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Kareo Help Center

Using Payer Scenarios

Setting up Payer Scenarios

Use Payer Scenarios to categorize patient encounters according to their billing situation (e.g. Medicare, Commercial, Workers’ Compensation, etc). Kareo adds a standard list of payer scenarios to all customer databases, however, you can customize the list according to the workflow and reporting needs of your organization.

There are a few key benefits from Payer Scenarios. First, they provide your users with a simple categorization scheme for billing situations. Second, you can filter and group various reports by payer scenario. Third, you can configure specific payer scenarios as “unpayable”, which means any charges associated with the payer scenario are not billed to patients. And finally, you can disable sending patient statements for charges associated with specific payer scenarios.

To Add a New Payer Scenario 

  1. Click Settings > Other List > New Payer Scenario.
  2. Enter the following information:
  • Name: Enter the name for the new payer scenario.
  • Type: Select the payer scenario type from the drop-down list ("Attorney Lien," "Normal," "Unpayable," or "Workers Comp").

Note: Any charges associated with a payer scenario that is 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 browser. You will be able to track unpayable encounters through certain reports, but the charges will not be reflected in patient or insurance balances.

  • Send patient statements?: To disable the sending of patient statements for this payer scenario, clear the checkbox.

Note: Any charges associated with a payer scenario that is set to not send patient statements, or any charges associated with a case record that is set to not send patient statements will be excluded from the Patient Statements wizard. Also, any charges which have open balances but which are associated with cases where the Send patient statement? checkbox is disabled will not be included in the list when a user is preparing to generate patient statements, or will not be considered in the patient balance, insurance balance, total balance, or the aging on the patient statements.

  • Description: Enter a brief description to describe the purpose of this payer scenario, if desired.
  1. Click Save.


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