New Encounter

Follow these steps to create a new encounter record:

1. On the Encounter menu, click New Encounter.

Optionally, you can click Find Encounters to open the Find Encounter task (or browser), and then click the New button on the Task Button Bar of the browser to open the New Encounter task.

As you become more familiar with the application, you will find that there are additional methods for adding new encounters to the system, as described below:

You can click the “Encounters” shortcut on the Navigation Pane to display the Encounters Home page, and then click Encounters from the Encounters Home page to open the Find Encounter browser. Once the browser is open, click the New button on the Task Button Bar of the browser to open the New Encounter task.
If you have already opened an existing patient record and are ready to create an encounter for that patient, you can click the Create Encounter button on the Task Button Bar of the Edit Patient task.
You can right-click on a patient appointment within the appointment scheduler, and then click “Create Encounter.” When using this method, the information on the appointment record will be carried over to the encounter.
If you already used theNew Encountertask to create at least one encounter, you can click theSave & Newbutton to enter additional encounters in the same work session.

Which method you will actually use in your day-to day work will depend on what works best for you.

2. Note that the New Encounter task is organized into two tabbed sections: "General" and "Log."

3. Under the "General" tab, enter the encounter information.

You will find that all fields of an encounter are displayed in a single window that scrolls down as information is entered so that all fields are shown within the same task window. The upper section of the task includes the general encounter information; the lower section of the task includes an area to enter the procedures, modifiers, units, charges, and one or more diagnosis for the encounter, and any notes that might apply to the encounter.

It is important to note that when you first open a new encounter task, certain fields may already be populated based on the encounter defaults set up in the system by the application administrator, and based on other defaults set up in the system by Kareo to help speed data entry. However, if the user types in an appointment ticket number, selects an appointment, or enters a patient, all of the pre-existing defaults discussed in the remainder of this topic prevail and may override the information in some of the pre-populated fields; in other words, some of the information in the fields of a new encounter may be overwritten once an appointment number, or patient has been entered in theAppointmentorPatientfield. Know that the user always has the option of manually changing the information in most of the pre-populated fields, if necessary. (To learn more about encounter defaults, see Encounter Options.)

Entering General Information

Appointment: Enter the appointment number, if available. Optionally, you can click the Appointment button to open the appointments browser; and then use the search function, if necessary, to locate the appointment. Once you find the appointment, double-click on the appointment to select it. Note that once an appointment number has been entered, the information related to the appointment will be automatically carried over to the encounter; including the patient name, case, primary insurance, authorization, service date, rendering provider, service location, etc.

Name: If there is no appointment number available for this patient, then enter the patient's name or ID. Once you tab out of the field, the system will automatically search for the patient; and if it finds the patient, it will drop the full name of the patient into the field and underline it so that you know a match was found. If a match was not found, the Find Patient task (or browser) will open, allowing you to perform a search for the correct patient. Optionally, you can click the Patient button to search for the patient record. For more information on locating a patient using the search feature, see the relevant steps in Find Patient. Note that once a patient is selected, then certain information will be pulled over to the encounter from the patient record. Verify that the information is accurate before proceeding.

Case: If there is only one case recorded in the patient record, the system will automatically populate the box with the name of the case. If two or more cases are recorded in the patient record, you may need to click the Case button and then double-click on the case that applies to the encounter being entered. Note, however, that if an appointment number was entered, then the system automatically populates this field with the case entered on the appointment record.
Primary Insurance: The system automatically displays the primary insurance policy recorded on the patient record for the case selected.
Prior Authorization: If an authorization number is required and has not been carried over from the patient case, then click the Prior Authorization button and select the authorization number for the encounter.
Service Date: The system defaults to either a) the service date carried over from the appointment record, or b) the service date of the last encounter entered if the user entered another encounter in the same work session. If the service date is not carried over from either of these sources, then enter the date of service using the format MM/DD/YYYY (e.g., 11/15/06).
To Date (optional): The system defaults to "None." However, if the ending service date is different than the starting service date, then manually enter the ending service date.
Post Date: The system defaults to either a) the post date of the last encounter entered if the user entered another encounter in the same work session, or b) if this is the first encounter being entered during this work session, the system defaults to the date that the encounter is being entered. The user has the option of changing the post date, if necessary.
Batch #: Enter the batch number, if applicable. Note that if a previous encounter was entered during the same work session, the system will carry the batch number over to the new encounter; however, you can change this batch number if necessary. This is an optional free-form text field, and can contain any alpha-numeric text to uniquely identify the batch. Entering a batch number for a group of encounters allows the medical or billing office to filter various reports by batch number.

