Encounter completion — charges & finalize

Code the visit (E/M & CPT)

The Charges section captures the billing codes. Pick an Evaluation & Management level with one click and Hero EMR fills in the matching CPT; add any procedure or other CPT codes by search.

1. Choose the E/M level. The buttons Straightforward, Low, Moderate, High, New Low, and New Moderate map to the right code — e.g. Moderate → 99214 — Established patient office visit, moderate complexity (30–39 min). Picking a level turns the E/M tracker chip green.
2. Add other CPT codes. Use Search CPT codes for procedures, vaccines, or anything beyond the office visit. Manage curates your charge favorites, and is also where you rename or hide the No charge button.
3. Or close the visit without an E/M code. Two pinned buttons sit at the front of the quick-button grid:
   • No charge — close the visit with no billing at all. Nothing is charged, no insurance claim is created, and the visit reports as “No billing” in the Billing Command Center. It is shown by default; you can rename it or hide it from your own charge favorites under Manage.
   • Cash pay — create a patient balance instead of an insurance claim. The caption under the button shows the configured price for this patient and visit type. If none is configured it reads Price required, and an administrator or billing staff member with charge-management access must enter a one-time amount before you can sign. Where a price is configured, the same permission lets you override it for this visit only.
   Either choice satisfies the “E/M or procedure code” requirement at signing, so you can close the visit without coding it.

Patient instructions

Hero EMR drafts after-visit patient instructions from your note. Review them, edit, or write your own, then they travel with the visit summary the patient receives.

1. Review the draft. The Instructions section proposes plain-language instructions based on the note’s plan.
2. Edit or add your own. Use Edit to revise, + Add instructions manually to write from scratch, or Copy to clipboard to reuse elsewhere.

Schedule the follow-up

The Follow-up section is pre-set from your note’s plan and lets you confirm the timing and book the next visit without leaving the encounter.

1. Check what’s already booked. Your Upcoming Appointments at the top of the section lists this patient’s scheduled visits (date, time, visit type) so you don’t double-book a follow-up that already exists.
2. Confirm the timing. Pick 2 weeks, 1 month, 3 months, 6 months, or Custom. Hero EMR shows a Recommended follow-up date based on your choice.
3. Set the visit type and book. Choose the Visit Type. Duration beside it is a read-only readout — it comes from that visit type’s default duration, so change the duration by changing the visit type (or its definition under Visit types). The star inside each visit-type option saves it as your default follow-up type (tooltip: Set as default follow up type).
   • Schedule Now does not create the appointment on the spot. It opens the scheduling workspace in a new tab, prefilled with the recommended date, the chosen visit type, and next-available search, where you pick the actual slot.
   • Or leave it as a follow-up request to be booked later. The F/U tracker chip turns green once set.
4. Once a visit is on the calendar. The request UI is replaced by a Follow-up appointment scheduled panel showing the date, time, and visit type, with Reschedule and Cancel appointment buttons. As it says there, the automatic follow-up request is turned off while that appointment is on the calendar — the two are mutually exclusive.

Reconcile medications

The Medications section is where you reconcile the patient’s list as part of closing the visit. It shows what this encounter adds and lets you discontinue anything no longer needed.

1. Confirm new medications. New Medications From This Encounter lists what you prescribed today (read-only here — edit it back under Writing a prescription).
2. Discontinue what’s ending. Under Active Medications, check any medication to discontinue it when the encounter is finalized. Each row shows strength, route, and sig so you can decide at a glance. Checking a row opens a Discontinuation reason box — fill it in so the stop is documented. A running N to discontinue badge sits next to the section heading.
3. Look for the Suggested badge. A medication Hero EMR proposed stopping from your note is tagged Suggested. It is still just a proposal — nothing is discontinued unless you check the box yourself.

Build favorites to move faster

Favorites turn the codes and orders you use most into one-click chips. They’re personal to you and appear at the top of the matching section.

Sign and close the visit

Sign & Close Visit finalizes the visit at once. It is the single action that turns your worksheet into a signed, billed, transmitted encounter. The footer chips are a progress hint, not the gate — the real requirements are checked when you click, and anything missing is reported inline and scrolled to instead of signing.

1. Meet the requirements that actually block signing.
   • At least one diagnosis. “Encounter requires at least one diagnosis before completion.”
   • Charges. An E/M code or at least one procedure code — unless you chose No charge or Cash pay, either of which satisfies this on its own (see Charges & E/M).
   • Every order linked to a diagnosis. If any medication, lab, imaging, referral, or screener has no diagnosis association, signing stops and the Associations grid is highlighted.
   • A pharmacy, if any prescription is still unsent. “Select a preferred pharmacy before signing since you have unsent prescriptions.”
   The Orders and F/U chips are progress hints only — a visit with no orders and no follow-up signs perfectly well.
2. Sign controlled prescriptions first. Any controlled order must be signed via EPCS before it can be transmitted, and an unsigned one keeps Sign & Close Visit disabled until you go back to Orders and sign it.
3. Answer the billability advisory if it appears. On a visit that will be billed to insurance, Hero EMR checks your diagnosis codes first. If any is a category header or an unrecognized code — a guaranteed clearinghouse rejection — a Some diagnoses can’t be billed as-is dialog opens with one-click billable subcodes. Pick a subcode, or choose Fix diagnoses to go back to the Diagnoses section. Sign anyway proceeds and records that you acknowledged the codes. This advisory never blocks you, but dismissing the dialog counts as “I’ll fix it” and does not sign.
4. Click Sign & Close Visit. Finalizing signs the note, sends any orders and prescriptions you haven’t already sent individually, submits the charges to billing, applies any medication discontinuations, and creates the follow-up request — in one step. Ctrl/Cmd+Enter does the same thing from the keyboard.

