Working with invoices

Estimated reading: 28 minutes

Cornerstone contains many features that allow you to create comprehensive invoices. You can place more than one patient on the same owner’s invoice. Posted invoices are the source of data used for revenue and activity-based reporting.

Before you start

Security
  • Invoice
  • Invoice Departing Instructions
  • Invoice Discount
  • Invoice Discount – Apply to All Lines
  • Invoice Manual Discount
  • Invoice Patient Visit
  • Invoice Reminders
  • Invoice Tax
  • Appointment – Schedule Appointments
  • Appointment – Schedule for Today
  • Lab New Requests
  • Lab Not Requested Lab Work
  • Boarding, if using

Setup

Important!

  • Once posted, invoices cannot be modified.
  • Reminders are updated and departing instructions display in history once an invoice is saved or posted.
  • An invoice can only be accessed by one workstation at a time.
  • You must have at least one invoice item on an invoice to save or post it.
  • To ensure charges are not missed and patient care it not impacted, note alerts and messages when invoicing, such as:
    • Transfer PVLs
    • Address not requested diagnostic results: unresolved results do not display in history and can delay patient treatment
    • Check out boarders
  • You can invoice an inactive client, but a written off client cannot be invoiced. Reinstatement is required, with security access.

Create an invoice

Navigate using any of the following:

  • Patient Clipboard > right-click client or patient > Invoice
  • Patient Clipboard > right-click patient > Patient Visit List > Invoice button

See Additional information for other options to navigate to the invoice window.

Invoice Workflow

The following steps are basic tasks that could be taken during the creation of an invoice. Specific details on these tasks are throughout the article.

