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 (a fixed Service Menu price counts even when it is hidden from patients). With no visit price but with billing codes on the visit, the cash price is worked out at signing from your CPT List Prices for those codes — and if one of those codes has no price, signing stops with “Cash pay needs a price for every signed code, and 99050 has none. Set a cash-pay amount for this visit, or ask billing to set a price for 99050 in CPT List Prices.” With no price and no codes, or for an Office review service, the caption reads Price required and an administrator or billing staff member with charge-management access enters a one-time amount before you 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.

Injections and other medicines given in the office

With In-office medications on, you don’t type drug or injection codes here. Each dose recorded in Medications given in clinic adds its own lines to Charges: the drug code with its units and NDC, JW or JZ, and the injection code such as 96372. Change those lines from Medications given in clinic, not here; see Billing for medications given.

Superbill or Good Faith Estimate for a patient paying out of pocket

When the visit is cash pay, the patient has no insurance on file, or the practice is out of network with their insurer (from the latest eligibility check, or your payer contracts), a bar in Charges says why — Cash pay., No insurance on file., or Out of network with {payer}. — and offers Superbill and Good Faith Estimate. Each saves the note first, then opens filled in from the codes and diagnoses already on this visit, ready to issue in two more clicks. The bar shows only to users who can see financial amounts: Superbill needs access to the patient’s invoices, and Good Faith Estimate needs admin or billing.charges.manage. A No charge visit shows no bar. The documents themselves are described under Financial documents.

Place of service

Place of service sits at the top of the Charges section, next to Manage. It is the CMS code the claim is filed with — where the service actually happened.

1. Leave it alone for an ordinary visit. The selector starts on Default, and the option names the code Hero EMR will use — for example Default · 11 Office, Default · 10 Telehealth, patient at home for a telehealth visit type, or Default · 22 On-campus outpatient hospital for a visit booked with an outside-facility visit type. Nothing changes from how visits have always been billed.
2. Override it when you worked somewhere else. Pick the place that matches; each option names its code: Office (11), On-campus outpatient hospital (22), Inpatient hospital (21), Ambulatory surgical center (24), Off-campus outpatient hospital (19), Emergency room, hospital (23), Skilled nursing facility (31), Nursing facility (32), Independent clinic (49), Public health clinic (71), Home, in person (12), Telehealth, patient not at home (02) or Telehealth, patient at home (10). Home, in person (12) is for a visit at the patient’s home in person; a video visit with the patient at home is Telehealth, patient at home (10) (see Where was the patient?). An explicit choice is badged OVERRIDE, and the claim is filed with it — the Billing Command Center will not flag it as the wrong place of service.
3. Go back to the default. Choose Default … again at the top of the list.
4. The facility on the claim. When the code is a hospital or facility setting, Hero EMR puts the facility's name, NPI, and street address on the claim as the service facility (CMS-1500 box 32): the facility chosen when the visit was booked with an outside-facility visit type, or, for a visit booked at one of the practice's own locations, that location. Keep those details current under Visit Config and Locations.

Rounding visits linked to a hospital admission are the exception: their place of service comes from the admission's patient class, so the selector is not offered there.

Hospital visits and consultant stays

For a hospital stay, Your role on this stay distinguishes Admitting / attending from Consultant. Visit roles follow service-date order, so a backdated first visit can change which later visit is a follow-up. Check the role shown above charges before choosing the E/M code.

Hero warns about an initial-care or consultation code on a follow-up and about modifier AI when the visit is not the admitting/attending physician’s qualifying initial care. Signing checks the billed lines for hospital visits. Correct the stay or visit role and the codes when they disagree. An unsigned discharge note must be changed to an appropriate follow-up before switching a stay to Consultant; consultants do not write a discharge-management note through the discharge action.

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 scheduler in its own tab with the chosen visit type selected, on the follow-up’s due date — or the first day with openings after it — with that day’s first open time picked and a note such as “Follow-up due Nov 21 → first opening Mon, Nov 23” (or “Follow-up due Nov 16 has openings”). Change the time if you like, then press Book. The booked visit is linked back to this follow-up.
   • 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.

Review medications during the visit

The Medications section shows the same list as the chart’s Medications tab in a compact form. It has the same groups (Needs review, Current, Scheduled, On hold and Past), the same names and release badges, the same supply lines and the same buttons. It also shows which chart medications this visit reorders, alongside what you are prescribing today and what you are stopping when you sign. Collapsed, the section header sums it up, for example 7 current · 2 to review · 1 stopping at sign · 1 new prescription.

