ACCOUNTS RECEIVABLE COLLECTIONS CONFIRMATION

MEMO

To:

From:

Date:

Subject:

We are currently conducting a routine audit of the procedures Company X follows for posting payments on
accounts sent to Company X’s collection attorneys. The following service dates, account numbers and patient
names for which you are listed as the guarantor have been randomly selected for payment testing:

Service Date Account Number Patient Name

For the accounts listed above, we have record of the following payments received after the account was sent to
our outside collection attorneys for collection:

(INSERT PAYMENT DETAILS)

If the payments listed above (if any) do not accurately reflect all payments made on these specific accounts
through (Date), please explain any exceptions in the space provided below and return this letter in the postage-
paid envelope provided. Please include all available documentation that supports the exceptions noted (e.g.,
copies of canceled checks and/or receipts).

If you believe the payment information is accurate, please indicate so and return this letter in the postage-paid
envelope provided. If you have any questions about this request, please call our auditors at (Insert Number). We
appreciate all payments made on these accounts.

Sincerely,

(Insert Name)
Company X Accounts Receivable Manager

1 Source: www.knowledgeleader.com
 Payment information is accurate

 Except for the following, the payment information listed above is accurate:

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2 Source: www.knowledgeleader.com