  1. Acknowledge any client alerts. The client’s A/R information, including their credit code, displays.
  2. Do one of the following:
    • Start a new invoice by pressing Tab in the Invoice # field, if the field is blank. The invoice number is assigned when the invoice is saved or posted.
    • Start a new invoice when an open invoice exists by pressing Ctrl +N in the Invoice # field, if the field is populated.
      • Click Yes to confirm to start a new invoice.
      • Use this method to create separate invoices per patient, if needed by the client.
    • Work with the client’s open invoice that was previously saved, but not posted. The client’s oldest open invoice automatically displays.
    • Work with a different open invoice. Press F2 and select the invoice from the Invoice List.
  3. Select or modify an Invoice Type, if using, or press the Tab key to accept the default invoice type displayed. This field may be set as required field under invoice defaults.
  4. Enter or modify the Receptionist staff ID or press F2 to search for and select the staff from the Staff List.
  5. In the Patient area, select the patient in the list.
    • Use the scroll bar if the patient is not visible.
    • You can also type the Patient ID or press F2 to search and select a patient from the client’s patient list.
  6. Acknowledge any patient alerts.
  7. Transfer any Patient Visit List (PVL) items. Invoice defaults will determine if the PVL opens automatically to transfer items, or if a message prompt displays, as each patient is selected on the invoice.
  8. To add invoice items to the invoice, do any of the following:
    • Enter the item ID in the next available ID field or press F2/double-click to search and select from the Invoice Item list and press the Tab key.
    • Click Travel Sheet to select items and click Transfer.
      • Enter the billing Staff ID and click OK.
      • Items are added in classification and item ID order This is regardless of the order they are selected in from the travel sheet.
  9. Address any of the following, as needed:
    • Group item selections: Ask before adding, ask for quantity
    • Pick lists
    • Dispensing items
    • Special actions: Prescription label, inhouse lab or imaging requests, vaccine tag, print document, etc.
    • Controlled substance reasons
    • Reminder information: Next reminder ask entry, Call back notes
  10. Modify item or billing details: Quantity, pricing, discounts, taxes, staff, revenue center, date, as needed.
    • Modify the item description if the item is a miscellaneous type. If the item is miscellaneous, the description will display in bold.
    • Staff ID appears if a staff ID is set up in the Invoice defaults. Additional items will copy from the previous line.
    • Right click on a row to view the price calculation.
    • The revenue center will default in based on the revenue center hierarchy.
    • The current date is used by default. Entered dates that are 45 days old or are a future date, will prompt for a confirmation. Click Yes or No.
  11. To change the order of items appearing on the invoice:
    • Highlight the item ID.
    • Move the item up or down, using the arrow buttons at the bottom of the window.
    • Group items must be moved as a group.
  12. To remove an item from the invoice, highlight the item ID and press Ctrl+D. To delete an item that is part of a group, click on the Qty, and press Ctrl+D.
  13. If applicable, use the buttons at the bottom of the window to perform additional tasks:
    • Select an item and click Rx Label to create a prescription label.
    • Click Special to view and/or process any special actions linked to the items on this invoice.
      • This will also display the Patient Visit List if it contains items for this patient.
      • See Invoicing Special Actions for more information.
    • Click Departing to add or update the departing instructions to print on this invoice. See working with departing instructions during invoicing for more information.
    • Click Pharmacy to access the Veterinary Pharmacy Reference tool. Subscription required.
    • Click Make Appt to access the Schedule for Today window and make an appointment.
      • Appointment information will print on the invoice, based on the invoice default settings.
      • Note: A prompt for next appointment can be setup. It will prompt after the posting/applying of payments.
    • Click Travel Sheet to select items from your travel sheet.
    • Click Copy To to copy invoice items on the invoice to another patient, owned by the same client. See copy invoice items to another patient for more information.
  14. For Petly Plans subscribers:
    • Click the View Plan icon to see available items on the invoice, per patient.
    • Click the Petly button to have the invoice checked for available plan items.
      • Apply plan discounts when the items and quantities requested are available, if using Petly discounting.
      • If a discrepancy is noted, it is recommended to change the unavailable plan line items to the nonplan equivalent service.
      • In the event a requested quantity is not available, retain the plan item at the available quantity and use the nonplan equivalent item and the remaining quantity.
  15. Continue adding items as needed for the patient.
  16. Repeat steps for any additional patient for the client. You can also click Copy to if the same/similar billing items are needed for other pets of the client and they are not using PVLs.
  17. Review the invoice for each patient and the invoice totals.
  18. Click Discount, if needed, to apply a discount to the entire invoice. Security access required.
  19. Click Post to save all information and close the invoice or click Save to save all information and leave the invoice open.
    • Open invoices allow for information to be changed or added at a later time.
    • Posted invoices update the client balance and populate revenue-based and activity count reporting.
      Examples: invoice, patient reporting
  20. Clicking Post or Save on an invoice performs a final sweep to check for:
    • Incomplete actions
      Example: Prescription label, lab requests, vaccine tag, etc.
    • Pending and potential charges
      Example: PVLs, not requested lab results, whiteboard patients not ready to go (RTG)
    • Unverified inventory details
    • The Below reorder point inventory warning will display, if the default is set.
    • Checked in boarding reservations
    • Applied discounts on available Petly plan items.

Note: Quantities transferred from the PVL that were sourced from an estimate may require review, because 0 qty items may have been transferred and not reconciled on the PVL. Although you can post an invoice when items are at 0 qty, the item still appears in patient history.

Invoicing special actions

Special actions are additional actions you should take when you invoice certain items. You should have already linked special actions to invoice items when you set them up in Invoice Item Information.
Example: When you invoice a vaccine/vaccination invoice item, Cornerstone prompts you to create a rabies/vaccine tag and print a rabies certificate.

When the Special button is active (not grayed out), special actions exist. If you have not performed the special actions when you save or post the invoice, Cornerstone displays a box containing the special actions. Special actions will also include Patient Visit List prompt for any patients of the client when clicking Post.

Do one of the following:

  • Click Process to perform the highlighted special action.
  • Click Continue to continue posting or saving the invoice.
  • Click Close to return to the invoice.

Working with departing instructions during invoicing

Use departing instructions to give your clients specific details about the medicine that is being dispensed or special instructions for a procedure that has been performed.

