Why Is Nothing Showing as Patient Responsibility in Office Ally?
Short answer: In Practice Mate, click the Accounting tab, then the payments and deposits sub tab, then Add New Payment or Deposit. Choose Insurance for a payer check or Patient for a copay, then Record a Payment and Process Payment. After you enter the amount the payer paid and the contracted write off, you have to check the patient responsibility box yourself. There is no autopost setting that will move a balance to patient responsibility for you.
What is really happening when a balance never gets billed
The payment posted. The write off posted. The books look correct. The remaining balance is still sitting on the account because nobody told the system it belongs to the patient.
This is the part people get wrong, and it is an understandable mistake. Every other piece of the posting screen behaves like software, so it feels reasonable to assume the leftover balance sorts itself out. It does not. A person has to physically check the box.
The steps
In Practice Mate, click the Accounting main tab. The tabs across the top are the main tabs and the row below them is the sub tabs.
Open the payments and deposits sub tab. It lists every payment previously posted.
To enter something new, click Add New Payment or Deposit. Legacy accounts display a different screen. This lesson uses the current layout.
Know the three payment types. Patient is money collected from the patient. Insurance is a payer payment you are entering by hand. The remittance advice tab holds insurance payments that arrive electronically because you have set up electronic remittance advice with Office Ally and the payer. If remittance is not coming into the system, everything has to be entered manually.
To enter an insurance check by hand, choose Insurance.
Choose the insurance company from your list, or type to search for it.
Click Record a Payment, then Process Payment. This keeps you in Accounting and moves you to the next screen.
Choose how the payment arrived. Do not use the credit card feature unless Stripe is integrated with your account.
For a check, enter the check number and the amount.
Write a comment. On the payment list you only see the check number, so the comment is where you note who the payment is for.
Click Submit. You are returned to the payments and deposits sub tab and the payment appears in the list.
Tick the box next to the payment, or click Apply.
Click the three dots under Patient ID.
Enter the patient last name. The first three letters are usually enough. Select the patient. You are now on the screen where the payment gets posted.
Confirm the payer shown matches the check you selected.
Read the amounts off the paper explanation of benefits and enter the amount the payer paid.
Enter the contracted write off, meaning the amount the payer stated they were writing off.
Label the remaining balance, for example co insurance.
Check the patient responsibility box. This is the step people skip.
Click Apply and Generate Statement if you want the statement now, or click Update if you are going to print multiple statements from Accounting later.
To take a patient copay before the visit exists, click the Accounting main tab, then click Add a Payment or Deposit in the sub tabs.
Choose Patient instead of Insurance.
Use the patient search at the far right and enter the last name. Scroll down to the list of patients with that last name and choose the patient.
Click Record a Payment, then Process Payment.
Choose the payment type: cash, check, credit card, or EFT. If your account is integrated with Stripe, choose credit card and a Stripe popup appears where you enter the card and process it on the spot. If the office runs cards through something else that is not integrated, choose cash instead.
Enter the amount.
In the comments, type the processor the office actually used, for example Square, plus the patient last name for reference.
Click Apply.
On the payment screen, choose Patient Payment from the drop down so the accounting reports the way you want.
Enter the amount collected. This is still considered patient responsibility.
Click Update. You are returned to the payments and deposits sub tab, where the payment shows as applied.
Read the list. The only column that tells you a patient payment from an insurance payment is payer type. Sort by payer type when you need to separate them.
Why the comment field is doing more work than it looks like
The payments list shows you the check number and the description you chose, and very little else. If the office runs a card through an outside processor and you record it as cash with no note, the true method exists nowhere in the system. Somebody has to log into that processor months later and match by hand. Write the processor and the patient last name in the comment while you are still on that screen, not after.
The mistake this prevents
After the insurance payment and the contracted write off are entered, the remaining balance sits in limbo until somebody checks the patient responsibility box. Nothing in Office Ally does this for you. There is no autopost rule, no setting, and no batch action that converts it. The payment posts, the books look correct, and the patient is never billed. The balance ages quietly and shows up months later as an accounts receivable problem that looks like a collections failure when it was really a one click omission at posting. Check the box before you click Apply or Update, every single time.
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Marie Matteson, MS, is a healthcare consultant, educator, and Office Ally specialist with more than 30 years in healthcare, emergency medicine, and practice management. Helping you understand what's really going on.
All patient information referenced here has been redacted. This content is educational and is not billing, legal, or coding advice. Always follow your payer contracts, your practice policies, and current coding guidelines. Not affiliated with or endorsed by Office Ally.
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