Entering Provider Information:

Scheduling Provider: The system defaults to a) the provider on the appointment record, 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 in the system by the application administrator, in that order. The user has the option of changing the scheduling provider for the encounter, if necessary.

Note: The "Scheduling Provider" field is used to track the provider that actually provided services to the patient, whereas the "Rendering Provider" is the provider used to bill out the claims. This field has been recently added to support situations where there is a physician assistant, nurse practitioner, or other mid-level provider that provides service but the practice bills out the claims under a different provider, usually a full MD. This field is necessary to internally track the productivity of the mid-level in conjunction with the rendering provider.

Rendering Provider: The system defaults to a) the provider on the appointment record, 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 in the system by the application administrator, in that order. The user should always make sure that the provider showing in this field is the provider that will actually appear on the paper and electronic claim; in other words, the provider that is actually reimbursed for services rendered.

Supervising Provider: The system defaults to a) the supervising provider from the patient's previous encounter, or b) the default supervising provider configured in the system by the application administrator. The user has the option of adding or changing the supervising provider if necessary, or leaving this field blank if there is no supervising provider for this encounter.

Note:There is an industry standard specification for electronic medical claims. Within that standard, there are fields for Rendering Provider and Supervising Provider. The Rendering Provider is always required and is the provider that must have a contract with the insurance company and is also the one that is actually reimbursed for services. In some medical situations, however, the insurance company may require both a rendering provider and a supervising provider; for example, when certain surgeries are performed where more than one type of MD is required and both have a contract with the insurance company.

Referring Provider: The system defaults to the referring physician recorded on the patient record, if one exists. To select a different referring provider, click the Referring Provider button to locate the physician from a searchable list of referring physicians associated with the practice.
Location: The system defaults to either a) the service location recorded on the appointment record, b) the default service location recorded on the patient record, or c) the default service location configured in the system by the application administrator, in that order. The user has the option of changing the service location for the encounter, if necessary.
Place of Service: The system presents a default place of service that is the same as the place of service associated with the selected service location. Note: This list is an industry standard list pre-set by Kareo, and is a requirement of Medicare and certain other insurance plans in order to pay for medical services rendered.

Entering Payments (if applicable):

Copay Due: The system automatically displays the copay due if a copay amount was entered for the primary insurance policy associated with the patient and case. This is a read-only field that is only meant to alert you that a patient may owe a copay.
If payment was made by the patient at the time of appointment and was entered from the appointment record on the scheduler, then the payment and payment reference number will be displayed within the "Payment" section of the encounter.

However, if a payment was made by the patient at the time of appointment but not entered from the appointment record on the scheduler, then enter the following information:

Payment Amount: Enter the payment amount. Note that once an amount is entered within this field, additional fields will display allowing you to enter the payment details.

Method: Select method of payment from the drop-down list.
Category: Select the payment category, if applicable. The drop-down list in this field displays a list of custom categories if the practice has chosen to set up payment categories in the system. (For more information, see Categories Setup.)
Reference #: Enter the reference number for the payment, if applicable (e.g., check number, credit card number, etc.).
Memo: Enter any notes you wish to add specific to the payment made.

Note: For more information on entering patient payments from the scheduler, see Enter Payment and Print Receipt.

