Prepaid packages, memberships and deposits: which EHRs actually support them
Three money mechanics that get called the same thing, what breaks when software fakes them, and what four vendors actually publish about each one.
November 10, 2026 · 8 min read
Three of the most useful things a cash-pay practice can sell are a package of sessions, a monthly membership, and a deposit taken at booking. Feature lists lump them together as "flexible billing," and they are not the same mechanism. One decrements a balance. One charges a card on a schedule. One holds money against a future invoice. A system can do one well and the other two badly, which is what usually happens.
The cost of getting it wrong is concrete: a spreadsheet of session balances only one person understands, a patient charged twice for a visit they already paid for, and a profit and loss statement saying you earned money you still owe in services. Below, the three mechanics separated, what breaks when software fakes them, and what four vendors publish.
The three mechanics, properly separated
A prepaid package. The patient pays once for a fixed number of visits, usually at a discount, and the balance draws down visit by visit. Ten acupuncture sessions for $700 instead of $80 each. Money on day one, service over three months.
What the software has to do: store a balance on the patient record, show it at check-in so the front desk does not take a second payment, decrement it when the visit is charged, and report what is outstanding across all patients. That last one is the test. A system that sells packages but cannot total unredeemed value gave you a sales feature, not an accounting one.
A membership. A recurring charge, usually monthly, against a card on file, for ongoing entitlements. Two visits a month, 20 percent off products, messaging access. The money arrives every month whether or not the patient comes in.
What the software has to do: keep a card on file, run charges on a schedule with nobody clicking anything, handle a decline with retries and a notice, and let you pause or cancel mid cycle with the proration you want. The decline part is where memberships quietly die. Cards expire constantly, and if nobody is told a charge failed you lose members one at a time.
A deposit at booking. A partial charge taken when the appointment is made, credited against the final invoice. Fifty dollars on a $250 consultation, days or weeks before the visit.
What the software has to do: take a real charge in the online booking flow, not a card number in a comments field, then carry that amount onto the invoice as a credit so the balance at the counter is $200, not $250. And handle the cancellation cases: deposit kept, refunded, or moved.
The three get confused because in all three the money arrives before the service. That is the only thing they share.
What breaks when the software does not really support them
Balances live in a spreadsheet. The usual workaround, and it fails in a specific way. The sheet sits on one computer, updated by one person, and it is the only record of what a patient has paid for. When that person is away, the front desk either charges for a session the patient already owns or waves it through. In a dispute you have a sheet with no edit history against a patient with a receipt.
Sessions charged twice. The mechanical failure. The visit gets invoiced through the normal flow, because that is what the system is built to do, and the package is not decremented because that is a separate manual step. Patients notice on the card statement, not the invoice, so you hear about it a week later.
Revenue recognition. The one that costs real money at year end. Cash from a ten session package is not revenue when it lands. It is an obligation: you owe ten sessions. Accounting treats it as a liability, often called deferred or unearned revenue, that converts to revenue as each session is delivered. Book it all as income in January and January looks excellent, April looks terrible, and in between you may pay tax on money you have not earned and might refund.
Two more. Expiration: some states regulate how prepaid service balances expire, so check yours before printing a twelve month expiry on the agreement. Provider departure: a patient holds six sessions bought while Dr. Reyes was on staff, Dr. Reyes leaves, and you own the obligation. Decide that in advance.
What four vendors publish
List prices and published feature claims, read on each vendor's own pricing page on November 3, 2026. Where a vendor does not publish the detail, that is what I write, rather than guessing at a feature list on somebody else's behalf.
| System | Prepaid packages | Memberships | Deposit at booking | Fee on top of the processor |
|---|---|---|---|---|
| Noterro | Yes, Max $77 only | Yes, Max $77 only | Not stated | Not published |
| Zanda | Not stated | Not stated | Not stated | Yes, a Stripe connect fee of US$0.50 |
| Carepatron | Not mentioned | Not mentioned | Not mentioned | Not published |
| Cliniko | Not mentioned | Not mentioned | Not mentioned | Not published |
| DrinCloud | Yes, all plans | As scheduled installments, not card-on-file recurring | Yes, all plans | None, the Stripe account is yours |
One line of our own row deserves the asterisk it is carrying. DrinCloud bills a membership as a scheduled installment plan against an invoice, not as an automatic charge to a card held on file. For a practice that wants the money to leave the patient's card on the first of the month with nobody touching anything, that is a real difference and it is the reason to look elsewhere. We put it on the direct primary care page too, because it is the kind of gap that is cheap to discover now and expensive to discover in month three.