If you have linked departing instructions with invoice items, Cornerstone automatically adds them to patient history and prints the instructions on the invoice. You can also:

  • Add, modify or remove departing instructions on an invoice item.
    • This can be done even if the invoice item has other linked departing instructions.
    • The modified instruction is saved in the patient’s medical file. The changes do not affect the master list of departing instructions.
  • Click the Departing button. The Invoice Departing Instructions dialog box displays showing the current departing instructions for this invoice.

To add, modify or delete an instruction:

  1. In the next available row, enter the departing instruction ID or press F2 to search and select from the departing instruction list.
    • If you have a blank departing instruction set up, choose this ID to type any additional instruction or message to the client.
  2. Enter the Staff ID of the person recommending the departing instructions. The staff ID is also saved to patient history with the instruction.
  3. Click Note to modify the instruction, if needed.
    • Change the instruction and click OK.
    • You can also click Spell Check.
    • Click Cancel, if needed, to discard any changes made.
  4. Click OK to save the departing instructions and return to the invoice.
  5. Repeat steps for any additional instructions.

Click OK to save the departing instructions and return to the invoice.

Copy invoice items to another patient

Copy items on an invoice to another patient or patients owned by the same client.
Example, if Cassy Johnson brings in her two cats Marley and Moose, you can enter all of the services on Marley’s record and copy them to Moose’s record. This saves you from having to re-enter the services on the invoice.

  1. When finished adding items on the invoice for first patient, click Copy To.
  2. A list of the client’s patients displays. To include all species or inactive patients in the list, select Include all species and/or Include Inactive patients, if needed.
  3. Select the patient(s) to whom you want to copy services and click OK.
    • If using group codes, do not clear Re-expand smart and nested groups. This will ensure any species, weight, sex, age dependent or pick list items are correct per the selected patient.
    • Note: Pick lists do not re-expand when added to an invoice outside of a group.
  4. Complete any group, special actions or reminder items per patient, as needed.
  5. Remove any lines per patient, as needed, using Ctrl + D in the Item ID or Qty field.

Note: Invoice items added to the invoice after the copy will not be copied automatically.

Invoicing deceased patients

Certain invoice items are related to the death of a patient and are set up with the corresponding special action. When you place one of these items on the invoice, one of two things may happen:

  • Mark as Deceased displays in the Special Actions dialog box. You need to process the special action for the patient to be marked as deceased.
  • The status of the patient is automatically changed to deceased when they are invoiced. This occurs if the Automatically Mark Patient as Deceased default is selected in the Invoice defaults.

When you mark a patient Deceased, the patient name displays with a (D) on the Daily Planner tabs, and the Patient and Census Lists. It will also display in red on the Patient Clipboard.

To manually process the action on the invoice:

  1. Click Special.
  2. Select Mark as Deceased and click Process.
  3. Verify the patient’s Status as Deceased.
  4. Change the Date, if necessary. The current date is used by default.
  5. Click OK to return to the Special Actions dialog box.
  6. Process additional special actions, if necessary.
  7. When finished, click Continue or Close to return to the invoice.

When the invoice is posted, a message displays reminding you the invoice includes items for a deceased patient. Click OK. Be sure to review the billing message to print on the bottom of the invoice. Change or modify the message as needed.

Note: Removing the item from the invoice will prompt you to update the patient’s status. Click Yes or No accordingly.

Identifying Pricing Discrepancies (Using the Calculated Price Pop-up Box)

Check price variances on invoice items by right clicking the amount field to view the Calculated Price pop-up box. Use this feature to view the current price of an invoice item.

You can access this information for any invoice item; however, it is most useful for determining:

  • The price difference on an item transferred from the Patient Visit.
    • Prices in green text on the Patient Visit List indicate a discrepancy between that price and the current price in the Invoice Item Information.
  • The original price of an item, which you have manually changed on the invoice.
  • A group item with a group modified price.

Tip: You can use the Calculated Price box from the invoice, Estimate, Patient Visit List or document Invoice Items pane.

