In November 2021, Kareo and PatientPop joined together to create Tebra. The website of Kareo now directs to Tebra. Kareo medical billing services include eligibility verification, claim scrubbing, electronic submission, ERA posting, patient payments, and an A/R dashboard. Practices can choose in-house or outsourced billing, depending on their needs. We cover the billing workflow at Kareo, challenges faced, and confirmation needed before outsourcing billing.
Those who have compared various medical billing software have likely heard about Kareo medical billing (at least once). They can find the software, but the company recently updated its name.
In November 2021, Kareo and PatientPop merged to create Tebra, and Kareo’s website now redirects to Tebra when accessed. Although they have merged into Tebra, Kareo medical billing still follows a structured approach.
Practices seeking services should learn how Kareo billing works, the features practices use, the cons we found, and billing errors. This information helps them choose the right approach for their medical billing needs.
One thing that needs to be mentioned right away: medical billing software structures billing tasks, but it cannot replace coding, claim follow-up, denial management, or payment posting. Therefore, choosing the right team with Kareo medical billing is equally important and requires proper processes and people.
- What is Kareo Medical Billing?
- How Does Kareo Medical Billing Work?
- How These Kareo Billing Steps Are Integrated into the RCM
- Key Features of Kareo Medical Billing Software
- What Problems Do Practices Encounter?
- Billing Software vs. Outsourced Medical Billing
- Is Outsourcing Kareo Medical Billing Without Changing Software Good?
- How to Pick the Right Billing Solution for Practices?
What is Kareo Medical Billing?
Kareo was established by former Scour Inc. founder Dan Rodrigues in 2004. Initially, the software was created for electronic health records (EHR), practice management, and billing tools for independent providers.
The company claims that with the merger, Tebra will combine PatientPop’s services for practice growth and Kareo billing software for clinical purposes, health records, and billing. So, today “Kareo medical billing” refers to the billing and revenue cycle management (RCM) tools within Tebra’s platform.
Tebra defines medical billing software as revenue cycle software that lets practices and billing organizations manage their claims, check insurance in real time Electronic Remittance Advice (ERA) and Explanation of Benefits (EOB) payments, process ERA/EOB payments, and monitor denials.
Therefore, billing software is the central place for creating, submitting, tracking, and matching claims with payments. However, billing professionals must distinguish the two concepts, which are often mixed up. Billing software is a tool that the medical billing team uses. At the same time, a Kareo medical billing service refers to a dedicated team that handles Kareo billing on your behalf.
How Does Kareo Medical Billing Work?
Kareo billing is a multi-step process in which a claim undergoes several steps, each influencing the next. The process is as follows.
1. Patient Registration and Insurance Eligibility Verification
The Kareo billing process generally begins before the encounter. During registration, the patient’s demographic and insurance information is obtained and validated as active coverage.
Tebra reports that its eligibility tool makes an ANSI X12 270 inquiry and receives a 271 response indicating active coverage, copay, deductible, and coinsurance from 2,700+ payers.
The transaction types mentioned above are national standards. As per CMS:
- 270/271 transaction type is used for eligibility and benefits verification.
- 837 is used for professional, institutional, and dental healthcare claims submission.
- 835 is used for payment and electronic remittance advice.
All of these transaction types are included in ASC X12 Version 5010 effective January 1, 2012.
2. Charge Posting, Claim Generation, Scrubbing, and Submission
Once the encounter is complete, the service charges are posted using CPT, HCPCS, and ICD-10 codes. These charges generate a claim that is sent to the payer later on (after the billing process is completed).
Before the claim is sent to the payer, claim scrubbing ensures the details are accurate. What’s more, automated claim scrubbing is generally done by Tebra, and payer-specific rules apply to detect errors before electronic submission in batches (where required).
3. Payment Posting, Remittances, and Denied Claims Follow-Up
When a payer processes a claim, it provides remittance advice. The electronic remittance advice uses the 835 standard mentioned above. A person, tool, or software matches every payment to its corresponding claim and posts it.
Tebra claims that automation allows automated ERA posting and unposted payments by business rules. However, the denied claims require decision-making. Tebra may choose to appeal, fix, resubmit them, or write them off.
Tebra claims that denied claims can be appealed or resubmitted automatically. However, the claims left unpaid are reflected in the accounts receivable (A/R) or the running account for the amount due.
How These Kareo Billing Steps Are Integrated into the RCM
All the above-mentioned features matter, but they have little value if considered individually. Instead, billers should consider them as a cycle.
Eligibility checks minimize denials caused by expired and inactive plans/benefits. Clean claims minimize rejections. Proper posting will identify what claims are pending.
A/R days and denials help identify mistakes in front-end or coding operations. So, when a particular stage indicates poor performance, the practice pays its price later.
Key Features of Kareo Medical Billing Software
Medical billing software is only as good as its features, and practices should consider them carefully before choosing.
The following data has been taken straight from the product description of Tebra. All the facts should be double-checked before opting for software because there may be certain modifications and updates.
Claim Management and Claim Submission
Tebra offers automatic claim checks for errors before submission and reviews payer-specific criteria to reduce rejections, along with batch claim submission with one click.