Optional Add Ons:

Hospitalization Dates: The Hospitalization Dates checkbox is initially unchecked, and the fields within this section will be hidden from view. If the patient was hospitalized due to a condition related to the encounter, place a check in the checkbox. This displays an add-on section to the encounter which allows the user to enter the Start and End Dates of the hospitalization.
Miscellaneous: The Miscellaneous checkbox is initially unchecked, and the fields within this section will be hidden from view. If a user places a check in the checkbox, an additional section will appear that allows the user to enter the following information:

There is a field on the CMS 1500 form (a.k.a. HCFA 1500) that is used as a miscellaneous field which might mean different things for different payers. A user can enter any text into this field and it will be printed in Box 19 of the CMS 1500 form when claims related to this encounter are printed.
The Do not send... checkboxes override the system if a user would like to force the system to print the claim on paper rather than sending it electronically.
The E-Claim Note Type and the E-Claim Notes text box allow you to select a note type and then add a free-form note that is 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. To select a free form note type, select the note type from the drop-down list, and then enter the note in the E-Claim Note text box.

Ambulance: The Ambulance checkbox is typically only used by ambulance services; and when checked, allows the user to enter details about services provided. This checkbox should be left unchecked unless the user is billing for ambulance services. To learn more about completing this section, see the separate help topic entitled, Ambulance Services.

Entering Procedures, Modifiers, Units, Diagnoses and Related Charges

The area in the lower section of screen is where one or more procedures are entered related to the encounter.

What to know before entering procedure line items:

The procedures grid is typically comprised of the following columns: Service date (From), Procedures column, a Procedure Modifier (Mod X) column, one or more Diagnosis (Diag X) columns, a Units column, a Unit Charge column, a Total Charge column, and an Apply Payments column. There are also optional columns that may or may not appear within the grid, as follows:

Ending service date (To) - When visible, contains the ending service date if a user were to enter an ending service date within the "Dates" section of the encounter.
Additional Modifier (Mod X) columns - When visible, allows a user to enter additional procedure modifiers to an encounter.
Additional Diagnoses (Diag X) columns - When visible, allows a user to enter additional diagnoses to an encounter.
Minutes - When visible, allows a user to enter the minutes used for anesthesia services. The system defaults to the time increment defined in the contract record. However, the minutes can be changed by the user, if necessary. Note that there are certain settings that must be configured within Kareo prior to billing for anesthesia services. For more information, see Anesthesia Services .
Type of Service (TOS) - When visible, contains a drop-down combo list of TOS codes (used for selecting a TOS code other than the default for CMS 1500 printing and eclaim submissions).
Reference Code (Ref. Code) - When visible, contains a drop-down list of service line reference codes (supports EDI claim-level notes).
Service Line Note (Line Note) column - When visible, can be used to add free-form notes that may be required for certain procedures that are billed electronically.

You can add or remove any of the above columns using the grid's customization feature. To customize the grid, right click anywhere on the grid and select "Customize" from the pop-up menu to display the Customization box. To add a column to the grid, click on the column header within the Customization box and then drag it to where you would like to place it on the grid header line. To remove a column from the grid, click on the header and move it to theCustomizationbox. To close theCustomizationbox, click the red "x" button on the upper right corner of the box.

The procedure and diagnosis code, once entered, will display both the alphanumeric code as well as the first two or three words of the code name. To view the full name of a procedure or diagnosis, hover your mouse pointer over the code. Exception: The procedure and diagnosis descriptions may not be visible if the application administrator has configured the system to not show code descriptions (See Encounter Options for more information on configuring certain options related to encounters.)

For help in locating a specific code when entering procedures and diagnosis within the procedures grid, entering a question mark [?] will launch a searchable list of codes. If necessary, use the search bar within the relevant code list, to locate the code. Once located, double-click on the code to select it.

Also note that recent features have been added that allow users to bill for certain types of drugs. If your organization works with NDC codes, speak with your administrator on how to handle procedures that relate to billing for these types of services.

To enter procedure line items, do the following:

Enter Procedure Code - Tab to the "Procedure" column and enter the first procedure code associated with the encounter. (Optionally, if a procedure macro has been set up in the system that relates specifically to the type of encounter currently being entered, the user can enter the name of the procedure macro. For more information on using Procedure Macros, see About Procedure Macros.)