The context behind the table matters more than the table.
Noterro puts both features on its top plan. Noterro lists Core at $33 a month, Plus at $55 and Max at $77, each with one practitioner seat. "Packages" and "Memberships & Automatic Payments" appear on the Max card and nowhere else. So a clinic whose charting needs are met by Core at $33 pays $77 to get packages: $528 a year for the billing mechanics, not the clinical software. Better decided knowingly than at upgrade time.
Zanda publishes a fee of its own on top of card processing. Zanda lists Starter at US$29 a month for one practitioner and Growth at US$49 base plus US$29 per extra practitioner. Its online payments section lists "Stripe connect fee: US$0.50" and then "Plus card processing fee (domestic and international cards)," linking out to Stripe rather than stating the card rate. A caveat from my check: the page gives that US$0.50 without saying how often it applies, and the FAQ says only that Stripe "deducts processing fees per transaction and includes a Connect fee." The per charge reading is natural, but get it in writing before you model it. Per charge, it bites hardest on small transactions, which is what a membership is: fifty cents on a $49 membership is roughly another 1 percent.
Carepatron and Cliniko do not publish the detail. Carepatron lists Free, Plus at $31 per user and Advanced at $39 per user, with a 50 percent six month discount showing when I looked. Cliniko lists $45 for one practitioner up to $395 for 26 to 200. Neither page mentions prepaid packages, session packs, memberships as a billing model, or booking deposits, and Cliniko's only prepaid item is SMS credit at 10 cents a message. That absence is not evidence the features are missing: both are serious products and the capability may exist under another name, such as concession passes. It does mean you cannot verify it before a sales call. What they do publish is in our EHR pricing index.
The processing fee question, answered honestly
Vendors handle card fees two ways and the difference gets oversold, including by us.
Some act as the payment facilitator and quote one all in rate: Jane publishes 2.85 percent plus $0.25 online, SimplePractice 3.15 percent plus $0.30. Those are complete numbers, not surcharges. Others, us included, have you connect your own Stripe account, so Stripe bills you directly at its published rates, 2.9 percent plus $0.30 online in the US. Against SimplePractice we come out cheaper, against Jane's online rate slightly dearer. Nobody is saving thousands of dollars here.
What is genuinely different is ownership. The Stripe account is in your name, so a volume discount you negotiate is yours, and if you already run Stripe you keep your rate. We add nothing on top. More on the payments page.
Seven questions to ask before you buy
Ask these in a live account, with the vendor driving.
- Sell a ten session package, check the patient in, show me the balance go from ten to nine.
- Show me total unredeemed package value across all patients, as of a date.
- Refund a partially used package. What does the system calculate, can I override it?
- Set up a $99 monthly membership and show me the schedule of future charges.
- Make a membership card decline. What happens, and where do I see it?
- Book online with a $50 deposit, then show me the invoice at the counter with $200 due.
- Cancel that appointment inside the cancellation window and outside it. Show me both.
If a vendor cannot do all seven live, the feature is on the website rather than in the product. Pairs with the real monthly bill at one, two and three clinicians and, if the money side is what you are weighing up, what a direct primary care practice actually needs.
Frequently asked questions
What is the difference between a package and a membership?
A package is a one time payment for a fixed number of visits that draws down as they are used, so the obligation shrinks to zero. A membership is a recurring charge that renews indefinitely. Packages need a decrementing balance. Memberships need a card on file, a charge schedule, and a process for declines.
Which EHRs support prepaid packages?
Among the systems checked on November 3, 2026, Noterro publishes packages and memberships on its Max plan at $77 and not on cheaper plans. Carepatron and Cliniko do not publish the detail, so ask for a live demonstration. We support packages, memberships and booking deposits on every plan.
The bottom line
Packages, memberships and deposits are three separate pieces of machinery, and a vendor supporting one is not supporting the other two. Get all three demonstrated live, get the unredeemed balance report in front of you, confirm any per transaction fee on top of the processor, and talk to your accountant about deferred revenue before you sell the first package.
DrinCloud is practice management and charting for US cash-pay clinics, with prepaid session packages, a deposit charged at online booking and memberships billed as scheduled installment plans, on every plan, from $49 a month. There is no automatic card-on-file recurring charge and we say so before you sign up. You connect your own Stripe account and we add no fee on top.
See it in your own practice
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