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Kareo Help Center

New Encounter CMS 1500

You can create an encounter using the CMS-1500 claim format in several ways:

  • Click Encounters > New Encounter in the top menu.
  • Open a patient record and click Create Encounter at the bottom.
  • In the Appointment Scheduler, right-click on a patient's name and select Create Encounter.

To learn more about encounter defaults, see Encounter Options. If you are billing for anesthesia services, there are specific settings that must first be configured within Kareo; see section Anesthesia Services. See also the FAQs about the new CMS-1500 form version 02/12.

To complete a new encounter using CMS-1500 format

  1. On the General tab of a new encounter, enter the general information. See below.
  2. When finished, choose one of the following:
  • Click Save as Draft: Places the encounter in Draft status.
  • Click Save for Review: Places the encounter in Review status.
  • Click Approve: Places the encounter in Approved status.

General Tab

New Encounter.jpg

  1. Patient: Enter patient information. Some fields may be auto-populated. If not, click the buttons to locate the information.
  • Appointment: Optional. Click to search for the patient appointment. Once you find it, double-click to select.
  • Patient: Click to search for the patient record. Once you find it, double-click to select.

  Note: Verify all information from the patient is accurate before proceeding.

  • Case: Auto-populated if there is only one case on the patient record. Click the button to select from multiple cases; once you find the case, double-click to select.
  • Prior Authorization: If prior authorization is required, click to select the authorization number.
  1. Primary (and Secondary) Insurance: Select Professional (CMS-1500) from the drop-down menu for the primary insurance (and secondary insurance if applicable). Click the insurance link to edit insurance. If you don't want to send the claim electronically, check the "Do not send claim electronically" box. If the patient does not have secondary insurance, the options will not be visible.
  2. ICD-9 or ICD-10 marker: Indicates if the payer is accepting ICD-9 or ICD-10 claims. This is determined by the ICD-10 Date set on the insurance company Practice Settings tab. See Practice Specific Settings.
  3. Dates: Enter service dates, posting date and batch number (if applicable).
    Note: Batch # is optional. Entering a batch number is helpful for running reports. For example, if you consistently use a naming convention such as date posted + initials of person posting (example: 021411CB), you can easily run reports for specific users who manage payment posting in your office.
  4. Provider: Enter providers and location of service.
  • Scheduling Provider: The provider who provided services to the patient. Kareo defaults to a provider based on this order: a) The provider on the appointment, b) the default rendering provider on the patient record, c) the scheduling provider from the patient's previous encounter or d) the default scheduling provider configured by the Kareo application administrator.
  • Rendering Provider: The provider used to bill out claims and appears on paper and electronic claims. Kareo defaults to a provider based on this order:  a) The provider on the appointment, b) the default rendering provider on the patient record, c) the rendering provider from the patient's previous encounter or d) the default rendering provider configured by the Kareo application administrator.
  • Supervising Provider: Some payers require both a rendering and supervising provider for certain medical situations. Kareo defaults to a provider based on this order: a) The supervising provider from the patient's previous encounter or b) the default supervising provider configured by the Kareo application administrator.   
  • Referring Provider: If one exists, Kareo defaults to the referring physician entered on the patient record.
  1. Payment: Enter payment if applicable. Once you enter the amount, additional fields become available regarding payment.
  • Copay Due: Auto-populated from the copay amount entered for the primary insurance policy associated with the patient and case.
  • Payment Amount: Enter the payment amount.
  • Method: Select the method of payment.
  • Category: Optional. These categories are specific to your practice and must be set up by your Kareo application administrator. See Categories.
  • Reference #: If applicable, enter the reference number of the check.
  • Memo: Optional. Enter any notes regarding payment.

New Encounter - Lines of Service.jpg

  1. Procedures: Enter procedures, diagnoses and charges as applicable.  
  • Mode: Switch between ICD-9 or ICD-10 codes. The encounter can be dual-coded. This is useful when the primary and secondary insurances are not yet both accepting ICD-10.
  • Click the field under a column to enter data.
  • Hover over a procedure or diagnosis code to see the full description.

Note: Descriptions may not be visible if your Kareo application administrator has configured the system to not show code descriptions. See Encounter Options.

