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Kareo Help Center

View/Edit Contract Rate

Changes made to contract rates are not logged in Kareo and will apply to new encounters once saved.

View the Contract Rate

  1. Click Settings > Contracts & Fees. The Contracts and Fees window opens.
  2. Use the Filter Contracts or Status Filter if necessary to sort the list.
  3. Once you find the schedule, click on the Name. The Standard Fee opens.
View_Contract_Rate.png

Edit the Contract Rate

Make changes to the necessary field(s).

  1. Effective Start Date: Enter a new date.
  2. Effective End Date: Enter a new date.
  3. e-Claims: Enter a new number of days.
  4. Paper Claims: Enter a new number of days.
  5. Add Procedure + Fees: Click to add new procedure codes.
    1. 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 -  The Medicare rates are based on your service location. See notes regarding Medicare rates below.
    2. If you selected to base the fees on Medicare rates, enter a percentage and click Enter on your keyboard. Then, select the Medicare rates you want to base the fees on.
      Important Note: This will update all existing and newly added codes to the Medicare rates.
    3. Enter procedure codes, separated by commas, and click Add.
  6. Code: Use the Filter if necessary to sort the list.
    1. Modifier: Select a modifier from the drop-down menu.
      • Once the modifier has been selected, a new row will open to add the Contract Rate for that code and modifier combo.
    2. Contract Rate: Enter the allowed amount per your contract with the insurance company.
    3. Delete: Click to select and click Delete selected procedures at the bottom.
  7. Capitated:  By clicking this option, all procedures will be treated as covered by the capitated insurance plan. See notes regarding capitation below.
    • If selected, click to clear the checkbox. The contract rate will be converted to fee-for-service.
  8. Who will use these fees?: Click +Add provider to select additional provider(s). Then click Continue.
  9. Where will these fees be used?: Click +Add locations to select additional service location(s). Then click Continue.
  10. When finished, click Save & Submit.
Edit_Contract_Rates.png

Notes:

Medicare Rates: 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 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.

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).

 

 

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