1. Watch the footer chip. The footer always shows a Meds chip next to Dx, Orders, E/M and F/U, for example Meds 7 · 2 to review. It turns amber while anything needs review, and clicking it jumps to this section. Its numbers always match the section’s group headers and the chart tab. With medication reconciliation on, it also shows (N pending) or (N to reconcile).
2. Check Prescribing today. Prescriptions in this visit’s Orders that are not on the list yet appear at the top, each marked Draft or Sent. The block is Read only. Change a prescription in Orders.
3. Work Needs review. Rows that ran out, that the patient reports not taking, that couldn’t be matched or that were imported without a status offer the same buttons as on the chart: Reorder, Still taking, Specify, Merge, and Stop at sign in place of Stopped. The chart tab explains what each one does.
4. Reorder adds the prescription to this visit. Inside an open visit, Reorder doesn’t open a separate order. It adds the renewal to this visit’s Orders, filled in from the last prescription with the product, directions, quantity and days’ supply, set to 0 refills and linked only to diagnoses already on the visit. Hero then expands Orders and opens the prescription in Edit Medication so you can check it. The summary at the bottom of the dialog shows Last sent to: and the earlier pharmacy. If this visit’s pharmacy is different, it says so, so you can switch under Pharmacy if the patient wants the earlier one. The renewal is signed and sent with the visit like any other order. Clicking Reorder again opens the one already staged (“already in this visit’s orders”) instead of adding a second. The renewal is for the product the chart lists, so if you used Specify to pick the ER form, the ER form is what gets renewed. If there is no prescription on file to copy, or Hero can’t confirm the product or how it is dispensed, nothing is added. Instead Hero opens the order search with the medication’s name (“Choose the product for …”) so you pick it. A signed visit takes no new orders, so renew from the chart instead.
5. Stop a medication at sign. Rows in Current, Scheduled and On hold carry Stop at sign. Clicking it turns the row amber with a Stopping at sign chip and a Discontinuation reason box, so you can document why. The button becomes Keep in case you change your mind. The row leaves the counts straight away, and the medication is discontinued when you click Sign & Close Visit. The note above the list says so: “Use ‘Stop at sign’ to discontinue a medication when this encounter is signed.”
6. Check stops Hero suggested. When Hero reads a stop in your note, it queues it for you. The row shows Stopping at sign plus a Suggested chip, and it will be discontinued at sign like your own stops. If the patient should stay on it, click Keep. With medication reconciliation on, suggestions work differently: nothing is queued, and the row shows Suggested stop with Discontinue and Dismiss (see The workspace).

AI-suggested reorders stay linked to the existing medication. Pressing Reorder accepts that suggestion or opens the reorder already staged, avoiding a duplicate. Orders tags the prescription as a reorder. A new reorder clears a queued stop for the same medication; stopping an unsent reorder asks you to Keep reorder or Remove reorder and stop. A prescription already sent or locked cannot be silently removed.

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 after the signing checks pass. 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.

If the open draft belongs to another clinician or is read-only on this device, the sign area explains why it cannot be signed. Resolve that ownership or editing restriction first. A visit dated after today also asks for confirmation before signing; verify the date before proceeding.

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.

Discard an untouched addendum

If you opened an addendum accidentally and have not saved or changed it, use Discard empty addendum, then Discard addendum. The signed note remains unchanged. The draft author, the visit’s physician, or an administrator can do this when the draft qualifies. An addendum with structured-data changes may need support review even when its note text looks unchanged.

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. Change charges right in the addendum — Hero handles the billing. Re-reading the note during an addendum leaves the visit’s charges alone, and it does not redraft the after-visit patient instructions. The Charges section stays open in every addendum, so you can add a missed code, fix a modifier, or record time. A short line above it tells you what will happen when you sign:
   • Claim not sent yet — your changes update the claim when you sign.
   • Claim already sent (or a payment is posted) — the addendum still signs, and your changes go to your billing team for review as a corrected claim. You are never blocked from signing.
   If you don’t touch the charges, billing stays exactly as it was. While an addendum with charge changes is open, Hero holds the visit’s unsent claim from automatic sending until you sign or discard it.

Send notes for co-signature: assign a reviewer or set supervision rules

Co-signing is off by default. A practice administrator or user with organization-management access opens Admin → Co-signing, turns on Enable co-signing, selects Who can co-sign, and saves. That is enough for clinicians to pick a reviewer note by note; the other settings are optional and also off until you set them. Turning the feature off prevents new requests; existing requests remain available.

The window checks the rules before it saves, for example “A rule’s co-signer must be checked under Who can co-sign.” or “A clinician cannot co-sign their own notes.” To untick a co-signer a rule names, change or remove that rule first.

