New Encounter: Professional (CMS-1500)
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Encounters are used to capture information and charges for a patient visit with a provider. The Encounter record includes general information about the visit, the patient’s condition, the parties responsible for payment and the treatment rendered by the provider.
- To aid in efficiency when users create new encounters, System Administrators can set default information under the Encounter Options.
- If you are billing for anesthesia services, there are specific settings that must first be configured for Anesthesia Services within Kareo so that the charges calculate correctly on the encounter.
Follow the steps below to create a new encounter using the Professional (CMS-1500) claim format.
- Do one of the following depending on the window currently open:
- Practice Home window: Click Encounters > New Encounter. The New Encounter window opens then proceed to step 2.
Tip: For faster navigation, click the New Encounter icon or press F4 on your keyboard.
- Edit Patient window: Click Create Encounter on the bottom of the window. The New Encounter window opens then proceed to step 2.
- Calendar window: Right click on the patient's name and select Create Encounter. The New Encounter window opens then proceed to step 2.
- Enter the necessary information.
Note: Certain information auto-populates depending on the window the New Encounter was initiated from, default information set (e.g., in the Patient record or Encounter Options), and the records (e.g., Appointment, Patient, Case) selected in the encounter.
- Patient section:
- Click Appointment to search and select the appropriate patient appointment if applicable.
- Click Patient to search and select the appropriate patient.
- The case auto-populates when there is only one case under the patient's record. Click Case to select a case when there are multiple or to create a new case under the patient's record.
- Click Prior Authorization to select or enter authorization information if required.
- The Primary Insurance displays the primary payer within the associated case. Click the insurance name to edit the insurance if needed.
Note: The Secondary Insurance displays when there is a secondary payer in the associated case.
- If not already selected, click to select Professional (CMS-1500) in the Bill Primary drop-down menu.
Note: The available formats are set under the Claim Formats section of the Encounter Options.
- If needed, click to select "Do not send claim electronically" to prevent the claim(s) associated with the encounter from submitting electronically to the payer.
- Dates section: Enter service dates, posting date and optional batch number.
Tip: Entering a Batch # is helpful for running reports when there is a consistent naming convention such as the posting date with the user's initials (e.g., MMDDYYYYAB). Then, when running a report (e.g. Encounters Summary), customize and filter by that specific Batch #.
- Provider section:
- Click to select the provider who provided services to the patient from the Scheduling Provider drop-down menu.
Note: Auto-populates based on this order; the provider on the associated Appointment record, the Default Rendering Provider on the Patient record, the Scheduling Provider from the patient's previous encounter, or the default Scheduling Provider set in the Encounter Options.
- Click to select the provider used for paper and electronic claims billing from the Rendering Provider drop-down menu.
Note: Auto-populates based on this order; the provider on the associated Appointment record, the Default Rendering Provider on the Patient record, the Rendering Provider from the patient's previous encounter, or the default Rendering Provider set in the Encounter Options.
- Click Supervising Provider to search and select if both the rendering and supervising provider is required by the payer.
Note: Auto-populates based on this order; the Supervising Provider from the patient's previous encounter or the default Supervising Provider set in the Encounter Options.
- Click Referring Provider to search and select a provider if applicable.
Note: Auto-populates with the default Referring Physician on the Patient record.
- Click to select the Location where services were rendered.
Note: Auto-populates based on this order; the Location on the associated Appointment record, the Default Service Location on the Patient record, or the default Service Location set in the Encounter Options.
- Place Of Service: Auto-populates based on the Location selected. If necessary, click to select a different Place Of Service from the drop-down menu.
- Encounter Mode: Defaults to In Office.
Note: The Encounter Mode feature is available for Kareo Telehealth subscribers but coming soon for all customers.
- To indicate a telehealth visit, click to select Telehealth from the drop-down menu.
- Payment section:
- Copay Due: Displays the Copay amount from the primary insurance policy within the associated case.
- If applicable, enter the Payment Amount. Once entered, additional fields become available:
- Click to select the Method of payment from the drop-down menu.
- Click to select the Category from the drop-down menu if the practice uses categories for certain payment reports.
- If applicable, enter the Reference # (e.g., check number).
- Memo (Optional): Enter notes related to the payment.
- Procedures section: Enter procedures, diagnoses and charges.
Note: Customize the Procedures section as needed.
- Mode: Defaults to the ICD codes the Primary/Secondary Insurance accepts. Click to select ICD-9 or ICD-10 as necessary from the drop-down menu.
- Click the field under a column to enter data.
Tip: Enter "?" in the procedure or diagnosis fields to search and select from the codes list.
Note: Enter the procedure macro name in the procedure field if the practice uses Procedure Macros.
- To see the procedure or diagnosis code description, hover over the procedure or diagnosis code.
Note: Descriptions display if they have been enabled under the Procedure Lists section of the Encounter Options.
- To reorder a service line, right click on the service line and select Move Up or Move Down.
- To remove a service line, right click on the service line and select Remove Procedure.
- Hospitalization Dates section: Click the double arrow to expand or collapse this section. Enter the hospitalization Start Date and End Date if the patient was hospitalized due to a condition related to the encounter.
- Miscellaneous (CMS-1500) section: Click the double arrow to expand or collapse this section.
- Submit Reason: Defaults to 1. Click to select another code from the drop-down menu only when it is specifically required by the payer.
- If submit reason code 6, 7, or 8 is selected, enter the associated Payer Doc Ctrl # (Payer Document/Claim Control Number) as required by the payer for claim processing.
- Claim Code (Box 10d): Designated by NUCC. When applicable, enter up to 19 characters to report appropriate claim codes to identify additional information about the patient's condition or claim.
- Add'l Claim Info (Box 19): Designated by NUCC or by a specific payer. When applicable, enter up to 71 characters to identify additional information about the patient’s condition or claim.
- E-Claim Note Type: When applicable, click to select the note type in the drop-down menu. Then, enter the E-Claim Note to be submitted to the payer as part of the ANSI 837 electronic claim format.
- Ambulance section: Click the double arrow to expand or collapse this section. Used only for billing Ambulance Services.
- Office Notes section (Optional): Enter any Medical or Business Office Notes (determined by the type of user currently logged in) related to the encounter.
- When finished, do the following as necessary.
- To perform a code check to validate the claim data against such coding rules dictated by Medicare, Medicaid, National Correct Coding Initiative Edits and other standard coding rules, click Check Codes.
Note: This feature can also be enabled to automatically perform a code check upon encounter approval under the Encounter Options.
- To place the encounter under the Draft status (to be completed), click Save as Draft.
- To place the encounter under the Review status, click Save for Review.
- To place the encounter under the Approved status and create claims associated with the encounter, click Approve.