Invoicing Patient Sex Modification Items

For a service that changes a patient’s sex, such as ovariohysterectomy, you can set up the service’s invoice item to initiate the Sex Modification special action during invoicing. When the service is added to the invoice, one of the following will happen:

  • If you have assigned Modified sexes for applicable patient sexes (Controls > Sex), Cornerstone will automatically process the Sex Modification special action during invoicing.
  • If you have not assigned Modified sexes for applicable patient sexes, the Patient Sex Modification window displays automatically.
  1. Select the patient’s new sex from the list and click OK.
  2. Click Cancel to process the action later, using one of the following:
    • The invoice Special button
    • The Special Actions dialog box that displays automatically when you post the invoice, if you haven’t performed all of the special actions.

Note: Removing the item from the invoice will require updating the patient’s information manually.

Creating a Prescription Label During Invoicing

Use the RX Label button to create a prescription label for items, not using the Prescription Label special action. Items with the special action will display the prescription label window automatically or can be processed using either the RX Label or the Special button.

  1. To create a prescription label during invoicing, do one of the following:
    • Add a prescription invoice item and with your cursor on the invoice item line, click Rx Label.
    • Add a prescription invoice item that has the Prescription Label special action linked to it.
  2. Proceed with creating a prescription in the Prescription Information dialog box, following any prompts based on prescription and inventory defaults.

Note: Making a prescription label by either method above and clicking OK adds the information to the RX tab of the Patient Clipboard and populates the Prescription History report. Canceling the print job does not cancel the label.

Using Travel Sheets

Items can be selected from multiple classifications and travel sheets.

  1. Click Travel Sheet. If multiple travel sheets exist, select one from the list.
  2. In the Classification area, narrow the list of invoice items by doing one of the following:
    • Click to view travel sheet items for all classifications.
    • Click the specific classification.
    • Use Shift + Click or Ctrl + Click to select multiple sequential or non-sequential classifications.
  3. To choose an item, click on it. The item row turns green. The quantity will change to 1.
    • Click again to add to the quantity or enter quantity.
    • To deselect the item or reduce the quantity, right-click it until quantity is correct or the item row is no longer green. Red indicates a negative quantity.
  4. Click on another classification or travel sheet to continue selecting items.
  5. To view the items that are selected for a patient, click View Selected Items.
  6. To transfer selected items to the invoice, click Transfer. Enter the billing Staff ID and click OK.
  7. Address any of the following, as needed:
    • Group item selections: Ask before adding, ask for quantity
    • Pick lists
    • Dispensing items
    • Special actions: Prescription label, inhouse lab or imaging requests, vaccine tag, print document, etc.
    • Controlled substance reasons
  8. Items are added in classification, item ID order regardless of selected order.
  9. Use onscreen arrows to rearrange nongroup items as needed.

Applying/removing Discounts to Specific Items on Invoices (Transaction Discounts)

When you set up your invoice items, you can link discounts to individual invoice items. If you invoice a client who is set up to receive a discount, Cornerstone automatically applies the discount and the button in the Discount column displays Yes.

  1. Click the Yes button in that item’s row within the Disc column.
    • The discount(s) currently being applied are highlighted.
  2. To add or remove a discount to an invoice item, click the Discount from the list. Click Add line discounts to all lines for this patient, if needed. Security access required.
  3. If the client is not set up to receive the discount, a message displays to confirm that you want to apply the discount to this client. Click Yes or No to confirm.
  4. Click OK to save changes or click Cancel to discard changes and return to the invoice.

These steps can be applied to estimates, Patient Visit List (PVL) document invoice item pane or invoices.

Notes:

  • To see the price calculation per line amount, including any applied dispensing fees or discounts, right-click a field on the line to display the Calculated Price window.
  • If an asterisk appears next to a discount , that discount has been modified since it was applied to this invoice. This is commonly found when using saved invoices or seen on Patient Visit Lists (PVLs) in progress.
    • To use the updated discount:
      • Click the modified discount (with the asterisk).
      • Click the discount again to apply the updated percentage. Click OK.
  • Based on invoice default settings, the discount details will be displayed on the client invoice preview/print.

Applying Discounts to the Entire Invoice (Manual Discounts)

You can manually apply a discount as an amount or percentage to the entire invoice before you post the invoice. This is different than the transaction discount column on the invoice. The discount column on the invoice allows you to apply discounts to specific invoice items.

