Create a Paid in Full Contract Without Insurance

When a patient chooses to pay for their treatment in full rather than make monthly payments, Tops allows you to create a Paid in Full Treatment Contract.

With this type of contract, the entire treatment fee is entered as the Initial Fee, rather than being distributed across monthly charges.

How the Initial Fee is satisfied depends on the practice's financial arrangements with the patient. The practice may choose to offer upfront discounts or courtesies, or the patient may be responsible for paying the entire amount. The Initial Fee can be satisfied through patient payments, applicable courtesies, or a combination of both.

When the contract is activated and the Initial Fee is charged, the full amount becomes due immediately.

Keep in mind: Charging the Initial Fee and collecting the payment are two separate actions. Even if the patient has not yet paid the full amount, the entire Initial Fee will appear in their Due Now balance once charged. Conversely, if the patient pays in advance, their payment will appear as a credit in Due Now until the contract is activated and the Initial Fee is charged.

When Should the Contract Be Activated?

Even when a patient does not have insurance, it's best to activate the Treatment Contract on the date of initial appliance placement.

Why does this matter? If the patient provides insurance information later and the practice needs to submit a claim, the procedure date generated in Box 24 will reflect the contract activation date.

Activating the contract on the date treatment actually begins helps ensure the procedure date on future insurance claims matches the patient's Treatment Start Date.

Before Activating the Treatment Contract

Tops Tip: We recommend recording the contract first and waiting to activate it until the patient's payment has been collected and they are ready to begin treatment.

Even when financial arrangements have been confirmed, patients may change their minds about how they want to pay. For example, a patient who originally agreed to pay in full may decide to use their HSA card to make monthly payments instead.

By collecting payment before activating the contract, the practice has an opportunity to make any necessary changes to the payment arrangements before the Initial Fee is charged.

Remember: Once the Initial Fee has been charged, it cannot be modified, deleted, or voided. Contract activation should ideally coincide with the initial placement of appliances.

Create the Contract

Treatment Contracts are created and recorded in the Contracts/Ledgers tab of the patient's chart. Before beginning, make sure you're working with the correct Treatment Phase and Treatment Plan.

1. Open the patient's chart; go to View > Patient Info or press Command I.
2. Click the Contracts/Ledgers tab.
3. Click New and select the appropriate Treatment Plan.
4. Click Quick Contract. The Quick Contract Worksheet displays.

5. Complete the fields:
   1. Total Contract: The total amount charged for treatment.

   2. Initial Fee: The amount charged to initiate treatment. This number should be the sum of what the patient is paying AND discounts they receive.

      For example, if a patient has a $5000 contract and their downpayment  is a discounted $4850 if they pay in full,  the initial fee would still be $5000.  The initial fee includes the patient's downpayment of $4850 plus the 3% pay-in-full courtesy of $150 (3%).

   3. Charges are Made: The frequency of the contract charges. This total should reflect 1 as there is only the initial fee that will be charged out to the patient.
   4. Monthly Charge: How much you will charge the patient per month. This amount should be $0. The full amount is being charged out in the initial fee.
   5. Other Charges: Not used at this time.
   6. First Charge Date: Tops Ortho calculates this date based on the date that the Quick Contract is created. If the next month is more than three weeks away, the first payment will be scheduled for the that month. If the next month is less than three weeks away, Tops Ortho will schedule the first payment for the following month.  There should be no amount reflected in the first charge date since the patient is paying in full.

6. Click OK.
7. Verify all numbers are accurate.
8. Click Record Contract.

Activating the Contract

Important: Before Charging the Paid in Full Initial Fee

Once the Initial Fee has been charged, it cannot be modified, deleted, or voided.

When creating a Paid in Full contract, the entire patient responsibility (or copay, when accepting insurance assignment) is charged as the Initial Fee.

If the patient later changes their mind and wants to make monthly payments instead, you cannot simply change the contract to distribute the amount already charged across future monthly installments.

The amount charged will remain in the patient's Due Now balance, and any payments collected will be applied against that balance.

Tops Tip: Before charging the Initial Fee, confirm that the patient intends to pay in full. If there is any uncertainty, consider recording the contract without charging the Initial Fee until the financial arrangements have been finalized.

1. When you are ready to activate the contract, go to Action > New Transaction or press Command T.
2. Select Initial Fee and select the recorded contract you wish to activate. Click Use Selected Contract.
3. Enter your note and click Process Charges and Payments.

Note: To enter the payment and any discounts, you can continue to tab within the same Transaction Window as the initial fee, or you can post them in a new transactions window. See below.

Recognizing an Active Contract

Active contracts will show one or two dots next to the contract total.

1. Contracts without insurance will display one dot.
2. Contracts with insurance will display two dots.
3. Deactivated contracts will display a dash.