Change a visit after you’ve signed it

A signed note is the legal record of the visit, so Hero EMR never lets you type over one. When something needs to change afterwards — a result came back, you forgot to document the counselling time, a diagnosis was wrong — you write an addendum. Hero EMR copies the signed note into a fresh, editable version, you make the change there, and you sign again. The version you signed the first time is kept in full and stays readable.

Everything else about the visit carries on as it was: the encounter keeps its signed date, the charges you already submitted stay submitted, and orders you already sent stay sent. An addendum adds to the visit; it doesn’t reset it.

1. Open the signed visit. There are two ways in, and both land in the note writer:
   • From the calendar — double-click the appointment row (Ctrl/Cmd+click does the same thing). Don’t go looking for the hover ▶ Begin encounter button: it disappears once a visit is signed or complete, and that’s expected.
   • From the chart — open the patient, stay on the Encounters tab, and single-click the visit’s row. The split-pane preview opens with a thin action strip on top of it, reading Encounter on the left and an Open encounter button on the right. Click that. (Double-clicking the row opens the same preview as a full-screen window instead — useful for reading, but it has no Open encounter button, so use the single-click preview when you actually want to get in.)
2. Answer the Encounter Already Closed dialog. It opens by itself the first time the note writer loads this visit. It reads “This visit has been signed. Create an addendum to reopen the note and update encounter details.”, with a smaller line underneath: “The prior signed note will be copied as a starting point.” Two buttons:
   • View read-only — you just wanted to read it. Nothing changes and the visit stays signed. Three things tell you where you are: the note is locked, with a grey chip above it reading “This note is finalized. Use the addendum flow to change it.”; down in the completion footer, Sign & Close Visit is greyed out beside the hint “Reopen this encounter to create an addendum before signing.”; and a small Encounter signed pill sits at the right-hand end of the patient header strip, just above the note. Click that pill whenever you want the dialog back.
     • Remember the pill. The dialog is a first-look prompt, not a permanent gate — once you’ve dismissed it, returning to the same visit later in the session opens it quietly, with the pill and no dialog. If you came back intending to amend and nothing popped up, that’s why.
   • Create addendum — Hero EMR copies the signed note into a new, editable version of itself and hands it to you.
3. Write the change into the copy. You are now editing a new version of that note, not the signed one. It starts as a word-for-word copy, keeps the same note label and the same position in the visit, and carries over the note’s patient-portal visibility settings, so a note you had hidden from the portal stays hidden. Add your addendum text however your practice prefers — most clinicians add a dated Addendum: paragraph at the end rather than rewriting the body, so the change is obvious to anyone reading later. The left pane is the same Encounter Completion checklist you used the first time, still carrying the visit’s diagnoses, orders, charges, and follow-up.
4. Let completion re-read the note, if you want it to. Press Save Note and, because the visit already has completion data, the Refresh encounter completion? dialog asks first. On an addendum it says so plainly: “This addendum will be analyzed without clearing the encounter’s existing diagnoses, orders, charges, follow-up, or patient instructions.” Run extraction reads your new text and adds what it finds — a new diagnosis joins the list rather than replacing it, and orders you already sent are never disturbed. Keep existing skips the re-read entirely. Either way you can still edit any section by hand.
5. Sign the addendum. Finish with Sign & Close Visit (or Ctrl/Cmd+Enter), exactly as you did the first time. The same requirements apply — at least one diagnosis, charges or an explicit No charge/Cash pay, every order linked to a diagnosis, and any controlled prescription signed through EPCS (see Sign and close the visit). Your addendum becomes the current version of the note, and the version you signed before it is kept underneath it.

Who can write an addendum

Physicians and practice administrators can always create one. Staff accounts need both encounter permissions on their profile:

A staff member holding only one of the two sees the same dialog with a different message — “This visit has been signed. You do not have permission to create addenda for signed encounters.” — and only the View read-only button. Ask an organization administrator to add the missing permission to the staff profile (see Staff accounts & permissions). Signing the finished addendum is still a physician action, exactly as it is for a first-time visit.

What the chart shows afterwards

1. One note, not two. On the chart’s Notes tab the addendum replaces the note it grew from — you see one row for that note, showing the current version, with its Signed: date. The earlier version isn’t deleted; it’s tucked underneath. The same is true of the note tab strip inside the visit.
2. Read the earlier version from History. Select the note on the Notes tab and click History — the clock button in the preview’s toolbar, sitting next to Print (its tooltip reads View version history). A Version History column opens beside the note listing every version by date and time with the author’s name. Click any entry to read that version in full — chief complaint, subjective, objective, assessment, and plan as they stood then. The same History button is on the toolbar of the full-screen note window.
   • Two badges, two different things. Current marks the version you are reading now — that’s the one that tells you which is live. Active appears on every version whose full text is still stored and instantly readable; once a version passes your practice’s retention window (90 days by default) it is moved to long-term storage and reads Archived instead, and has to be retrieved before you can open it.
3. Nothing is re-billed by accident. Re-reading the note during an addendum deliberately leaves the visit’s charges alone, and it does not redraft the after-visit patient instructions. If the addendum genuinely changes what should be billed, change the Charges section by hand before you sign.