  1. Click Discount.
  2. Type the Discount Percentage or the discount amount.
    • The percentage or amount of the discount displays.
    • Cornerstone adjusts the invoice’s total after discount.
  3. Type a Description of the discount.
  4. Click OK.

For Petly Plans subscribers using automated plan item discounts: Manual discounts should only be applied to the invoice amount after any preset or Petly discounts are applied.

Applying/removing Taxes to Specific Items on Invoices (Transaction Taxes)

When you set up your invoice items, you can link taxes to individual invoice items. If you invoice a client for one of these items, Cornerstone automatically applies the transaction tax and the button in the Tax column displays Yes.

  1. Click the Yes button in that item’s row within the Tax column.
  2. The taxes currently being applied are highlighted.
  3. To add or remove a tax to an invoice item, click the Tax from the list. If the client is set up as tax exempt, you cannot apply a tax.
  4. Click OK to save changes or click Cancel to discard changes and return to the invoice.

These steps can be applied to estimates, Patient Visit List (PVL) document invoice item pane or invoices.

Notes:

  • Tax is calculated as the greater of the minimum price or (base price x quantity) + dispensing fee/item x the tax rate %.
    • If multiple taxes are used, this method is applied to calculate each tax, and then the tax amounts are added and displayed on the invoice.
  • If an asterisk appears next to a tax , that tax has been modified since it was applied to this invoice.
    • This is most commonly found when using saved invoices or seen on the Patient Visit Lists (PVLs) in progress).
  • To use the updated tax:
    • Click the modified tax (with the asterisk).
    • Click the tax again to apply the updated percentage. Click OK.

Post an invoice

Posting the invoice saves all the information and closes the invoice. When you post an invoice, it:

  • Applies invoice totals to the client’s account balance and populates revenue-based and activity count (invoice, patient visit count) reporting.
  • Checks out the patient(s).
  • Continues to the payment or the online payment request window, if selected.
  • Prompts for the next appointment based on the next due reminder, if setup in Appointment Scheduler defaults.
  • Prints and/or emails the invoice.

Clicking Post on an invoice performs a final sweep to check for:

  • Incomplete special actions: Prescription label, lab requests, vaccine tag, etc.
  • Pending and potential charges: PVLs, not requested lab results, whiteboard patients not set to ready to go (RTG).
  • Unverified inventory details: Lot numbers, expiration dates, location.
  • Below reorder point inventory warning display, if set in invoice defaults.
  • Checked in boarding reservations.
  • Applied discounts on available Petly plan items.
  • Complete any prompts to ensure all charges are accounted for and patient record is accurate.
  1. In the Post Invoice window, do any of the following:
    • Apply payments: Opens the Payment dialog box to apply the client’s payment. Clear the check box if the client is not making a payment at this time.
    • Pay Online: Email or text a payment request with the invoice attached. This option is for Cornerstone payments subscribers. Selecting this option will clear the Apply payments option.
    • Print invoice: Prints the invoice and specified number of copies. Clear the check box if you do not want to print the invoice.
      Note: If Enable electronic signature capture is selected in an integrated Payment Type setup and a capture device and/or tablet is detected, select whether you want to print the full invoice or an invoice receipt. A captured signature prints only on an invoice receipt.
    • Email invoice: An invoice PDF will be emailed to the client and will display in the communications log.
      • Based on invoice default settings, the box may be already checked.
      • Clear the check box if you do not want to email the invoice.
    • Check-out patients: Checks the patient(s) included on the invoice out of the practice.
    • Apply payments to invoice for productivity by provider: Clear the selection if you don’t want the payment for this invoice applied to the billing staff on this invoice. This option displays only if A/R by provider is set up in Invoice defaults.
    • Print Special action documents: This lists any special action documents set as Print after invoice is posted that were not processed at the special actions prompt from posting the invoice.
    • Message: Modify or select a different message to print on the invoice, if needed. The default message displays.
  2. Click OK. Click Cancel to return to the invoice, if needed.