This means that the mistake rate of practices is significantly reduced with Kareo billing. The software finds mistakes that you could have easily avoided, which makes your process more efficient.
Eligibility and Patient Payments
Besides checking patients’ insurance coverage, the eligibility check also tells you about copay and deductible amounts. These billing details help in charging payers upfront and prevent delays in payments using Kareo billing.
Patient payment features of Tebra consist of payment links via email/text message, card-on-file payments (both online/offline), and automated payment reminders.
Batching of patients in Tebra is possible through patient statements. This allows practices to add charge details, insurance details, balance, and QR codes for payments.
Medical Payment Posting, Reporting, and Accounts Receivable Monitoring
There are reviews that discuss Kareo billing software’s reporting capabilities. Tebra has a lot to offer when it comes to its reports. They give details on revenue cycle management, payment history, and claims statuses.
The software makes sure that practice managers keep track of important financial figures. Moreover, Tebra has an A/R dashboard that can explain poor collection processes.
Using Billing Information to Identify Problems and Repetitive Denials
The A/R dashboard by Tebra gives information about repetitive denials and A/R trends, detects gaps in the workflow that may result in rework, and uncovers training problems. One of the good ways to apply this information is to group denials by payers and types and analyze denial reasons.
Each aspect mentioned above is an important component of medical billing for any practice. Hence, before choosing Kareo billing software, practices need to evaluate their requirements.
What Problems Do Practices Encounter?
But as with all other billing software, there are some drawbacks of Kareo medical billing software. These are:
- Problems during integration with other systems except for the Kareo system. Thus, extra work will be needed in order to bill patients.
- The program can be hard to operate in a multi-site practice, complicating the structure.
- Learners need extra time and effort to learn all features of the Kareo program.
- The mobile application is less functional than the web version.
User reviews on Capterra form a somewhat controversial picture regarding the Tebra software. From these reviews, it becomes clear that the software provides reliable assistance with billing procedures to many small clinics. It is recommended for those practices that look for an integrated solution for scheduling, billing, and records management.
At the same time, according to some of the reviews, they have often faced long waiting periods with the software, and also problems with billing or ERA even after the onboarding process. Nevertheless, we recommend that you check the most recent reviews related to your specialty before making a decision.
In terms of cost, the software is available on a subscription basis with discounts for non-physicians, such as chiropractors and physician assistants. Practices should still verify the current prices available on Tebra’s website.
Billing Software vs. Outsourced Medical Billing
Purchasing the Kareo billing software and hiring a billing team are two distinct processes. Each has pros and cons that practices should know.
Billing Software
Billing software lets practices handle billing-related tasks in-house. In-house billing (as described in Tebra’s FAQs) is billing handled by your staff through billing software.
With the software, practices edit codes, post payments, and make calls to collect payments. In-house billing lets the staff input charges and submit claims automatically, while payments are tracked and updated in real time. All training, turnover, and claims are in the practice’s control.
That said, the overall features of the billing software hold great importance. This is why Kareo medical billing software has such a great reputation.
Outsourced Medical Billing
Outsourcing involves working with an outside revenue cycle partner. Therefore, the billing company or partner will be involved in claim filing, tracking, and claim appeals, usually on a percentage basis.
Outsourcing billing includes claim submission, claim tracking, follow-up of unpaid claims, and payment posting. Denial management and A/R follow-up are typical aspects a billing service provider handles.
Therefore, before you choose a service provider, you should be clear regarding their scope. Handing off your medical billing to a less reputable service provider can damage your reputation or finances. Conversely, the right medical billing services provider lets practices focus on patient care instead of billing.
The right option between them varies for each practice. Therefore, practices should consider their individual needs before deciding. Generally speaking, outsourced medical billing services are better for medical practices.
Is Outsourcing Kareo Medical Billing Without Changing Software Good?
Normally, yes, but there is no automatic transition. Tebra or Kareo billing can be seamlessly integrated with almost any top EHR software through HL7/FHIR or API Bridge integration, thus enabling practices to outsource their medical billing services without changing the EHR software.
However, those are vendor claims and need to be verified by the practice. To avoid problems later on when working with your Kareo medical billing or any other vendor, make sure you clarify the following:
Software Integration
Can the billing company connect to your software, or will it have to export the data to its own platform?
Account access
Who will get an account and who will lose theirs once the contract is terminated?
Duties
Who will be posting charges, payments, calls of patients, and approving appeals?
Security
How is the health information protected?
Medical billing partners work with protected health information. It is reasonable to ask these questions at the very beginning. Your medical billing company may promise more than it can provide, so always be careful not to fall for the marketing gimmicks.
How to Pick the Right Billing Solution for Practices?
Kareo medical billing software is one option among hundreds of options that practices can choose from. However, not every billing software is the same. Kareo billing helps practices track their claims, handle denials, and manage their accounts receivable.
The right outsourced billing company streamlines these activities daily. This is effective, especially when practices lack sufficient in-house resources.
Before you consider Kareo medical billing, consider your requirements. Before deciding, consider the questions we discussed in this guide for better decision-making. These questions can provide insight into the situation and indicate whether billing software or outsourced billing is ideal for you.