Note that once you tab to the "Procedure" column, the starting and ending service dates entered on the upper section of the screen are automatically carried forward to the first procedure line of the encounter.

Enter Procedure Modifier - Tab to the "Mod 1" column, and enter a procedure modifier code, if applicable.
Enter Units - Tab to the "Units" column, and enter the amount of units, if other than the default unit count shown. The default unit count is defined in the Procedure Code settings for certain types of procedures; however, the user has the option of changing the unit count, if necessary.
Enter Unit Charge - Tab to the "Unit Charge" column, and enter the unit charge associated with the procedure. Typically the charge amount automatically defaults to the charge associated with the contract that governs the procedure; however, the user has the option of changing the unit charge, if necessary.
Total Charge - The "Total Charge" column is automatically populated by the system, and is the total amount of units times the unit charge.
Enter Diagnosis - If there was a prior encounter entered for the same patient and case, the system presents one or more diagnosis codes that are the same as the diagnosis codes used from the first procedure of the prior encounter. However, the diagnosis codes can be changed or added to, if necessary. To add or change a diagnosis code, tab to the applicable columns and enter the diagnosis code(s) that apply to this encounter.

Apply Payment - If a payment was made at time of appointment and recorded under the “Payments” section of the encounter record, then the payment amount will be automatically transferred to the first procedure line under the "Procedures" section of the grid. Note that, by default, the application assumes you want to apply the total amount of the payment to the first procedure. However, you can override this default behavior by entering any amount in the “Apply Payment” column up to the lesser of the payment amount or the total charges on a procedure.

It is important to note that you cannot apply an amount that is greater than the total payment. So 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. However, you may apply an amount that is less than the total payment. If you do this, the payment will be created and any amount less than the total payment amount will be left unapplied. You can later open the payment and apply the remaining unapplied amount to any open charges.

Patient Responsibility - There is a new optional column added to the procedures grid, labeled “Patient Responsibility.” If the system has been configured to automatically bill missed copays, and the patient only has ONE insurance policy that covers the case being treated, and a copay due was entered on the patient's insurance policy record, then the copay amount entered on the policy will be carried forward to this column. If a copay was missed at the time of the patient appointment or at the time of creating the encounter for the corresponding appointment, the system will automatically bill the patient concurrently with the insurance billing process.

Note that if a copay due has NOT been entered on the insurance policy, the user may still transfer a portion of the Total Charges on a procedure to the patient by manually entering an amount in the “Patient Responsibility” column of any procedure.

Also note that this column replaces the two copay columns originally included in the grid; and will only be visible if the practice has configured the system to bill for missed copays. This column will be hidden from view if the practice has opted not to bill patients for missed copays concurrently with the insurance billing process.

Note: If you should have further questions related to tracking and billing for missed copays, refer to the features document located under the "Guides" section of theHelp & Supportwebsite entitled "Managing Copays." This document explains in much greater detail how copays are handled in the system.

Tab to the remaining columns and enter any other required information ("TOS," "Ref. Code," "Line Note," etc.). Note: If a note is entered in the "Line Note" column, be sure to select the reference code ("Ref. Code") that relates to the type of note being entered.
Continue this process until all procedure line items have been entered.

Note that the tab order as discussed above may differ slightly depending on how you have configured the procedure grid within the Encounter task.

Entering Notes

Proceed to the Notes section and enter any ad-hoc notes or other information to store with the encounter.

4. Under the "Log" tab, note that the fields in this section are automatically populated by the system once the encounter has been entered; and includes the current status of the encounter, the date the encounter was created, and the date the encounter was submitted.

5. Once the encounter has been created, do one of the following:

To save the encounter so that you can return to it later for further editing, click the Save button on the Task Button Bar. This places the encounter in the "Drafts" section of the Find Encounter browser.
To submit the encounter, click Submit. This places the encounter in the "Review" section of the Find Encounter browser.
Business Office only: To approve the encounter, click Approve. This places the encounter in the "Approved" section of the Find Encounter browser and in the "Assigned to Insurance" section of the Claims browser.
To close the New Encounter task without saving the new entry, click Cancel.