Based on selections made in the Post Invoice window, complete any of the following as needed:

  • Complete payment information and click Post.
    • Enter your cashier password, if using and press the Tab key.
    • Enter the amount using either:
      • Right-click in the Amount field and select Client Balance
      • Manual entry, watching decimal placement and transposed numbers.
    • Select a Payment Type.
      • Type the prompt Answer, if using. Example: check number.
    • Repeat steps for any additional payment entries.
    • Adjust Change given, if needed.
    • Verify New payments and Balance after payments information is correct.

Note: If Apply payments was selected when you posted the invoice, but there are no payments to apply, click Post in the Payments dialog box to post the invoice without a payment.

  • Schedule an appointment using the next appointment reminder:
    • On the Next Appointment Reminder window, select Yes or No.
    • The Appointment Scheduler displays the schedule for the date the reminder is due for the first patient listed in the Next Appointment reminder window. If the reminder is overdue, the schedule displays tomorrow’s schedule. Navigate to a different date as needed.
    • Double-click the time slot to schedule for.
    • Click Yes to confirm you are scheduling for the selected client and patient.
    • Fill in appointment information, noting the patient’s Reminders list, since the patient may have reminders for several services that are due the same day.
    • Appointments scheduled using either the invoice Make Appt button or from the Next Appointment Reminder feature will display on the printed/emailed invoice.
  • Complete online payment request:
    • Verify or enter the payment amount.
      • The current debit/invoice balance defaults in.
      • Zero, negative, or amounts outside the displayed minimum/maximum range are not allowed.
    • Specify who is sending the request in the Staff field.
    • Select Email or Text. You can use only one method per request.
    • Verify or update the email address or phone number. Only one address or number can be used per request.
    • If using an email request, update any messaging, if needed.
    • Review or remove the attached invoice, if needed.
      • You cannot add other attachments.
      • Based on the configured card vendor, text requests may include the attached invoice.
    • Click Request.
    • Click Close to acknowledge the Check in alert, if one was entered on the check in/out window, at the time of check in.

Print and email invoices

You can print or email an invoice at any time during the invoicing process. You can also change the message that appears at the bottom of the invoice. An invoice can be reprinted or resent as needed.

To print or reprint a copy of an invoice, navigate to either:

  • Toolbar > Client Account > double-click the invoice.
  • Patient Clipboard > Account information tab > double-click the invoice.
  1. Click Print.
  2. Modify or select a different message from the drop-down list.
  3. Click Preview or Print.

To email or resend a copy of an invoice, navigate to either:

  • Toolbar > Client Account > double-click the invoice.
  • Patient Clipboard > Account information tab > double-click the invoice.
  1. Click Email.
  2. Modify or select a different message from the drop-down list.
  3. Click Email.
  4. In the Communications window, make any changes as needed to the Staff, subject line, recipients, or message as needed.
    • The client’s email address is populated if entered under Client Information.
    • Any changes that are made on this window do not update the client record.
  5. Click Send.
  6. This is recorded in the patient history as a sent email and displays under the Client Communications tab of the Patient Clipboard and in the Communication Log.

To print or email an invoice when posting:

  1. Select Print Invoice or Email Invoice.
  2. Click OK. The invoice is printed/sent after any payments have been made, if Apply payments is selected.

Notes:

  • The invoice prints on the printer set up in Printer Assignments. If a printer is not defined in the Printer Assignment dialog box, the invoice prints on the default printer.
  • If you open a closed invoice, you can only apply a payment or print/email the invoice.

Additional Information

Additional paths to start an invoice

Alerts
  • Information set to alert and potential suppression settings are determined by Alert Defaults.
  • Client and patient alerts can be viewed under the respective Alerts tab of the Patient Clipboard.
  • The more than 20 patients alert can be set/cleared under Invoice defaults.

Default settings that impact invoicing

Reminders

Viewing the PVL

Multiple patient invoices

Discounts

Petly Plans

View invoice

Related Reports

These Cornerstone reports provide information from the actions outlined in this article. Each report has its own security access under the Reports tab of the Security Setup window.

  • Patient Visit List Report
  • Patient Visit List By Date report
  • Patient Visit List By Type report
  • Daily Inv and PVL Entries reports

Resources

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