Kareo Managed Billing

PURPOSE

The purpose of this policy is to ensure that Kareo is taking every opportunity to improve billing performance and collections for your practice and that routine adjustments of significantly-aged, uncollectable claims are completed in order to increase visibility for workable Accounts Receivable.

This policy outlines the due diligence that is used to identify uncollectable accounts receivable, improve measurement of Kareo Managed Billing Customers’ accounts receivable and ensure the most effective and efficient use of revenue collection resources.

POLICY

It is Kareo’s policy to actively pursue collection of past-due accounts receivable, regularly review the status of past-due accounts, and adjust amounts determined to be uncollectable. A write-off of uncollectable accounts receivable from customer records does not constitute forgiveness of the debt or gift of public funds and customers may continue to work these claims if they so desire.

SCOPE

This policy applies to all Kareo Managed Billing Customers.

PROCEDURES

Collection procedures are established by Kareo Managed Billing expert teams and will vary depending on the nature of the receivable. Accounts receivable will generally be adjusted during the quarter in which an account is determined to be uncollectable. Subsequent collection of an account previously written-off will be treated as new revenue.

Designation of an Account as Uncollectable

1. An account will be considered uncollectable after the appropriate collection procedures have been followed and it meets one or more of the following criteria:
   • Is a Commercial, Medicare, or Medicaid insurance claim older than one year. There may be some exceptions, such as Worker’s Compensation, Liens, Personal Injury, and claims pending due to legal review or appeal
   • Is a claim with contractual adjustments
   • Is a claim where Billing Tasks or customer responsibility items were not completed as requested
   • Is a claim that has missed Timely Filing due to the delay in charge submission by customer
   • Is a Medicaid Secondary Adjustment
   • Is a Capitation claim older than three months
   • Is old AR that was not adjusted or had no payments applied prior to customer contracting with Kareo
   • Is a claim where customary or standard adjustments were not previously taken by the billing team (i.e. inclusive/bundled) resulting in unworkable AR
   • Is a claim where initial charges provided by the practice were not clean (contained coding errors, missing prior authorization, no benefits/eligibility verification, not credentialed) which resulted in denials and subsequent unsuccessful corrections or appeals
   • Is a claim that is determined to be not medically necessary per CARC and RARC codes
   • Is an outstanding patient or insurance small balance of $4.99 or less
2. Preparation for Adjustment of Accounts Receivable
   

   Kareo Accounts Receivable Expert Teams deliver an "Uncollectable" report monthly in the month-end reporting packages and will conduct quarterly reviews to identify any accounts receivable for which it is responsible that meet the criteria for designation as an uncollectable account. A request for adjustment of accounts receivable will be prepared by the AR expert teams and submitted to the Advisor for review and approval. The request for adjustment of accounts receivable sent to the Advisor will include an itemized list of the uncollectable accounts to be written off specifying the following:

   • Claim/charge/account identification number
   • Account balance
   • Criteria under which the account was deemed uncollectable

   For each uncollectable account, documentation will be provided in the software’s claim tracking functionality to support the uncollectable account designation and substantiate that Kareo has followed its collection procedures and exercised due diligence in its collection efforts.

3. Adjustment Process
   

   Upon receipt of a request for write-off of accounts receivable by the Billing Team, the Advisor will review the request to ensure that it is complete and that all necessary due diligence has been taken. Once the Advisor has completed its review of a request, he/she will notify the customer and the qualified accounts will be written-off 30 days after notification.

   After the adjustments have been made, Kareo will produce an Excel spreadsheet of claims that have been adjusted and will store it in Kareo Documents for easy customer reference. Kareo will use Adjustment code “K99” (the Kareo Management Adjustment code for tracking and reporting) when adjustments are made so they can be easily identified in the patient account and rports.