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      Invoicing- How It Works

      Invoicing Responsibilities

      RCM Billing Fees

      • Health Prime Generally charges monthly collections with a monthly minimum fee; whichever is greater or a flat rate per encounter,  in accordance with state and federal laws.  If a percentage is used, it can range from 4 to 10% typically, and flat rates range from $3.50 to $11 per encounter. Minimums are outlined below.
        • Collections are equal to payment postings (Cash, Check and EFT) from the 1st – 31st of each month for patient and insurance collections.  Payments are posted by date received.
        • Month-end payment summary reports are run by the Accounting Department on an agreed upon date by Management between the 3rd and the 10th of each month (depending on when month end falls), and all payments need to be posted prior to the cutoff date which is the 3rd business day of each following month.
        • Contracts are renewed annually for another 12 month term unless contract stipulates otherwise. Customer can cancel without fees with a cancellation notice  90 days prior to end of Term on most.
      • RCM invoicing starts at “signup” date unless otherwise agreed to, review of agreement may be required as newer contracts start invoicing at go live date. 
      • There is a minimum monthly pricing fee of $600 / month for accounts signed between 1/1/2014 and 1/1/2015. For accounts signed between 2015 and 2019, they have a minimum of $750 to $1500 a month; accounts signed after 1/1/2020 will have a monthly minimum of $2000. (PLEASE REVIEW AGREEMENTS/ ADDENDUMS ON FILE) otherwise the invoice defaults to the agreed upon % rate; whichever is greater.  
        • Applicable after 90 days from sign up date, even if not live yet, if billing service fees collected are less than the monthly minimum customer must pay the monthly minimum per practice.
        • Transition from PM to RCM, in the 90-day period from sign up date, existing software customers must continue to pay software fees and associated fees until the billing service fees exceed the software fees.
        • For customers who do not meet minimum pricing requirements [and are new practices], they will be required to join our Smart Start Program (which includes credentialing).  Fees begin month 1 and the customer guarantees $1000/month for a period of first 6 months that credentialing is taking place. *NOTE: Invoice reviewer for all Smart Start Accounts should be the Credentialing Manager for the initial 6 months from sign up*
      • Any exclusions to invoicing on full collections must be provided prior to invoicing and documented in Hubspot in the form of an addendum to the contract.  Examples:  Copays, special procedures, liens, etc.  This should be discussed and documented during the sales process, but it may come up during onboarding or later during billing services. We do not voluntarily exclude anything—contract addendum is required and both parties must be in agreement.
      • Invoice amount will be auto-paid by credit card or ACH per agreement. Preferred method is ACH. Below are the links for providers to enroll. 
        • ACH Enrollment needs to be coordinated by our Success Coaches during the onboarding stage with the customer.   NOTE:  We no longer allow customers to be set up for ‘pay by check’; if this is requested during onboarding please contact your management team and accounting.
        • Health Prime ACH
        • Prime Managed Billing ACH
      • Any monthly reports or special reports should be coordinated by the Operations Consultant and delivered with delivery confirmation (All reports containing PHI should be loaded to the software the practice uses or sent via secure, encrypted email.  (Here is a list of all Kareo Required Month End reports that can be set up in Kareo saved reports if needed. These are sent to the subscribed user in the Kareo system ONLY and are secure.)
      • Invoices are automatically emailed to each customer on or around the 10th of each month.
      • Automatic payment is taken on or around the 12th of each month for net collections for the month prior.

      Patient statements

      • Statements are charged separately at current postage rate and includes printing and processing,  per statement
      • There are no additional fees for providers or access to the Kareo patient payment portal or to send email notification of statements due from Kareo system. 

      Add-On Services

      • Credentialing A la Carte & Maintenance
      • Escribe
      • Coding
      • Prime Virtual Office
      • Stand Alone Datalytics

      Kareo PM Customer Conversion to RCM

      • PM Software billing is done on or about the 10th of month for the next month (in advance of service).  The rate is $75-$150 per provider per month depending on which plan they were on and which modules are active (Clinical / Engage). Converted clients will normally pay for the software fees until go live unless otherwise mentioned in agreement.
      • If the customer signs up for RCM services mid-month, then Software fees will have already been paid for that month. 
        • NOTE: Transition from PM to RCM, until the customer is live they will continue to pay the full Software fees they have always paid.
      • Unless customer is part of the Smart Start Program. See below for Smart Start pricing details.
      • If the customer has a specific request to exclude previous biller payments for more than the first 30 days from Kareo taking over their billing, an addendum must be on file to document this in the Salesforce account in which both parties agree.

      Software Module Pricing

      • Kareo Clinical pricing is $150 per physician per month, $75 per non-physician per month
      • Engage: $150 per physician per month, $75 per non-physician per month
      • Billing (Practice Management fees per provider): full volume $300 per physician per month, low volume physician $150 per month. 
      • Telehealth is a pass through charge from Kareo and is $50 per provider per month unless otherwise outlined in an addendum for this service (where Kareo has agreed to another fee- this is rare)

      Smart Start Packages

      • This initial 6 months for credentialing, will have all fees reported to invoicing by the Credentialing Manager each month by no later than the 4th of the month.  In month 7, or when the account begins actively billing,  this duty is transferred to the billing team for all future invoice review. 
      • No mater what, even if not billing, come month 7,  the monthly minimum for billing or the percentage is due whichever is greater. 

      Early Termination Fees

      • There is an early termination fee (ETF) due if customer cancels prior to the end of the contract period, other than for material breach on the part of Health Prime.  That fee is calculated as follows:
        • Review of agreement is required as many are different depending on the date signed. 
          • Old KMB Agreements
            • The minimum early termination fee is $2,500 or 3x baseline bookings whichever is greater (see Exhibit A of signed order).
          • Health Prime Agreements
            • The early termination fee is 3x monthly invoiced amounts shall pay Company a Closeout Payment equal to the prior three (3) months’ of Revenue Cycle Management fees
          • Smart Start Packages
            • For participants in our Smart Start Program, Health Prime is guaranteed at total $6,000 for group and provider (Each additional provider in Smart Start must also pay $2500 for ETF in addition to $6,000 for 1 grp & 1 provider in initial package)
            • Smart Start Fees are a base credentialing fee of  $1,000 per provider for 6 months. At any time if the % is greater than the monthly base credentialing fee the percentage or billing monthly minimum will be billed instead (it is whichever is greater).