Fee Schedules & Contracts
Increase collections by managing your fees and contracts
Fee schedules & contracts help you increase your collections by setting the right fees for your services and managing contracts to verify you're getting paid what you're owed from insurance companies. You can build your standard fee schedule, load insurance contracts for your major payers, set fees during charge entry, identify underpayments during payment posting, and compare and enforce your insurance contracts. By closely managing your fees and contracts, you can increase your collections and eliminate manual audits.
You start by building the standard fee schedule for your practice. Simply select a procedure from the master list of CPT®/HCPCS codes that comes pre-loaded in your database and then enter the fee you want to charge patients and out-of-network insurance companies. You can also set fees for a specific combination of procedure and modifier and/or diagnosis. Your fee schedules can be set for a specific provider and location or multiple providers and locations. You can also set an effective date range for which your fee schedule applies. It's important to note that most providers don't set fees for all procedures in the master list, but rather, set fees on the common procedures and other services provided by their practice.
Once you've built your standard fee schedule, you'll also want to load in the insurance contracts that set forth the pre-negotiated fees your provider has agreed to accept in joining each insurance network. Most providers focus on their largest payers, such as Medicare, Medicaid, Blue Cross, Blue Shield, Aetna, Cigna, and United Healthcare. Similar to your standard fee schedule, you can also set the billing fees for each procedure code. But you'll also be able to set the allowable amounts that correspond with the pre-negotiated fees under the contract. Your contracts can apply to a specific provider and location or multiple providers and location. You can set an effective date range for which the contract applies. You can also load in the contractual response time required for paper claims and electronic claims, which enables Kareo to automatically alert you when you have not received a response from an insurance company on a claim within the contractually required response time.
Set Fees During Charge Entry
After you've built your standard fee schedule and loaded your insurance contract, Kareo will automatically populate the fees during the charge entry process. If the patient's primary insurance policy is with an insurance company for which you've loaded a corresponding insurance contract, the billing fee from the contract will be used. If you did not load a contract for that insurance company, or if you're billing the patient for self-pay charges, Kareo will automatically populate the fees from your standard fee schedule.
Whether you post insurance payments manually using explanation of benefits (EOB) reports or you post insurance payments automatically using electronic remittance advice (ERA) reports, Kareo will automatically compare the allowed and payment amounts reported by the insurance company with the allowed amounts loaded in your insurance contracts. If the insurance company pays an amount different than what's required by the contract, Kareo will automatically alert you to the underpayment so you can immediately appeal the insurance companies erroneous adjudication of the insurance claim.
Use Advanced Reports to Enforce Insurance Contracts
While identifying underpayments one-at-a-time during the payment posting process can be helpful, Kareo also provides the tools you need to periodically (e.g. monthly) audit the payment practices of your insurance companies to appeal underpayments and renegotiate your contracts. Kareo provides advanced contract management reporting that lets you compare the allowed amounts and payments from different insurance companies for the same service. These reports also provide you the information you need to identify routine underpayments so that you can provide a list of insurance claims that have been underpaid for a period of time.
Track RVUs for Productivity Reporting
Under the Resource-Based Relative Value System, Medicare assigns a Relative Value Unit (RVU) to each procedure code in order to estimate the relative complexity of one procedure to another. RVUs were originally created to provide more fairness in how Medicare compensates for different procedure codes. However, many practices now take advantage of the relative value scale as a way of more accurately measuring the productivity of physicians. For more information about RVUs, visit the Wikipedia page on the Resource-Based Relative Value System.
When you build your standard fee schedule in Kareo, you can load in the RVU for each procedure code as set by Medicare. This includes the three components of RVU; the Work, Practice Expense, and Malpractice. Once RVUs are loaded into your standard fee schedule, you can use advanced productivity reporting to compare the relative productivity of providers within your practice in a manner that's independent of the insurance company that was billed.