Payer scenarios are used to categorize patient encounters according to their billing situation (e.g. Medicare, Commercial, Workers’ Compensation, etc). Kareo PM includes a standard list of payer scenarios within the application, however, you can customize the list according to the workflow and reporting needs of your company.
Key benefits of payer scenarios:
- Provides a simple categorization scheme for billing situations
- Filter and group various reports by payer scenario
- Configure specific payer scenarios as “unpayable”, meaning any charges associated with the payer scenario are not billed to patients
- Disable sending patient statements for charges associated with specific payer scenarios
To add a new payer scenario
- Click Settings>Other Lists>Find Payer Scenarios on the top menu.
Note: To avoid duplication, a best practice is to first search the database to see if the payer scenario already exists in the system.
- If the payer scenario is not in the system, click New at the bottom.
- In the Name field, enter a name for the payer scenario.
- In the Type field, select the payer scenario type from the drop-down menu. Note that any charges associated with a payer scenario type set to "Unpayable" will be excluded from claims generated by encounters; instead, once an encounter has been approved, it will be placed under the "Unpayable" tab of the Encounters window. Unpayable encounters can be tracked through certain reports, but the charges will not be reflected in patient or insurance balances.
- At the "Send patient statements" checkbox:
- Check this box to enable the sending of patient statements for this payer scenario.
- Uncheck this box to disable the sending of patient statements for this payer scenario.Note that any charges associated with a payer scenario or case record that are set to not send patient statements will be excluded from the Patient Statements wizard and the charges with open balances will not be considered in the patient balance, insurance balance, total balance or the aging on patient statements.
- In the Description field, if desired, enter a brief description of the purpose of the payer scenario.
- Click Save.