Billing setup

Find billing configuration and learn the three layers

All billing configuration lives in the Billing Command Center (Admin > Billing). The left sidebar groups screens into Operations (day-to-day work), Programs, and Configuration (setup). Everything in this part lives under Configuration, and almost every rule resolves through the same three-layer hierarchy.

1. Open Admin > Billing. The Command Center opens on the Dashboard. Confirm the practice name and payment model in the header (for example, Dr. Romero's Practice · Insurance) — the payment model decides which configuration tabs appear.
2. Find the Configuration group in the sidebar. It holds Payment Model, Collections & Fees, Service Menu, Subscriptions, Charge Fees, Claim Submission, and Simulator.
3. Learn the three layers. Collections & Fees sets the organization default; the Service Menu adds per-service overrides; the patient chart's Billing tab adds per-patient exceptions. Each layer only changes what it explicitly sets — anything left on Use organization default inherits from the layer above.

Set organization billing defaults in Collections & Fees

Collections & Fees is the organization-wide baseline — the rules applied to every visit and every patient unless a service or patient overrides them. A Live summary across the top recaps the current posture (payment model, default collection, billing-type rules, missed-appointment fees, outstanding-balance guard, saved card) so you can see the effect of your changes at a glance.

1. Default pre-visit collection. Collect a payment at booking? (Yes / No), and if yes, What do you want to collect? — Copay only (use the eligibility copay when available) or a Fixed deposit. Turn on Use different rules per insurance or billing type? to vary by payer — for example, require a deposit from Cash Pay patients while collecting only copays from insured ones, with cash-pay upfront options of No upfront, Full cash price, Fixed deposit, Percent of price, or Office review.
2. Saved card & autobilling. Require a saved payment method to book? (Yes / No), and whether saved cards are charged automatically before the visit — Off, Simulate, or Live — with a lead time (hours), retry count and backoff, and a failure action (Staff review or Mark unpaid).
3. Missed appointment policy. Late cancellation: a free-cancellation window (minutes) and a fee of No fee, Fixed $, or Forfeit deposit. No-show: a fee of No fee or Fixed $. Cancellation fees apply before the visit; no-show fees apply after the appointment time passes.
4. Outstanding balance & scheduling. Decide whether an unpaid balance blocks new appointments: Off, Any balance, Threshold (block above $X), or Threshold + age (also weigh how old the balance is). An optional payment-plan exception lets enrolled patients keep scheduling.
5. What patients see. A live preview of the exact booking and check-in messaging your settings produce — useful for confirming the patient-facing wording before you save.
6. Insurance & routing options. Collect patient share only applies the collection rules to the patient's portion (copay / coinsurance) rather than the full billed amount; an online-fallback option lets cash-only offices still take portal payments.
7. Claims processing defaults. (Insurance-style payment models.) Organization-wide claim defaults — Accepts assignment and Participating provider — applied to professional claims; set here, not on physician profiles.
8. Validate and save. Validate Policy checks the combination for conflicts before you commit; the footer shows the policy version and last-saved time.

Override pricing and rules per service in the Service Menu

The Service Menu lists every service — a provider paired with a visit type — alongside the patient-facing price and collection rule. Any service can override the organization defaults from Collections & Fees; leave a field on Use organization default to inherit it. This is how a free telehealth check-in and a $250 cash physical can live in the same practice.

1. Open the Service Menu tab. The table lists each service with Provider, Visit Type, Duration, Online, Patient Sees, Collection, and Status. A banner counts online visit types that still have no price set, and the Status column marks rows that carry service-level overrides.
2. Edit a service's pricing. Click Edit. Price mode offers Use organization default, Free, Fixed cash price, or Office review; set the Cash price, an optional Display label (for example FREE, $150, or Contact office) that overrides the auto-generated price text, and Show price in patient portal.
3. Set pre-visit collection for the service. Collection policy ranges across No collection, Card on file, Required at booking, Suggested before visit, Required before visit, Collect at check-in, and Invoice after visit, with deposit type/amount/percent, balance collection, an hours-before-visit window, and an Insurance vs. cash handling choice (Use organization default, Insurance when available, Cash only, or Office review).
4. Override cancellation & no-show (optional). By default the service inherits the organization policy. Tick Override for this service to set a service-specific cancellation window and fee and a no-show fee; leave it unchecked to keep using Collections & Fees.
5. Override saved card & autobilling (optional). Card on file and Auto-charge mode each default to Use organization default; switch either to require/skip a card, or to off/simulate/live auto-charge, for this service only.
6. Save. Use Apply to same name to push the same settings to identically named services across other providers in one step.

Override billing for one patient from the chart Billing tab

The narrowest layer applies to a single patient and beats both the service and organization rules. It lives on the patient's chart, not in the Billing Command Center: open the patient info bar at the top of the chart, then the Billing tab.

1. Open the patient and the Billing tab. In a patient chart, click the patient's name in the patient info bar to open the demographics dialog, then switch to the Billing tab (alongside Demographics and Insurance).
2. Set exceptions. Bypass card on file means card requirements won't block this patient from booking; Bypass booking collection moves any booking-required collection to check-in for this patient.
3. Set per-patient cash rates. The Cash charge rates table lists every visit type and provider with the read-only Service rate (the inherited service-level default) beside an editable Patient cash rate. Leave it on Default to inherit, or type an amount and Save to override; the reset button clears an override and returns the patient to the service rate.
4. Reclassify on the Insurance tab (related). The neighboring Insurance tab carries Bypass insurance (treat as cash pay) and a manual Billing type — use these to move a patient to self-pay or set their billing classification.

Preview the result with the Simulator

The Simulator answers “what will actually happen if I book this?” without touching a real appointment. Pick a patient, a service, and a scheduled time, and it resolves all three layers — organization, service, and patient — into a concrete scheduling and charge outcome. It is read-only: nothing is booked or charged.

1. Open the Simulator tab and set the inputs. Choose a Patient (search by name or MRN), a Visit type (any provider + visit type), and a Scheduled time, then click Run simulation.
2. Patient and Coverage. Confirms the patient's billing type, insurance status, primary payer, and plan — the inputs that steer the insurance-vs-cash path.
3. Booking Gate. Whether the patient can book, any outstanding-balance action or override, whether online collection is available, and provider readiness.
4. Saved Payment Method. Whether a card is required, its readiness, the default card on file, and the auto-charge mode and lead time that would apply.
5. Quote & Charge Timeline. The resolved Path (Insurance, Cash, …), the patient-facing label, and the amounts due at booking, before the visit, and at check-in — plus any projected collection events on the timeline.

How a charge is decided, and common gotchas

When Hero quotes a patient at booking or check-in, it resolves the three layers from most specific to least: the patient's exception or cash rate first, then the service-menu override, then the organization default. Use the Simulator (§5.5) to preview the resolved outcome for any patient and service.