Adding contract rates assists in tracking the fees that have been agreed upon from specific payers. 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.
When adding a new contract, you can easily select how you want to add the procedures and fees: Either manually or by importing or copying an existing schedule. Once added, your Contract Rates list will include all payer-specific contracts, the effective dates of the contracts, the basis or "source" of the fee, and the status.
To add contract rates
1. Click Settings > Contracts & Fees.
2. Click the Contract Rates tab.
3. Click Add New Contract Rates.
4. Select an insurance company.
5. Select an option to add the procedures and fees:
- Import from file: This option provides an Excel template to help you enter your fee schedule in the correct format. Once you have done this, choose the file for import. Once the file is imported, you can make edits to the schedule (see below).
- Add Procedures and Rates Manually: Enables you to manually enter each procedure and fee (see below).
- Copy from existing Contract: Allows you to copy a fee schedule that was already created or that is from another practice on your account. After selecting the file to copy, you can make edits to the schedule (see below).
Add Procedures & Fees Window
a. Select how you will add fees:
Add fees manually - Allows you to enter (or modify) the fee amount for each procedure that you add.
Base on Medicare - Updates the entire fee schedule based on Medicare rates; the Medicare rates are based on your service location; see Tip below; see Tips below.
b. If you selected to base the fees on Medicare rates, enter a percentage and select the rates you want to base the fees on.
c. Enter procedure codes, separated by commas, and click Add.
d. Modifier: Optional. Select a modifier from the drop-down menu.
e. Your Fee: Manual entry of fees.
f. Medicare: Displays the Medicare rates of the procedure for easy comparison.
g. To delete a procedure, check the box and click Delete selected procedures at the bottom.
h. Click arrows to navigate between multiple pages.
i. Click Continue to complete the fee schedule.
6. Finalize the contract:
- Enter the Effective Start Date and Effective End Date.
- Enter a number in the "e-Claims No Response Trigger" box: This is the number of days after which the system will alert you when payments for electronic claims have not been received; Kareo PM recommends 21 days.
- Enter a number in the "Paper Claims No Response Trigger" box: This is the number of days after which the system will alert you when payments for paper claims have not been received; Kareo PM recommends 30 days.
- Capitated: If the contract supports capitated charges, check this box. By checking this box, all procedures will be treated as covered by the capitated insurance plan. For more information, see Tips below.
- Add the providers who will be using the fee schedule.
- Add the locations that will be using the fee schedule.
7. When finished, click Save & Submit.
Capitated: When this box is checked, 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).
Medicare: The Medicare rates provided are based on the most current published Medicare Physician Fee Schedule Relative Value Units. They are calculated with your corresponding Geographical Practice Cost Index (GPCI) and then multiplied by the current conversion factor. Though Medicare values are displayed for the majority of procedures, not all are reimbursable under the Medicare program (i.e.: Outpatient and Inpatient Consultation). Kareo PM has opted to include these values since commercial payers are still accepting these codes, and the values displayed can serve as a reference for defining your fee schedules. Please consult with your Medicare administrative contractor for confirmation on reimbursable procedures for your specialty and region.