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Kareo Help Center

Add Contract Rates

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.

Add Contract Rate

  1. Click Settings > Contracts and Fees. The Contracts and Fees window opens.
  2. Click the Contract Rates tab.
  3. Click Add New Contract Rate.
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  1. Click View Your Insurance Companies. The View Insurance Companies pop-up window opens.
  2. Search for and click the select the insurance company.
    Note: Once the contract rate is saved, insurance company cannot be changed.
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  1. 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.
    • Add Procedures and Rates Manually: Enables you to manually enter each procedure and fee. Click Add Procedures & Fees. The Add Procedures + Fees pop-up window opens.
    • 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.
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Add Procedures & Fee Window

  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 - Updates the entire fee schedule based on Medicare rates. 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.
  3. Enter procedure codes, separated by commas, and click Add.
  4. Modifier: Optional. Select a modifier from the drop-down menu.
    1. Once the modifier has been selected, a new row will open to add the Contract Rate for that code and modifier combo.
  5. Contract Rate: Enter the allowed amount per your contract with the insurance company.
  6. Medicare: Displays the Medicare rates of the procedure for easy comparison.
  7. To delete a procedure, click to select and click Delete selected procedures at the bottom.
  8. Click arrows to navigate between multiple pages.
  9. Click Continue to complete adding procedures and fees.
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Finalize the Contract

  1. Enter the Effective Start Date and Effective End Date.
  2. Update the e-Claims No Response Trigger and Paper Claims No Response Trigger, if desired.
    • e-Claims No Response Trigger: If the claim status is still "Pending Insurance" after the set number of days, it will be moved to "No Response." The default it set to 21 days.
    • Paper Claims No Response Trigger: If the claim status is still "Pending Insurance" after the set number of days, it will be moved to "No Response." The default it set to 30 days.
  3. Optional, click to select "Capitated." By clicking this option, all procedures will be treated as covered by the capitated insurance plan. See notes regarding capitation below.
  4. By default, all active providers are populated. Click Remove to disassociate the provider from this contract rate.
    Note: Once the contract rate is saved, provider(s) cannot be removed.
  5. By default, all service locations are populated. Click Remove to disassociate the service location from this contract rate.
    Note: Once the contract rate is saved, service locations(s) cannot be removed.
  6. When finished, click Save & Submit.
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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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