point when met; ratings score the points shown for each option. The overall score is the percentage of points earned, with N/A answers excluded. In Bindy you can add photos, assign corrective actions, require sign-off and compare results across sites.

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