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Kareo Help Center

New Encounter UB 04

You can create an encounter using the UB 04 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.

To complete a new encounter using UB 04 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 UB-04 from the drop-down menu for the primary insurance (and secondary if applicable). Click the insurance link to edit insurance. For the primary insurance, if you don't want to send the claim electronically, check the "Do not send claim electronically" box. UB-04 secondary insurance claims cannot be sent electronically, therefore this box is disabled. 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.

  1. 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.

  • Attending 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.
  • Operating Provider: The provider who is responsible for performing the surgical procedure(s).
  • Referring Provider: If one exists, Kareo defaults to the referring physician entered on the patient record.
  • Other Provider: If applicable, any other provider who is involved in the patient's care.
  1. Submit Reason: Leave at the default “1” unless specifically requested by a payer to select one of the other options.
  2. 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.

 

Encounter - Lines of Service.jpg

 

  1. Procedures: Enter procedures, procedure modifiers 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 procedure modifier 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 procedure modifier 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

Procedure

Procedure Code. See also New Procedure Macro.

Mod X

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

Rev Code

Code associated with the Procedure Code that identifies the specific accommodation, ancillary service or unique billing calculations or arrangements.

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.

Non Cov Chrgs

Charges that are not covered by the payer as pertaining to the revenue code.

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

Assessment Date

Used to capture the assessment date by Inpatient Rehabilitation Facilities, Skilled Nursing Facilities and Swing Bed Providers. Note that Kareo does not currently support these specialties. If the payer does require this data to be submitted, please contact the payer for instructions on how to properly submit this data using Occurrence Codes.

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.

Provider

Drop-down list of providers.

 

Encounter - UB04 Misc.jpg

 

i. Miscellaneous (UB-04): Click arrows to expand this section.

  • 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. Please contact your payer to verify requirements for submitting notes as part of your claim.

j. Diagnosis:

  • Principal Diagnosis: Diagnosis code that describes the principal diagnosis (i.e. the condition established to be chiefly responsible for the admission of the patient for care).
  • Admitting Diagnosis: For inpatient visits only. Diagnosis code describing the patient’s diagnosis at the time of admission.

k. Procedure:

  • Principal Procedure: For inpatient visits only. Procedure code that identifies the principal procedure performed during the billing period on the claim.
  • Date: The corresponding date to the Principal Procedure.
  • DRG: Diagnosis Related Group; a classification system that groups patients according to diagnosis, type of treatment, age, and other relevant criteria.  

l. Health Information: On each line, as applicable, select the code Type from the drop-down menu and enter the CodeTo/From Dates and Amount.

  • Condition Code: The corresponding code(s), in numerical order, used to describe the conditions or events that apply to the billing period on the claim.
  • Occurrence Code: The code and associated date defining a significant event related to the claim that may affect payer processing.
  • Other Diagnosis: The diagnosis codes corresponding to all conditions that coexist at the time of admission, that develop subsequently, or that affect the treatment received and/or length of stay.
  • Value Code: A code structure to relate amounts or values that identify data elements necessary to process the claim as qualified by the payer; consult your payer for guidance on when it is appropriate and/or necessary to submit value codes with your claim.

m. Admission:

  • Date: Start date for the episode of care for home health and hospice or date of admission for all inpatient services.
  • Hour: The code referring to the hour during which the patient was admitted for inpatient care.
  • Type: Required. The code that indicates the priority of the admission or visit.
  • Point of Origin: Required on all bill types except hospital lab services to non-patients. The point of origin is the location from where the patient came before being admitted to the healthcare facility.
  • Discharge Hour: The code indicating the discharge hour of the patient from inpatient care.
  • Discharge Status: Required. The code indicating the patient’s discharge status as of the "To Date" of the billing period on the claim.

n. Remarks: Enter any comments as applicable; comments in this section will appear on the claim. This field allows the practice to capture additional information necessary to adjudicate the claim; confirm with the payer if remarks are required to be submitted with your claim.

o. Medical/Business Office Notes: Optional. Enter any notes to save with the encounter.

p. Check Codes: Click to perform code checking upon approval. You can also turn on automatic code checking for your practice.

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