Kareo Responsibilities Frequently Asked Questions (FAQ)
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Kareo Responsibilities Frequently Asked Questions (FAQ) The following FAQ outlines both parties’ basic responsibilities in delivery and utilization of Kareo services as referenced in the Kareo Terms of Service Agreement, Section 2 – Use of Services. This FAQ will be updated on a regular basis to ensure regulatory compliance, allow adjustments for various changes in workflow, updated product features and operational efficiency. Kareo Services 1. Kareo Electronic Health Record (EHR) 2. Kareo Billing Services Kareo EHR ‐ Service Responsibilities 1. Q: What tools does Kareo EHR provide in Clinical decision‐making such as information and reminders on drug interactions, allergies, dosages and general health‐care related information and resources? A: Kareo EHR provides relevant information to allow the clinical user to understand relevant situations regarding the individual patient. However ‐ since every patient situation and condition is different – the information provided is not a substitute for the practice’s professional judgment and the information presented should be used for informational and educational purpose. Kareo is not responsible for third party information or links. 2. Q: Does Kareo EHR provide a Patient Portal? A: Kareo EHR includes a Patient Portal that the practice can use to allow their patients to gain access to their health information. The practice has full control of the information it makes available to their patients as well as the ability to grant and revoke access to their individual patients. Customer may not use this portal to make available the health information of any person under the age of 18 years. Kareo Billing Services – Service Responsibilities 1. Q: Does the Kareo Billing Services allow our users to access the features of Kareo PM for patient registration, scheduling and reports? A: Absolutely! Kareo PM is included with your service and is our primary tool to perform your billing. Kareo Terms of Service Agreement – Responsibilities FAQ 1 2. Q: What are the things that we have to do to start utilizing your service? A: One of the most important steps in transitioning your billing to Kareo Billing Services is to get all of your billing providers credentialed and contracted with your payers. Having all your providers credentialed will allow us to enroll your providers through our clearinghouse for electronic claims submission, eligibility verification, and electronic remittance advice (ERA). 3. Q: What is included in the Kareo Billing Services? A: Excellent question! After completing the setup of Kareo and completing the enrollment for electronic claims submission, your account manager will manage the following: a. Audit charge encounters for completeness and accuracy b. Submit and track electronic and paper claims (Paper claims are submitted when necessary or pending electronic claims enrollment and/or approval) c. Follow‐up on payer rejections and resubmit corrected claims d. Follow‐up on payer denials and resubmit corrected claims e. Monitor outstanding claims and follow‐up on all pending outstanding claims when appropriate f. Post received payments g. Process patient statements h. Provide courtesy notices to patients on outstanding balances i. Make all reasonable effort to process claims within 2 business days of completed Customer encounter entry j. Provide customer support for medical billing service inquires k. Provide monthly reports of the Customer’s revenue cycle l. Provide an online file sharing service for document transmissions. 4. Q: What are the things that my practice will need to do to ensure success? A: Please review the list below. a. Ensure that all your billing providers are credentialed and contracted with your payers b. Ensure that medical coding is in accordance with government, payer and published general coding requirements c. Accurately capture customer and insurance data and scan each customer driver’s license and insurance cards (front and back of cards) d. Provide complete and up‐to‐date patient demographic and insurance information e. Proactively verify and update the system on any changes in the patient’s demographic information and insurance coverage with each patient visit f. Perform insurance verification and any required preauthorization prior to visit Kareo Terms of Service Agreement – Responsibilities FAQ 2 g. Collect copay, patient balance and any outstanding balance from previous visit during the patient visit h. Daily post or enter all encounter/charge information as required to bill the claim including, but not limited to procedure codes, modifiers, diagnosis codes, and all other data required to submit a complete claim i. Post all office payments (including copayments, patient and guarantor payments) into the Kareo system by the close of business of that day, j. Scan and upload all insurance payer correspondence related to billing or outstanding claims within 2 business days of receipt k. Actively work with your account manager by providing all requested data or take corrective actions on the claims or encounters flagged, rejected or denied to allow timely submission or resubmission to the payer l. Actively work with your account manager by providing all relevant supporting documentation in any investigation initiated or any action brought by any third party m. Issue refunds checks to payers and patients on a timely basis or as required by your insurance payers or by local, state and federal laws. n. Review and return the list of patients identified for referral to the external collection agency within two business days of receiving the list from your account manager 5. Q: Who does the coding of the services performed by my practice? A: Kareo does not code any services performed by the customer or its providers. The customer is solely responsible for all coding of services. 6. Q: What if Kareo’s edits or code scrubbing flags any combination of coding that the practice entered in the encounter? A: In cases where the submitted combination of codes is flagged for correction based on published coding edits (NCD, LCD, LMRP, CCI, Coding Guidelines, etc.), Kareo will place the encounter on hold and request for a correction from the practice. If requested, your account manager will also provide any appropriate published guidelines to assist in clarifying the edit. Note that only the practice can change the codes submitted – our policies prohibit our account managers from changing the codes you supplied with the encounter. 7. Q: Does this same rule apply to claims rejected by the clearinghouse or denied by the payer? A: Yes. Kareo will place the item on hold and request the practice to correct or update the affected items. As with the previous item, the account manager will provide any appropriate published guidelines to assist your practice in correcting the issue. The update or correction will need to be performed by provider’s staff. Kareo Terms of Service Agreement – Responsibilities FAQ 3 8. Q: Does Kareo accept existing receivables prior to the effective date of the agreement? A: Though Kareo’s general recommendation is for the practice to continue working their old receivables in their current system and assure a smooth transition to the Kareo service, there are situations where it may be ideal for Kareo to also take over your existing accounts receivable. Please consult with your Account Manager/ Representative to determine if your account meets the requirements. Notes: Recovery of previous receivables is typically offered at a higher rate and will be quoted accordingly by your Account Manager/ Representative.) Recovery of previous receivables is a short‐term offering (typically completed within 180 days) and focused on targeted accounts with a high recovery probability. 9. Q: How do you track which items were billed by Kareo and which items were previously billed by our current staff or previous billing service? A: To simplify transition, Kareo Billing Service will take over all accounts with the Dates of Service on or after the agreed upon Contract Start Date. Kareo will not work any accounts with Dates of Service prior to the Contract Start Date unless an agreement for Kareo to recover previous receivables is in place. 10. Q: When does Kareo typically refer a delinquent account to an outside collection agency? A: After sending two statements to the guarantor, Kareo will perform a final courtesy call to encourage the patient to pay the balance. If the patient fails to make arrangements, then Kareo will refer the account to Kareo’s designated collection agency and the balance will be written off from the system as Bad Debt. 11. Q: For various reasons, I want to be able to exclude some of my patients from being referred to a collection agency. What is Kareo’s policy and how does Kareo handle these requests? A: Kareo does understand that there are cases where the practice does not wish to forward a delinquent account to a Collection Agency. Once accounts are identified for 3rd party collections, the list is sent to the practice to review. At that time, the practice can choose not to send patients to the collection agency. The practice can choose to exclude up to 3% of the claims per month from being referred to the collection agency without incurring fees. If the customer chooses to exclude more than 3% in a month, then Kareo will charge the Customer the standard service fee for the additional waived claims. 072213 Kareo Terms of Service Agreement – Responsibilities FAQ 4 .