Doctor (Physician) Invoice Template

Downloads: 1,217

Doctor (Physician) Invoice Template can be used by any Practitioner or Doctor’s Office seeking payment for services that were rendered. This remains a very basic template since, in many cases, medical information is considered very sensitive. This may not necessarily be the case when billing a Patient who requests to be billed directly however when billing another entity (such as insurance company), it is strongly advised that you are familiar with how the laws and the Recipient will need certain information presented.

Salary & Hourly Wage ($/hr)

  • Salary: $208,000 per year (source: BLS)
  • Hourly Wage: $100.00 per hour (source: BLS)

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How to Write in PDF and MS Word

Download: Adobe PDF & Microsoft Word (.docx)

1 – Secure The Doctor (Physician) Invoice To A Readily Accessible Folder

Determine whether you wish to work with an “Adobe PDF” file or a “Microsoft Word (.docx)” file then select the appropriately labeled text above. A button (“Word” or “PDF”) near the image may also be selected to obtain this file

 

2 – The Office Or Practitioner Must Be Introduced In The Heading

The Doctor’s Office issuing this invoice will need to have its credentials presented at the onset of this invoice. Enter the legal entity name of the Doctor’s Office or Practice with any required suffixes in place of the “Company Name” text of the first field.    The Doctor’s full “Name” or that of an authorized Office Employee able to act as a point of contact between the Doctor and Patient/Client should be produced on the next blank space.   The “Street Address” where the Doctor engages in mail correspondence should be displayed using the “Street Address” and “City, State, Country” lines. Its “ZIP Code” must be entered on the line below these separately.   Proceed to fill in the office “Phone” number of the Physician. This should be a number where the Client can reach the Doctor or a Representative who can discuss this bill or make payment arrangements.   If the Doctor or his or her Office maintains an “E-Mail” address, make sure to include this by entering it on the last line here.   

 

3 – Report The Physician’s Invoice Number For This Bill

A lot of paperwork can be generated by a practicing Doctor (Physician) or the Practice he or she is a part of. The Patient or the Recipient of this invoice should be given an easy way to refer to it in a discussion with its Sender. Thus, determine the invoice number that should be used according to your accounting system then input it to “Invoice #”    Submit the invoice “Date” that notes when this bill will apply to the Patient or Client’s account in the Doctor’s bookkeeping records on the next blank line.   

 

4 – Directly Bill The Patient Or Billed Party

The Payer of this Doctor’s invoice should be named. Produce the legal “Name” of this entity below the heading “Bill To.” If you are not directly billing a Patient, then input the complete “Name” Organization or Entity that will pay this invoice. Follow this by producing its entire mailing address by filling in the lines labeled “Street Address” through “ZIP Code.”     

 

5 – Present The Services Or Medical Supplies Provided

The services the Doctor provided will need to be discussed for the purpose of requesting the “Amount” of money you will list for this invoice. The table below the Payer’s billing information will nicely provide an area for these tasks. First, list the services, tests, or procedures that must be paid for under the “Description” heading. There will be a box with ample space provided however, you can expand it by inserting lines if more room is required.    The “Amount” the Doctor expects in exchange for the provided care should be presented in the next box.   Traditionally, you should list the full dollar amount expected for all the services or care provided in the box labeled “Subtotal” Remember to exclude taxes from this sum.     If the government requires you charge “Tax” for the amount that must be paid, then report this as a dollar value in the area labeled “Tax.”   The “Total” will summarize precisely how much the Payer is expected to send in response to paperwork. This must be the “Subtotal” and “Tax” values you provided above summed to one “Total.”       

 

6 – Deliver Additional Instructions As Required

Oftentimes, it is considered good practice to include some instructions for payment. This will help avoid unnecessary delays and can be delivered as a concise statement by inputting the number of “.Days” on the blank line following the phrase “…Due Within…”          Information regarding the care provided or the charges due can be documented for the Patient or Client’s benefit on the blank lines attached to “Comments Or Special Instructions”   

 

How to Write in MS Excel

Download: Microsoft Excel (.xlsx)

1 – The Doctor (Physician) Invoice Can Be Saved As A Spreadsheet Template

Save the Doctor’s invoice to your system using the “Microsoft Excel (.xlsx)” link on this page.

 

2 – Identify The Doctor (Physician) Issuing This Invoice

The invoice will begin with a clear request to detail the Doctor and his or her contact information. The first cell where you must supply content is cell A1 at the top left of this sheet. This field has been reserved for the banner or logo that the Doctor (Physician) uses to identify his or her Office or Practice.    In addition to the logo, the official name of the Practice or Doctor’s Office must be presented. Submit this name to cell A2, then identify the individual the Patient or Client should contact in cell A3. Next, the address where the Patient or Client should issue a payment or send mail must be presented in this area as well. This should be listed as a “Street Address” (in cell A4) and “City, State, Country” (in cell A5) on the first two of these lines. Cell A6 will require you produce the appropriate “ZIP Code” to its contents.
The next set of cells in the header will enable you to present the Doctor or Practice’s “E-Mail” address used for invoice correspondence as well as the appropriate “Phone” number.

 

3 – This Document And Its Recipient Must Be Declared

Although we have identified the Doctor sending this document, we have yet to identify this paperwork. Replace the text in cell F4 with the invoice number that will be used to keep track of this bill. Notice the current “Date” in cell H4. This will be taken as the active “Date” of this document by the Patient or Client. You may edit this as needed or leave it unattended.    Now, turn your attention to column A once more. Cell A11 will begin a set of fields where you will need to identify the entity paying this invoice. This will be the same entity this invoice is being sent to so you will need to provide his or her full “Name” in cell A11 then use the next three fields (cells A12, A13, and A14) to report the address. Remember if you are not billing a Patient directly but rather an Organization or Business Entity, then you must include that entity’s status suffixes (i.e. corp., ltd.,) if they are part of its “Name.”

 

4 – Invoice The Patient Or Recipient Using The Table

The next portion requiring attention will be in a table. Find cell A17 then discuss the medical services provided the Invoice recipient must pay for in its contents.          The second column of this table will be comprised of a few rows. Begin with cell H17 where you should provide the dollar “Amount” the Invoice Recipient owes for the charges you listed in the first column then continue to the “Subtotal” (H18) where you must supply the full cost of care without any taxes added.  Locate cell H19 then use it to inform the Patient of the “Tax” amount he or she must pay. This cell must be added to one sum then entered in “Total” (Cell H20).      If desired, you can impose a time-limit on when the Patient or Client can send an on-time payment. This should input as a number of “Days” in cell A21 as a substitution for the bracketed symbol.   If any additional instructions, disclosures, waivers, or general information should be included with this invoice you can utilize cell A22 to present it or the name of an attachment with such information.

 

Downloads: 1,217
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