Adding patient responsible fees

We want be able to add a fee that is to be paid by the patient and not get sent to the clearing house when we transmit the billing at the end of the day.

The fee we want to add is a “no show fee”. I see where people have asked this question in the past for earlier version of emr. We are using V7 P2. I was wondering if that is a capability that has been added in version 7.


Hi @bearzillasquatch -
When I worked on this a few years ago OpenEMR allows for adding custom codes to the fee sheet which will appear in the Fees/ Payment, and Fees/ Checkout screens but will not be sent in the claim file to the clearinghouse. Pretty sure it still can do this.

This page gives the all the necessary steps even though you will have to adapt the instructions to your specific task:

  1. Edit the ‘Code Types’ list and create a new usefully named custom code type, perhaps, ‘In House Codes’
  2. Create the code itself in ‘Admin/ Codes’ and assign to it all the desired values, like the name, the dollar amount etc.
  • you can assign it any code number that is not already used by the official codesets. E.g., IH0001 (for, ‘InHouse’???). Be sure you can use alphanumeric in the code, or maybe it’s just numeric…
  1. Assign the code to your custom code type and put it in the category you want it to appear in on the fee sheet.
  2. When filling out the fee sheet, open that category’s dropdown and select the fee. It will appear in invoices and the Payments/ Checkout screens. Since it’s not a billing code it will not be sent to the clearing house.
    Good luck!
  • HT

Thanks for the info. That appears to be the best solution at this time.

Ultimately I wish we didn’t have to create an encounter for a no show. But I’ve been looking at the billing part of the code and it seems as though every query oemr makes with regards to billing and patient balances requires an encounter number. So i guess making a non-encounter fee would be a major undertaking.

hi @bearzillasquatch, just as an aside found this article that talks about best practices for handling no shows.

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@stephenwaite That’s good information. We do some of the good things in the article. There is always room for improvement.

We don’t charge the patient a fee unless they have 3 unexplainable missed appointments. Fortunately that doesn’t happen very much but it seems to be happening more often as time goes by.

@bearzillasquatch -
You are correct in what you said just now-- I realized I had mis-red your original post so was correcting mine when you replied to my latest! :slight_smile:

I sympathize with your wish to be able to charge a no-show fee without creating an encounter, but OpenEMR’s patient records are almost completely encounter dependent. Everything that happens to a patient is associated with an encounter. But that’s good: if you want to run a report to find how many times a patient pulled a no-show, or how many no-shows have occurred in your practice over a period, that report looks at encounter statuses.

You can set the status type of ‘No Show’ to create the appointment and so reduce the number of clicks involved: In ‘Admin/ Forms/ Lists’ open the Appointment Status list and select ‘Check In’ for the ‘No Show’ status. That will make that status be a ‘Check- in’ operation which will create the encounter form when that status is selected.
Screenshot at 2023-12-13 10-46-03

If you were thinking of customizing your system to avoid using encounters you might instead invest the dev time in automatically adding the no-show fee to the encounter’s fee sheet when the ‘? No Show’ status is selected. But that’s getting into the dev business and I am not a dev.

Good luck- Harley

@htuck that’s what we do.

The problem is, if we charge a no show fee we have to create an encounter to add a fee sheet with the fee. I don’t see anyway to create a fee sheet and add a fee without there being an encounter. If that’s not correct I’m eager to hear how to do that.


@bearzillasquatch - please see my revised post before your latest!
Best- Harley

@htuck , that makes sense.

In my mind i don’t “like” the idea of creating an encounter just to add a fee. But if that’s what has to be done then it has to be done.

Thanks for all the useful info.

You’re v welcome, and maybe your practice managers can find a worthwhile use for the extra data that will (or could) be generated from ‘no show’ encounters.
Best- HT

I’m not sure if this is still relevant but there’s the link to the ‘Custom
Service Codes for v7’ docs I just posted to the wiki…

The section relevant to the ‘Patient Responsible Fees’ is described the Appendix, calling them ‘in-house codes’

For some reason putting the url in here doesn’t bring up the page, but if you go to the wiki and use the search tool at bottom for
HOWTO: Add Custom Service Codes To The Fee Sheet - Updated
it does…
Best- Harley

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I followed the new instructions and it works like a champ.

Thanks Harley

Alriiiight-- glad it works for you!
Best- HT