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Kareo Help Center

About Contracts and Fees

Healthcare providers keep track of the procedures they perform, and associated fees for those procedures, through fee schedules. Fee schedules can be divided into two different categories: Standard Fees and Contract Rates.

Though most practices bill out claims utilizing a standard fee schedule, Kareo PM also provides an option to bill by contract rates. It is important to note that there are laws and terms within payer contracts that govern what practices can bill individual payers, especially if billing Medicare. Be sure to confirm with your payers regarding rules and restrictions before submitting by contract rates.

  • Standard Fees: These are typically the default charges for the practice. Many consider it a best practice to always bill out based on the practice's standard fee schedule and make adjustments after reimbursement from the payer. Standard fee schedules typically contain fees that are higher than the contract rates for the same procedures.

  • Contract Rates: Used to track a pre-negotiated fee schedule associated with a contract between a health care provider and a government payer or an insurance company. It's important for the practice to import contract rate schedules so they can be referenced when receiving reimbursement from a payer.

Capitated Accounts

When creating new contract rates with a payer, you will have the option to mark it as capitated; all procedures by default will then be treated as covered by the capitated insurance plan. This means that the system will automatically adjust the balance on capitated charges to $0.00 upon approving an encounter where the primary insurance policy is governed by a capitated payer. However, you can also carve out specific procedures as fee-for-service exceptions to the capitated insurance plan by adding the procedures and charge amount to the corresponding capitated contract fee schedule. You can also set up capitated accounts in the system and apply portions of a payment to a capitated account (see About Capitated Accounts).

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  1. Select to add standard fees or contract rates.
  2. Configure settings for how your practice will bill, including provider type for Medicare rates.
  3. Click to add a new fee schedule.
  • Select the options that will apply to your practice.
  • Click Save & Submit.
  1. Click to view, edit or print a fee schedule.
  2. Indicates the source of the fee schedule.
  3. Indicates if the fee schedule is active, scheduled, unused or expired.
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