  • Enter "?" in the procedure or diagnosis fields to launch a searchable list of codes.
  • To remove a line item, right-click on the procedure line and select Remove Procedure.
  • Columns can be customized. Right-click on the column header and select Customize to view/add/move fields: To add, double-click on an item. To move, click and drag column to desired location. To remove, click and drag the column header back to the Customize box.
  • Convert to ICD-10/ICD-9: Click to access the code conversion feature. See ICD-9 to ICD-10 Code Conversion.If you attempt to submit the wrong code version, you will be prompted to either skip the conversion or convert the codes to the correct version.

Column Header

Description

From

Beginning service date

To

Ending service date

Procedure

Procedure Code.  See also New Procedure Macro.

Mod X

Procedure Modifier: If applicable, enter a procedure modifier code.

Diag X

Diagnosis Code: If previously entered on an encounter, the system presents one or more diagnosis codes that are the same as the ones used from the first procedure of the prior encounter.

Units

The default unit number is defined in the procedure code settings for certain types of procedures; you can change it if necessary. See also Anesthesia Services.

Unit Charge

Charge associated with the procedure. The charge amount may automatically default to the charge associated with the contract that governs the procedure; you can change it if necessary.

Total Charge

Automatically calculated by Kareo and is the total amount of units multiplied by the unit charge.

Apply Payment

If a payment was entered on the encounter, enter the amount in the "Apply Payment" field. If there are multiple procedure lines, enter the amount of the payment to apply to each line.

Note: You cannot apply an amount that is greater than the total payment. This means the sum of the “Apply Payment” column on all procedures must be less than, or equal to, the total payment amount entered under the Payments section of the encounter.

Patient Resp.

Patient Responsibility: An amount is automatically entered here if 1) Kareo settings have been configured to automatically bill missed copays, 2) Patient only has ONE insurance policy that covers the case being treated, 3) A copay due was entered on the patient's insurance policy record. If a copay was missed, Kareo will automatically bill the patient concurrently with the insurance billing process. You can also manually enter an amount to transfer a portion of the charges to the patient.

Note: This column is hidden if the practice has opted not to bill patients for missed copays concurrently with the insurance billing process. See also Enter Copays.

Concurrent Procedures

For Anesthesia services; if provider is overseeing more than one patient at a time. Enter the number of patients the provider is overseeing in addition to the patient on current encounter.

Note: Kareo does not send this information electronically.

Start Time

Beginning service time

End Time

Ending service time

Line Note

Service Line Note: Used to add notes that may be required for certain procedures that are billed electronically. If you enter a line note, also add a reference code.

Ref. Code

Reference Code: Drop-down list of service line note reference codes (supports EDI claim-level notes).

Minutes

If applicable, enter the minutes used for anesthesia services. The system defaults to the time increment defined in the contract record; you can change it if necessary. For anesthesia settings within Kareo , see Anesthesia Services.

TOS

Type of Service: Drop-down list of TOS codes (used for selecting a TOS code other than the default for CMS 1500 print and electronic submissions).

Provider

Drop-down list of providers.

 

New Encounter - Hosp Misc Amb Notes.jpg

  1. Hospitalization Dates: Click arrows to expand this section. If patient was hospitalized due to a condition related to the encounter, enter the Start and End Dates of the hospitalization.
  2. Miscellaneous (CMS-1500): Click arrows to expand this section. The Miscellaneous fields can be used to enter the following:
  • Submit Reason: Leave at the default “1” unless specifically requested by a payer to select one of the other options.
  • Document Ctrl Number: Used for Medicare claims with secondaries. Some payers require the Document Control Number to process a secondary claim.
  • Claim Code (Box 10d) and Add'l Claim Info (Box 19): There are fields on the CMS-1500 form used as a miscellaneous field to indicate various messages for different payers. Enter text in each field, as applicable, and it will be included in Box 10d or Box 19 of the CMS-1500 form when claims related to this encounter are printed.
  • E-Claim Note Type: If applicable, select a note type from the drop-down menu and add a note in the text box to be sent to the payer as part of the ANSI 837 electronic claim message format. These fields are used for a variety of situations as set forth by specific payers.
  1. Ambulance: Click the arrows to expand this section. Used only for billing ambulance services; see section Ambulance Services.
  2. Medical/Business Office Notes: Optional. Enter any notes to save with the encounter.
  3. Check Codes: Click to perform code checking upon approval. You can also turn on automatic code checking for your practice.
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