How a note reaches a co-signer

1. Assign a reviewer from the desktop sign button. Open More signing options beside the sign button and choose Assign co-signer…. Search for an eligible provider other than the note’s author.
2. Choose Assign or Assign & sign. The first saves the reviewer choice; the second also starts your usual sign workflow. Before completion, Change co-signer… and Remove co-signer are available when you have access. A signed note also offers Request co-sign.
3. Or let a supervision rule send it. When a clinician with a rule signs a note for the first time, Hero sends it to the rule’s co-signer: every note under All signed notes, or, under a share, notes picked at random one by one, so nobody can tell in advance which will be picked. A rule covers every note the clinician signs in Hero, not only visit notes. Addenda and later versions, appointment cancellation and screening notes, and imported notes are never sent. A reviewer assigned before signing is kept, and a rule never sends the same note twice.
4. Controlled-substance rules. Under Notes with a controlled-substance prescription, a note is sent when its visit has a C-II to C-V prescription written in Hero that is signed, sent, or waiting for a supervising physician’s signature; the prescriber does not have to be the note’s author. A refill sent from the Refill Center counts for its refill note. Drafts, cancelled, errored and deleted prescriptions, pharmacy requests nobody has answered, and imported medication history never count. If the prescription is signed after the note (for example, the EPCS approval comes in later), the note is sent at that moment, as long as it was signed after the rule was saved and has never been sent by a rule. Under Controlled-substance notes + a share of the rest, every controlled-substance note is sent and the other notes are picked at random at the percent you choose.
5. The reviewer opens the request in the Inbox. In the Co-sign folder, read the full signed note as well as the AI summary. Under Statement source, choose Practice default or one of your dotphrases, edit Co-sign statement, then press Co-sign note. Due dates, filters, co-signing several notes at once, and the All co-signers view are in Co-sign folder; the monthly report is in Co-sign report.

While a signed note waits, it shows Awaiting co-sign · Ana Rivera; once co-signed, Co-signed · Ana Rivera, which opens the date and the statement. Co-signing is a separate review of a signed note; assigning a co-signer does not replace the author’s signature or make an unsigned draft complete.

Sign a visit documented by an attached outside note

When your own note for this visit is already attached as an outside note, you can use that document as the visit’s documentation without signing an empty or duplicate Hero draft.

1. Verify the attachment belongs to this visit. Encounter Completion names the attached outside note. Choose Use the outside note as this visit’s documentation — don’t sign my draft note.
2. Read Use the outside note only?. It lists drafts that will be removed when you sign, including whether they contain writing. Confirm with Use outside note only. If there is no draft, there is nothing to remove.
3. Review diagnoses, charges, and orders, then sign the visit. The outside-note choice does not discard those structured details or bypass the other signing checks. If a draft or attachment changes after confirmation, Hero asks you to review the choice again.

Use Sign my visit note if you want to sign the Hero draft instead. An unrelated outside record is not a substitute for your documentation of this visit.

Video visits: say where the patient was

A video visit is billed differently when the patient was at home than when they were somewhere else (place of service 10 or 02), so Hero asks one plain question, Where was the patient?, and remembers each patient’s answer for their next video visit. You never have to pick a code for it.

1. Find the chip in the note. On a video visit, the note toolbar shows a chip just before the date of service: Patient at home, Patient not at home, or, in amber when nothing is known yet, Patient location?. Hover it to see where the answer came from: this visit, From this patient’s last video visit ({date})., or Your practice’s default.
2. Click it to answer or change it. Choose At home (Their home or another private residence) or Not at home (Work, school, a car, a clinic or another facility). One click saves it. A suggested answer shows where it came from, for example Suggested from the visit on Oct 2.
3. Sign as usual. Signing records the answer the chip shows. Only when Hero knows nothing at all (no answer on the visit, no earlier video visit, no practice default) does Sign & Close Visit ask Where was the patient during this video visit?: “This decides how the visit is billed. Hero remembers it for this patient’s next video visit.” Picking an answer saves it and signing goes on; Cancel leaves the visit unsigned.

After signing, the chip is read-only (Recorded when the note was signed.). The question is only asked for a billed visit: not on an addendum, a No charge visit, or a visit whose Charges already name a different place of service.

Place of service 12 on a video visit

In Charges, place of service 12 is labelled Home, in person (12): it means the clinician was at the patient’s home in person. If 12 is chosen on a video visit, Charges warns “Place of service 12 is for an in-person visit at the patient’s home. For a video visit with the patient at home, answer ‘At home’ under ‘Where was the patient?’ (place of service 10).” and offers Use “At home” (10) instead, which clears the 12 and records At home. On an addendum the button reads Use “Telehealth, patient at home (10)” instead. The warning never blocks signing; billers see the same warning on the claim.

The practice default

In Billing → Configuration → Claim Submission, Telehealth patient location default is used only for a patient with no earlier answer: No default: clinicians answer for each patient, Patients join from home — POS 10 (non-facility rate), or Patients join elsewhere — POS 02. The claim must match where the patient actually was, so clinicians still change the chip whenever the default is wrong.